Revista clinica espanola最新文献

{"title":"Estudio comparativo de la efectividad de tolvaptán frente a urea en pacientes con hiponatremia causada por SIADH","authors":"Á. Martínez González ,&nbsp;M. González Nunes ,&nbsp;P. Rodeiro Escobar ,&nbsp;J. Llópiz Castedo ,&nbsp;A. Cabaleiro Loureiro ,&nbsp;R.P. Martínez Espinosa ,&nbsp;R. Ruades Patiño ,&nbsp;G. Lorenzo Canda ,&nbsp;J. Aguayo Arjona ,&nbsp;S. Rodríguez Zorrilla","doi":"10.1016/j.rce.2024.08.005","DOIUrl":"10.1016/j.rce.2024.08.005","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Hyponatraemia is common in elderly and hospitalised patients, often caused by the syndrome of inappropriate antidiuretic hormone secretion (SIADH). This study evaluates the efficacy and safety of tolvaptan and urea in patients with hyponatraemia and SIADH.</div></div><div><h3>Materials and methods</h3><div>An observational cohort study was conducted on 198 patients with SIADH and hyponatraemia (Na+<!--> <!-->&lt;<!--> <!-->135<!--> <!-->mmol/L) at the Complejo Hospitalario Universitario de Pontevedra (January 2015-May 2022). Of these, 86 were treated with tolvaptan (average dose of 7.5<!--> <!-->mg) and 112 with urea (average dose of 15<!--> <!-->g). The primary outcome was the normalisation of sodium levels (Na+<!--> <!-->≥<!--> <!-->135<!--> <!-->mmol/L).</div></div><div><h3>Results</h3><div>The tolvaptan group showed higher sodium concentrations at the end of therapy compared to the urea group (ME<!--> <!-->=<!--> <!-->136, IQR<!--> <!-->=<!--> <!-->135-137 vs. ME<!--> <!-->=<!--> <!-->134, IQR<!--> <!-->=<!--> <!-->132-137; p<!--> <!-->&lt;<!--> <!-->0.001). The time to normalise sodium was shorter with tolvaptan (4<!--> <!-->±<!--> <!-->3.4 days) compared to urea (6<!--> <!-->±<!--> <!-->3.6 days; p<!--> <!-->=<!--> <!-->0.03). A higher percentage of patients achieved sodium normalisation with tolvaptan (83.72 vs. 59.82%; p<!--> <!-->=<!--> <!-->0.005). Tolvaptan had more adverse effects, such as dry mouth, thirst, and sodium overcorrection, while urea caused dysgeusia, abdominal pain, and diarrhea. There were no significant differences in mortality between the groups.</div></div><div><h3>Conclusions</h3><div>Tolvaptan was more effective and quicker than urea in normalising sodium levels, though it showed a higher percentage of adverse effects, which did not require discontinuation of the drug.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 85-91"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infecciones de pie de diabético en los servicios de Medicina Interna de España (2018-2022)","authors":"C. Fuentes Santos ,&nbsp;J.A. Rueda Camino ,&nbsp;Á. Asenjo Mota ,&nbsp;A. Castañeda Pastor ,&nbsp;A. Zapatero Gaviria ,&nbsp;J. Canora Lebrato ,&nbsp;R. Barba-Martín","doi":"10.1016/j.rce.2024.08.008","DOIUrl":"10.1016/j.rce.2024.08.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Diabetic foot infections represent a common and serious complication of diabetes mellitus, with a wide range of clinical presentations. Despite their significance, uncertainties persist regarding their management and impact on Internal Medicine services.</div></div><div><h3>Materials and methods</h3><div>A retrospective cohort study was conducted using data from the Registry of Specialized Healthcare Activity (RAE-CMBD) over a five-year period (2018-22). Patients discharged from Internal Medicine with a diagnosis of diabetic foot were included. Demographic, clinical, and activity data were collected, and the cumulative incidence of diabetic foot, in-hospital mortality, need for amputation, and associated costs of hospitalization were analyzed.</div></div><div><h3>Results</h3><div>15402 episodes with a diagnosis of diabetic foot were identified, representing 0.41% of Internal Medicine, which implies an age-adjusted incidence rate of between 2 and 3 cases per 1000 admissions in these services. These patients had a high in-hospital mortality rate (16%) and a significant percentage required amputation (8.25%). Advanced age, the presence of comorbidities, and complications during admission were associated with a higher risk of mortality and amputation. The average cost per admission is over €6000.</div></div><div><h3>Conclusions</h3><div>Diabetic foot is a pathology with a high impact on Internal Medicine services, both due to the volume of activity and the high mortality and cost generated by this condition.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 125-130"},"PeriodicalIF":2.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La difícil relación entre la investigación y la asistencia: una encuesta a internistas españoles","authors":"J.C. Trullàs ,&nbsp;A. Maestre","doi":"10.1016/j.rce.2024.11.001","DOIUrl":"10.1016/j.rce.2024.11.001","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 176-177"},"PeriodicalIF":2.