José María López Martín

Atrial fibrillation (AF) is highly prevalent in internal medicine and often requires timely echocardiographic assessment. Limited availability of standard studies may delay management, particularly in acute or resource-limited settings. We conducted a multicenter, cross-sectional study across 35 Spanish hospitals, enrolling adults with new-onset or chronic AF without echocardiography in the previous 12 months, comparing internist-performed point-of-care ultrasound (POCUS) with blinded cardiologist-performed transthoracic or transesophageal echocardiography (TTE/TEE) as the reference standard. The primary outcome was diagnostic accuracy for structural abnormalities. Secondary outcomes included comparison with auscultation and the clinical impact of POCUS findings. Among 441 patients (mean age 80.4 ± 9.9 years; 51% women), POCUS showed good diagnostic accuracy for left ventricular (LV) dilation (sensitivity 83%, specificity 94%) and LV systolic dysfunction (sensitivity 81%, specificity 94%), and moderate accuracy for left atrial (LA) enlargement (sensitivity 91%, specificity 64%). Compared with auscultation, POCUS was significantly more accurate for detecting mitral and tricuspid disease. POCUS findings frequently prompted therapeutic adjustments, including anticoagulation in mitral stenosis, individualized rate-control strategies in LV dysfunction, diuretic titration in congestion, and referral for significant valvular disease. Pericardial effusion, though less common, strongly influenced management. Internist-performed POCUS demonstrated robust diagnostic performance in AF and directly informed bedside therapeutic decisions. Although it does not replace comprehensive echocardiography, particularly for detailed valvular assessment, it represents a valuable extension of the physical examination and may improve timely and equitable cardiac evaluation.

Clarifying the influence of sensorimotor factors on feeding participation problems (FPPs) in children with autism may have implications for therapeutic interventions. Our objective was to assess the prevalence of FPPs in a population of children with autism and to study its association with sensorimotor factors (oral and tactile reactivity and oral praxis). Descriptive observational study including 26 autistic children aged 3 to 12 years. Behavioral Pediatrics Feeding Assessment Scale (BPFAS), Sensory Profile 2 (SP-2), and Oral Praxis (OPr) tests were used. Caregiver stress was evaluated by Parental Stress Index–Short Form (PSI-4-SF). Multivariate logistic analysis and Receiver Operating Characteristic curve was used to predict the risk of FPPs. 26 children (84.6% boys) were included, with a mean age of 6.92 years (95% CI 5.94–7.91). Feeding behavior difficulties were observed in 53.8% of participants, 80.7% exhibited oral praxis issues, and 65.4% of caregivers reported stress related to their child’s FPPs. Oral reactivity and sensory avoidance behaviors were significantly associated with FPPs. Among children with higher support needs, tactile reactivity was also significantly related to FPPs. FPPs in children with autism were associated with oral and tactile hyperreactivity, higher levels of sensory avoidance, dysfunctional parent–child interactions, and increased support needs.

Background: The COVID-19 pandemic prompted concerns about delays in cancer diagnosis and treatment, particularly for lung cancer (LC). We assessed the impact of the pandemic on lung cancer care, diagnostic efficiency, treatment timelines, and short-term survival in a Spanish tertiary hospital. Methods: We performed a retrospective cohort study including 530 patients diagnosed with primary lung cancer from March 2019 to March 2022. Patients were grouped into three cohorts: pre-pandemic (2019), first pandemic year (2020), and second pandemic year (2021). Key intervals—referral-to-diagnosis and diagnosis-to-treatment—along with survival outcomes were compared across cohorts. Multivariate Cox regression identified independent predictors of mortality. Results: LC diagnoses declined by 19% in 2020, rebounding by 42% in 2021. The proportion of patients receiving the first definitive treatment remained stable (~70%). Diagnostic timeliness improved: the median referral-to-diagnosis interval shortened from 19 to 14 days (p < 0.0001), with >80% of patients diagnosed within 30 days throughout all periods. Molecular testing turnaround increased (median 11 to 15 days, p = 0.0226). The diagnosis-to-treatment interval remained unchanged (median 34–35 days). One-year survival improved from 37% (2019) to 43% (2020–2021), and two-year survival from 22% to 30%. In multivariate analysis, only advanced stage and poor ECOG performance status independently predicted mortality; delays in diagnosis or treatment had no significant impact. Conclusions: Despite pandemic-related disruptions, essential LC care and short-term outcomes were largely maintained in our center. Early stage at diagnosis and favorable performance status outweighed the effect of moderate delays. Health system resilience and streamlined care pathways proved critical for sustaining cancer outcomes during the COVID-19 crisis. These findings offer actionable lessons for the Spanish healthcare system and may help guide national preparedness strategies for future oncologic crises.