Revista clinica espanola最新文献

{"title":"Comparativa de resultados obstétricos en pacientes con lupus eritematoso sistémico (LES) y enfermedad indiferenciada del tejido conectivo (UCTD): un estudio de cohorte descriptivo","authors":"C. Muñoz Muñoz ,&nbsp;F. Farinha ,&nbsp;T. McDonnell ,&nbsp;H. Jbari ,&nbsp;H. Nguyen ,&nbsp;D. Isenberg ,&nbsp;A. Rahman ,&nbsp;D. Williams ,&nbsp;J. Alijotas-Reig ,&nbsp;I. Giles","doi":"10.1016/j.rce.2024.04.006","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.006","url":null,"abstract":"<div><h3>Background</h3><p>Females diagnosed with systemic lupus erythematosus (SLE) face an elevated risk of adverse pregnancy outcomes (APOs). However, the evidence regarding whether a similar association exists in patients with undifferentiated connective tissue disease (UCTD) is inconclusive.</p></div><div><h3>Methods</h3><p>We conducted a retrospective review (2006-2019) of pregnancy outcomes among patients with SLE (n<!--> <!-->=<!--> <!-->51) and UCTD (n<!--> <!-->=<!--> <!-->20) within our institution. We examined the occurrence of various APOs, encompassing miscarriage, stillbirth, termination, preterm birth, pre-eclampsia, eclampsia, HELLP syndrome, intrauterine growth restriction, abruption placentae, congenital heart block, or other cardiac abnormalities.</p></div><div><h3>Results</h3><p>The mean age at pregnancy was 35<!--> <!-->±<!--> <!-->7.0 years for patients with SLE and 35<!--> <!-->±<!--> <!-->6.8 years for those with UCTD (<em>P</em> <!-->=<!--> <!-->.349). The proportion of Caucasian women was 47% in SLE and 80% in UCTD. Pregnancies in both groups were planned (81% in SLE and 77% in UCTD), and patients presented with inactive disease at conception (96% in SLE and 89% in UCTD). Hydroxychloroquine at conception was utilized by 86% of women with SLE, in contrast to 36% in the UCTD group. Both, SLE and UCTD cohorts exhibited low rates of disease flares during pregnancy and/or puerperium (14% vs. 10%). The incidence of APOs was 15.6% in SLE patients compared to 5% in those with UCTD (Risk difference 19.5%; 95% confidence interval: −3.9 to 43.1; <em>P</em> <!-->=<!--> <!-->.4237).</p></div><div><h3>Conclusion</h3><p>Our study underscores the importance of strategic pregnancy planning and the maintenance of appropriate treatment throughout pregnancy to ensure optimal disease management and minimize adverse outcomes in both SLE and UCTD pregnancies.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 357-365"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294892","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":"Precisión diagnóstica de la procalcitonina para la infección bacteriana en el servicio de Urgencias: una revisión sistemática","authors":"A. Julián-Jiménez ,&nbsp;L. García de Guadiana-Romualdo ,&nbsp;G. Merinos-Sánchez ,&nbsp;D.E. García","doi":"10.1016/j.rce.2024.04.010","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.010","url":null,"abstract":"<div><h3>Introduction and objective</h3><p>The care of patients with a suspected infectious process in hospital emergency departments (ED) accounts for 15%-35% of all daily care in these healthcare areas in Spain and Latin America. The early and adequate administration of antibiotic treatment (AB) and the immediate making of other diagnostic-therapeutic decisions have a direct impact on the survival of patients with severe bacterial infection. The main objective of this systematic review is to investigate the diagnostic accuracy of PCT to predict bacterial infection in adult patients treated with clinical suspicion of infection in the ED, as well as to analyze whether the different studies manage to identify a specific value of PCT as the most relevant from the diagnostic point of view of clinical decision that can be recommended for decision making in ED.</p></div><div><h3>Method</h3><p>A systematic review is carried out following the PRISMA regulations in the database of PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov from January 2005 to May 31, 2023 without language restriction and using a combination of MESH terms: “Procalcitonin”, “Infection/ Bacterial Infection/ Sepsis”, “Emergencies/ Emergency/ Emergency Department”, “Adults” and “Diagnostic”. Observational cohort studies (diagnostic performance analyses) were included. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the method used and the risk of bias of the included articles. No meta-analysis techniques were performed, but results were compared narratively.</p></div><div><h3>Results</h3><p>A total of 1,323 articles were identified, of which 21 that met the inclusion criteria were finally analyzed. The studies include 10,333 patients with 4,856 bacterial infections (47%). Eight studies were rated as high, 9 as moderate, and 4 as low. The AUC-ROC of all studies ranges from 0.68 (95% CI: 0.61-0.72) to 0.99 (95% CI: 0.98-1). The value of PCT 0.2-0.3 ng/ml is the most used and proposed in up to 12<!--> <!-->of the works included in this review whose average estimated performance is an AUC-ROC of 0.79. If only the results of the 5 high-quality studies using a cut-off point of 0.2-0.3 ng/ml PCT are taken into account, the estimated mean AUC-COR result is 0.78 with Se:69% and Es:76%.