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Documento de posicionamiento sobre la realización de ecografía clínica en la insuficiencia cardíaca: recomendaciones desde los Grupos de Trabajo de Insuficiencia Cardíaca y Fibrilación Auricular, y de Ecografía Clínica de la Sociedad Española de Medicina Interna (SEMI)","authors":"Y. Tung-Chen ,&nbsp;M. Beltrán Robles ,&nbsp;J. Rubio Gracia ,&nbsp;G. García de Casasola Sánchez ,&nbsp;P. Llàcer Iborra ,&nbsp;S. García Rubio ,&nbsp;M. Méndez Bailón ,&nbsp;E. Montero Hernández ,&nbsp;M. Sánchez Marteles ,&nbsp;M. Torres Arrese ,&nbsp;J. Torres Macho ,&nbsp;J. Pérez Silvestre","doi":"10.1016/j.rce.2024.08.006","DOIUrl":"10.1016/j.rce.2024.08.006","url":null,"abstract":"<div><div>This document provides a comprehensive analysis of the use of point-of-care ultrasound in heart failure (HF), offering detailed recommendations on echocardiography, lung ultrasound, and venous ultrasound. These advanced imaging techniques allow for an accurate, detailed, and non-invasive evaluation of heart failure, facilitating rapid and effective clinical decision-making.</div><div>Echocardiography enables a rapid assessment of cardiac function at the point of care, enhancing traditional physical examination and being essential for the management of heart failure (HF). Lung ultrasound provides a detailed view of the pulmonary status, crucial for diagnosing pulmonary congestion without using ionizing radiation, ideal for continuous monitoring. Venous ultrasound evaluates systemic congestion by measuring the inferior vena cava and other parameters, aiding in the estimation of right atrial pressure and monitoring pressure and volume overload, improving patient understanding and prognosis.</div><div>Together, the use of these ultrasound modalities not only complements but enriches the traditional physical examination, establishing themselves as indispensable tools in the comprehensive and effective management of patients with heart failure. By incorporating these techniques into clinical practice, healthcare professionals can achieve better evaluation, diagnosis, and treatment, resulting in more personalized management of these patients.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 148-156"},"PeriodicalIF":2.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validación externa de la escala «HOSPITAL simplificada» como predictor de reingreso a 30 días tras hospitalización en servicios médicos de OSI Araba","authors":"N. García-Perotti ,&nbsp;S. García de Garayo-Díaz ,&nbsp;J. Regalado-De Los Cobos","doi":"10.1016/j.rce.2024.10.010","DOIUrl":"10.1016/j.rce.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>A readmission is defined as a new admission to hospital for at least one night in the 30 days following a discharge. Some are caused by events unrelated to the reason for the initial admission (unavoidable) and others caused by the same pathology (related). Different predictive models allow the identification of patients at higher risk of readmission. The “HOSPITAL simplified” score stands out for its performance and simplicity.</div></div><div><h3>Aim</h3><div>To validate the “HOSPITAL simplified” scale in a cohort of patients at the University Hospital of Alava.</div></div><div><h3>Method</h3><div>Review of patients discharged from OSI Araba Medical Services in June and November 2023. The scale was applied to each of them and re-admission was studied in the 30 days following discharge. The Brier score, discrimination and calibration capacity were analysed, using the guidelines of the TRIPOD declaration.</div></div><div><h3>Results</h3><div>In 1849 discharges there were 240 unscheduled readmissions: 73 for causes unrelated to the previous admission and 151 related. For predicting related readmissions the scale obtained a Brier score<!--> <!-->=<!--> <!-->0.0703. The mean score for cases with related readmission was 4.7 versus 2.66 for cases without readmission (<em>P</em> <!-->&lt;<!--> <!-->0.001). The area under the ROC curve<!--> <!-->=<!--> <!-->0.747. Related readmission occurred in 29.3% of patients at high risk, compared to 17.3% predicted by the scale.</div></div><div><h3>Conclusions</h3><div>The “HOSPITAL simplified” scale showed in OSI Araba a higher discrimination capacity than the original series although it underestimated the real risk. The scale offers good portability.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 117-124"},"PeriodicalIF":2.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presentación clínica del feocromocitoma y recomendaciones de cribado","authors":"O.F. Arroyo Ripoll ,&nbsp;E. Achote ,&nbsp;M. Araujo-Castro","doi":"10.1016/j.rce.2024.10.008","DOIUrl":"10.1016/j.rce.2024.10.008","url":null,"abstract":"<div><div>Pheochromocytomas are neuroendocrine tumors that derive from sympathetic adrenomedullary chromaffin tissue and produce catecholamines. Due to the excess release of catecholamines, they can produce arterial hypertension, tachycardia, sweating, headache and a large number of other clinical manifestations secondary to the stimulation of α and β adrenoreceptors. Screening for pheochromocytoma is recommended in patients with paroxysmal, resistant or early-onset arterial hypertension, in cases with symptoms suggestive of catecholamine hypersecretion, patients with hereditary syndromes associated with pheochromocytomas, diabetes mellitus of atypical presentation and in adrenal incidentalomas with radiological characteristics not typical of adenoma (with &gt;<!