</p></div><div><h3>Conclusions</h3><p>PCT has considerable diagnostic accuracy for bacterial infection in patients treated in ED for different infectious processes. The cut-off point of 0.25 (0.2-0.3) ng/ml has been positioned as the most appropriate to predict the existence of bacterial infection and can be used to help reasonably rule it out.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 400-416"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294512","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 Enhanced Feedback for Effective Cardiology Treatment (EFFECT) de predicción de mortalidad en pacientes que ingresan por insuficiencia cardiaca agudizada en Álava, España","authors":"S. Goya-Lirio ,&nbsp;M. Hernando-Llorens ,&nbsp;S. García de Garayo-Díaz ,&nbsp;J. Regalado-de Los Cobos","doi":"10.1016/j.rce.2024.04.008","DOIUrl":"10.1016/j.rce.2024.04.008","url":null,"abstract":"<div><h3>Objective</h3><p>To validate the EFFECT (Enhanced Feedback for Effective Cardiac Treatment) scales, which predict mortality at 1 month and 1 year after admission, in a defined cohort of patients admitted to the Araba University Hospital (HUA) with a diagnosis of acutely decompensated heart failure.</p></div><div><h3>Method</h3><p>External validation study of a predictive model, in a retrospective cohort of patients admitted between October 1, 2020 and September 30, 2021.</p></div><div><h3>Results</h3><p>A total of 550 patients were included. The two scales demonstrated good overall discriminatory ability in our series, with an area under ROC (0.755 y 0.756) and values in Brier score (0.094 y 0.194) similar to the original series. Calibration was assessed using the Hosmer-Lemeshow test and calibration plots and was also adequate. All this despite the fact that significant differences were observed in many clinical characteristics between our series and the original one.</p></div><div><h3>Conclusions</h3><p>The EFFECT scales showed good predictive ability and transportability. The one-month prediction scale was also useful for predicting mortality at one year. For both time periods, mortality was similar in the groups established in the original as low and very low risk.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 379-386"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141031175","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":"Eventos adversos cardiovasculares, obstétricos y perinatales en el embarazo y puerperio en pacientes cardiópatas","authors":"N.E. Guzmán-Delgado ,&nbsp;C.E. Velázquez-Sotelo ,&nbsp;M.J. Fernández-Gómez ,&nbsp;L.G. González-Barrera ,&nbsp;A. Muñiz-García ,&nbsp;V.M. Sánchez-Sotelo ,&nbsp;P. Carranza-Rosales ,&nbsp;A. Hernández-Juárez ,&nbsp;J. Morán-Martínez ,&nbsp;V. Martínez-Gaytan","doi":"10.1016/j.rce.2024.04.004","DOIUrl":"10.1016/j.rce.2024.04.004","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Cardiovascular changes during pregnancy carry greater risk in heart disease. We analyze cardiovascular, obstetric and perinatal adverse effects associated with congenital and acquired heart disease during pregnancy and postpartum.</p></div><div><h3>Materials and methods</h3><p>Cross-sectional and retrospective study, which included the 2017-2023 registry of pregnant or postpartum patients hospitalized with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric hemorrhage, prematurity and perinatal death) were compared with the clinical variables and the implemented treatment.</p></div><div><h3>Results</h3><p>112 patients with a median age of 28 years (range 15-44) were included. Short circuits predominated 28 (25%). Thirty-six patients (32%) were classified in class IV of the modified WHO scale for maternal cardiovascular risk.</p><p>Heart failure occurred in 39 (34.8%), acute lung edema 12 (10.7%), stroke 2 (1.8%), maternal death 5 (4.5%), obstetric hemorrhage 4 (3.6%), prematurity 50 (44.5%) and perinatal death 6 (5.4%). Shunts were associated with prematurity (adjusted odds ratio 4; 95% CI: 1.5-10, <em>P</em> <!-->=<!--> <!-->.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6-194, <em>P</em> <!-->=<!--> <!-->.001) and heart failure (adjusted OR 16; 95% CI: 3-84, <em>P</em> <!-->=<!--> <!-->.001). An increased risk of obstetric hemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5-616, <em>P</em> <!-->=<!--> <!-->.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2-16, <em>P</em> <!-->=<!--> <!-->.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4-68, <em>P</em> <!-->=<!--> <!-->.021).</p></div><div><h3>Conclusions</h3><p>Severe complications were found during pregnancy and postpartum in patients with heart disease, which is why preconception evaluation and close surveillance are vital.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 337-345"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0014256524000791/pdfft?md5=a7217d798adebba80b4ba4fa2958ee2f&pid=1-s2.0-S0014256524000791-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141038020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La fuerza de presión inicial como factor predictivo del riesgo de amputación en pacientes con pie diabético","authors":"E. Imre ,&nbsp;E. Imre ,&nbsp;S. Ozturk","doi":"10.1016/j.rce.2024.04.005","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.005","url":null,"abstract":"<div><h3>Background</h3><p>We aimed to analyze the prognostic significance of handgrip strength as predictor of lower extremity amputation at 1 year follow up in patients with type<!--> <!-->2 diabetes.</p></div><div><h3>Methods</h3><p>We evaluated 526 patients with type<!--> <!-->2 diabetes between August 2020 and June 2022. We collected from the electronic medical records demographic variables, laboratory data and history of amputation. The handgrip strength was assessed using a handheld Smedley digital dynamometer following the NHANES Muscle Strenght/Grip Test Procedure. Low handgrip strength was defined for women as less than 16<!--> <!-->kg and for men less than 27<!--> <!-->kg. Outcome variable was major or minor lower extremity amputation.</p></div><div><h3>Results</h3><p>A total of 205 patients with complete data entered the study. Patients mean age was 59<!--> <!-->years old, 37% were women and the mean diabetes disease duration was 14<!--> <!-->years. Seventy-seven (37%) patients suffered from lower extremity mputations (26 major and 51 minor amputations). After controlling for age, gender, presence of peripheral artery disease, body mass index and white cell counts as confounder variables, patients with low handgrip had an increased risk for amputations (Odds Ratio 2.17; 95% confidence interval: 1.09-4.32; <em>P</em> <!-->&lt;<!--> <!-->.001).</p></div><div><h3>Conclusion</h3><p>Low handgrip stregth is an independent prognostic marker for lower limb amputation at one year in patients with diabetes.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 346-356"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294590","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":"Carta al editor sobre el artículo «¿Cómo detectar a los pacientes mayores no institucionalizados en riesgo de malnutrición durante su hospitalización? Comparación de 8 herramientas de cribado de malnutrición o de riesgo nutricional»","authors":"F.J. Teigell Muñoz","doi":"10.1016/j.rce.2024.04.012","DOIUrl":"https://doi.org/10.1016/j.rce.2024.04.012","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Page 417"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294889","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":"Réplica a carta al editor «Resumen ejecutivo del documento de consenso sobre el manejo de la anemia perioperatoria en España»","authors":"M. Muñoz,&nbsp;en representación del panel del documento de consenso sobre el manejo de la anemia perioperatoria en España","doi":"10.1016/j.rce.2024.05.001","DOIUrl":"https://doi.org/10.1016/j.rce.2024.05.001","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 418-419"},"PeriodicalIF":2.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294891","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":"El espejismo del DOI","authors":"K. Moustafa","doi":"10.1016/j.rce.2024.03.006","DOIUrl":"https://doi.org/10.1016/j.rce.2024.03.006","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 5","pages":"Pages 334-335"},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823545","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":"Carta al editor sobre «Los retos de la bioética en la práctica clínica del siglo XXI»","authors":"M.F. García Aguilera ,&nbsp;N. García Méndez ,&nbsp;E. Álvarez Muñoz ,&nbsp;J. Lagarda Cuevas","doi":"10.1016/j.rce.2024.02.007","DOIUrl":"https://doi.org/10.1016/j.rce.2024.02.007","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 5","pages":"Pages 331-332"},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823547","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":"Sospecha clínica, diagnóstico y seguimiento de la amiloidosis cardíaca: documento de actualización y resumen ejecutivo","authors":"S. Yun ,&nbsp;J. Casado ,&nbsp;J. Pérez-Silvestre ,&nbsp;P. Salamanca ,&nbsp;P. Llàcer ,&nbsp;R. Quirós ,&nbsp;R. Ruiz-Hueso ,&nbsp;M. Méndez ,&nbsp;L. Manzano ,&nbsp;F. Formiga","doi":"10.1016/j.rce.2024.03.007","DOIUrl":"https://doi.org/10.1016/j.rce.2024.03.007","url":null,"abstract":"<div><p>In recent years, the interest in cardiac amyloidosis has grown exponentially. However, there is a need to improve our understanding of amyloidosis in order to optimise early detection systems. Therefore, it is crucial to incorporate solutions to improve the suspicion, diagnosis and follow-up of cardiac amyloidosis. In this sense, we designed a tool following the different phases to reach the diagnosis of cardiac amyloidosis, as well as an optimal follow-up: a) clinical suspicion, where the importance of the “red flags” to suspect it and activate the diagnostic process is highlighted; 2) diagnosis, where the diagnostic algorithm is mainly outlined; and 3) follow-up of confirmed patients. This is a practical resource that will be of great use to all professionals caring for patients with suspected or confirmed cardiac amyloidosis, to improve its early detection, as well as to optimise its accurate diagnosis and optimal follow-up.</p></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"224 5","pages":"Pages 288-299"},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823534","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}