--> <!-->10 Hounsfield Units on non-contrast CT). In this article we present an exhaustive review of the clinical data and complications that can be associated with pheochromocytomas, and we summarize the main indications for pheochromocytoma screening.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 157-167"},"PeriodicalIF":2.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcaptonuria. Descripción de 2 casos de una rara entidad","authors":"A. Rosales-Castillo,&nbsp;A. Bustos-Merlo,&nbsp;J. Escobar Sevilla","doi":"10.1016/j.rce.2025.01.001","DOIUrl":"10.1016/j.rce.2025.01.001","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 178-179"},"PeriodicalIF":2.3,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inteligencia artificial en la práctica clínica: calidad y evidencia","authors":"R. Puchades ,&nbsp;L. Ramos-Ruperto ,&nbsp;en nombre del Grupo de Trabajo de Medicina Digital de la SEMI","doi":"10.1016/j.rce.2024.07.009","DOIUrl":"10.1016/j.rce.2024.07.009","url":null,"abstract":"<div><div>A revolution is taking place within the field of artificial intelligence (AI) with the emergence of generative AI. Although we are in an early phase at the clinical level, there is an exponential increase in the number of scientific articles that use AI (discriminative and generative) in their methodology. According to the current situation, we may be in an «AI bubble» stage; requiring filters and tools to evaluate its application, based on the quality and evidence provided. In this sense, initiatives have been developed to determine standards and guidelines for the use of discriminative AI (CONSORT AI, STARD AI and others), and more recently for generative AI (the CHART collaborative). As a new technology, AI requires scientific regulation to guarantee the efficacy and safety of its applications, while maintaining the quality of care; an evidence-based AI (IABE).</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 23-27"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patrón circadiano de presión arterial en pacientes con EPOC estable","authors":"J. Díez-Manglano ,&nbsp;J.A. Díaz-Peromingo ,&nbsp;R. Boixeda-Viu","doi":"10.1016/j.rce.2024.08.004","DOIUrl":"10.1016/j.rce.2024.08.004","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the circadian blood pressure (BP) pattern in stable COPD patients.</div></div><div><h3>Methods</h3><div>We included stable COPD patients from Internal Medicine Departments. Office BP and ambulatory BP monitoring were performed. Patients were classified as BP reducers (dipper or extreme dipper) or non-reducers (non-dipper or riser).</div></div><div><h3>Results</h3><div>We included 43 patients (5 women, mean age 69.5<!--> <!-->±<!--> <!-->9.5<!--> <!-->years). Among them, 11 had sustained normotension, 13 sustained hypertension, 2 white coat hypertension, and 17 masked hypertension. Arterial stiffness was observed in 12 (27.9%) patients. Overall, 26 (60.5%) exhibited a non-reducer BP profile. Non-reducers had a higher frequency of previous major cardiovascular events (50% vs. 11.8%, <em>P</em> <!-->=<!--> <!-->.020) and long-acting muscarinic antagonist use (84.6% vs. 47.1%, <em>P</em> <!-->=<!--> <!-->.009).</div></div><div><h3>Conclusions</h3><div>Hypertension is often masked in COPD patients, who frequently display an altered circadian BP pattern. Longitudinal studies with larger samples are needed to evaluate the impact of these patterns on COPD progression.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 45-50"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Los derechos e intereses de los participantes como límites de los ensayos clínicos","authors":"R. Dal-Ré","doi":"10.1016/j.rce.2024.10.001","DOIUrl":"10.1016/j.rce.2024.10.001","url":null,"abstract":"<div><div>Point 8 of the Declaration of Helsinki requires that the rights and interests of research participants must always prevail over the scientific interests of the research. Recently, it has been proposed that point 8 be modified to indicate the opposite, that is, that it is acceptable for scientific interests to prevail over the interests of the participants. This article argues against this change. What happened with the masked placebo-controlled trials of experimental vaccines against SARS-CoV-2 is held up as an example. When the high efficacy of the vaccines became evident, questions arose as to what should be done, whether to keep the trials masked until data on long-term efficacy, immunogenicity, and safety were obtained or to unmask the trials and offer the vaccine that had been shown to be efficacious to participants who received the placebo. The latter was the correct approach, which translates point 8 into practice.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 1","pages":"Pages 28-34"},"PeriodicalIF":2.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}