Revista clinica espanola最新文献

{"title":"Yield of ultrasound-guided biopsies of focal lesions in an Internal Medicine Department.","authors":"L Porcel, S Alas, S Bielsa, J M Porcel","doi":"10.1016/j.rceng.2025.502285","DOIUrl":"https://doi.org/10.1016/j.rceng.2025.502285","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided biopsy (UGB) is a diagnostic procedure that is usually performed by radiologists; however, its use by internists has been poorly studied. This study evaluated the diagnostic yield, accuracy, and safety of UGB for focal lesions with a high suspicion of malignancy in an Internal Medicine Department.</p><p><strong>Methods: </strong>We retrospectively analyzed 255 UGB in 248 patients between 2021 and 2024. Solid organ biopsies were performed to evaluate diagnostic yield, complications, and factors associated with success.</p><p><strong>Results: </strong>The overall diagnostic yield was 84% with an accuracy of 83% for malignancy and 89% for benignity. The biopsies predominantly comprised of hepatic, pulmonary, and lymph node specimens. Major complications occurred infrequently (3%). Factors such as sample size and accumulated experience improved the results.</p><p><strong>Conclusions: </strong>UGBs performed by internists for focal lesions suspected of malignancy are safe and effective. Its implementation can reduce diagnostic time and improve patient care.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502285"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Executive summary of the consensus document on home care treatment of pulmonary embolism.","authors":"L Ordieres Ortega, J L Modesto Dos Santos, P Parra Caballero, T Sánchez Soriano, C Sánchez Del Hoyo, E Coloma Bazán, M Anta Fernández, M Martín Del Pozo","doi":"10.1016/j.rceng.2025.502280","DOIUrl":"https://doi.org/10.1016/j.rceng.2025.502280","url":null,"abstract":"<p><strong>Introduction: </strong>Home Hospitalisation (HH) is a safe care modality that reduces costs and risks compared to conventional hospitalisation. Evidence supports the safety of outpatient management in patients with pulmonary embolism (PE).</p><p><strong>Objectives and methods: </strong>To establish a protocol for the identification and clinical management of patients with PE who are candidates for HH management. This document has been prepared jointly by the Venous Thromboembolic Disease Group (VTD) and the Home Hospitalisation Group (HH) of the Spanish Society of Internal Medicine (SEMI).</p><p><strong>Results: </strong>A total of 44 statements were considered. Voting was carried out using a Likert scale. A total of 39 recommendations reached consensus.</p><p><strong>Conclusions: </strong>The SEMI VTD and HH working groups recommend evaluating home treatment of PE in patients with a low risk of complications.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502280"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urgent indications for therapeutic apheresis. Spanish Apheresis Group (GEA). Second edition 2024.","authors":"I M Parra Salinas, J A García Erce","doi":"10.1016/j.rceng.2025.502284","DOIUrl":"https://doi.org/10.1016/j.rceng.2025.502284","url":null,"abstract":"<p><p>The Spanish Apheresis Group (GEA) presents the second edition of the \"Urgent Indications for Therapeutic Apheresis\" document, updated 12 years after its initial publication. This revision addresses the need to standardize its application, given the variability observed across different centers and the lack of resources in some provinces. A critical review of the most recent scientific evidence was conducted, including the latest edition of the American Society of Apheresis (ASFA) guidelines and other evidence-based recommendations. Through a methodological review and expert consensus, the list of conditions in which therapeutic apheresis-whether plasma exchange, red blood cell exchange, or cytoreductive apheresis-should be considered an urgent treatment has been redefined. This update introduces new indications and clinical scenarios where apheresis can provide significant therapeutic benefits.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502284"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical governance in internal medicine: the challenge of length of stay","authors":"L.S. Pinheiro","doi":"10.1016/j.rceng.2025.02.001","DOIUrl":"10.1016/j.rceng.2025.02.001","url":null,"abstract":"<div><div>Clinical governance highlights the relevance of the combination of “quality” and “safety” with “excellence” and “improvement”. In hospitals, as highly complex organizations, the principles and practices of clinical governance are key elements for success. Several angles would be pertinent in the application of clinical governance to the hospital context, and specifically to internal medicine. The length of stay of patients in hospital is frequently used as a quality indicator of clinical activity. Ideally the patient should remain in the hospital during the time in which he has benefit, minimizing inherent risks. With its centrality in the patient, clinical governance, interpreted in the light of the Seven Pillars Model, can provide a comprehensive framework for addressing the management of length of stay. We should try to bring to the day-to-day of our organizations the aggregating vision of clinical governance, whose foundational values need to be reinforced and deepened.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 240-243"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"VERICIDuAT: Real-life study of vericiguat in patients with heart failure with reduced ejection fraction","authors":"S. Russo Botero ,&nbsp;M. Ripoll Martínez ,&nbsp;L. Fácila Rubio ,&nbsp;A. Lamilla Álvarez ,&nbsp;V. Montagud Balaguer ,&nbsp;D. García Escrivá ,&nbsp;E. Chover Sierra ,&nbsp;Á. Sánchez Montagud ,&nbsp;J. Pérez Silvestre","doi":"10.1016/j.rceng.2025.02.006","DOIUrl":"10.1016/j.rceng.2025.02.006","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The aim of this study is to assess the safety in a real-world cohort of patients with heart failure with reduced ejection fraction (HFrEF).</div></div><div><h3>Methods</h3><div>Observational, retrospective and single-center study with patients on vericiguat treatment from the Cardiology and Internal Medicine outpatient clinic of the Valencia General University Hospital Consortium during 2023 year and with minimum follow-up of 6 months. Patients with HFpEF diagnosis and optimized treatment according to the ESC 2021 clinical practice guidelines were included, to whom treatment with vericiguat was started.</div></div><div><h3>Results</h3><div>We included 123 patients with a mean age of 78 years, mostly men (62%) and with NYHA II functional status (52%). 98 patients completed follow-up after a median follow-up of 162 days (IQR 13–343). The average dose of vericiguat used was 8,3 ± 2,7 mg and 75 patients achieved the target dose of 10 mg (71%). At the end of follow-up, no significant changes were observed in the values of proBNP (pg/mL), CA125, hemoglobin (mg/dl), electrolytes, glomerular filtration rate (mL/min/m²) and systolic blood pressure (mmHg). Of all the patients who completed follow-up, 11 (11%) discontinued treatment due to adverse effects, mostly symptomatic hypotension, digestive symptoms and pruritus; 25 died (20%).</div></div><div><h3>Conclusions</h3><div>The use of vericiguat is safe, if used according to the technical data sheet, in terms of the established parameters. Further long-term studies are needed to evaluate the impact of vericiguat as a potential disease-modifying treatment.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 204-210"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positioning for the use of multivessel clinicalultrasound in vascular risk evaluation: VASUS+protocol. 2024 Recommendations of the Vascular Risk WorkingGroup of The Spanish Society of Internal Medicine (SEMI), Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Hypertension-Spanish League for the Fight against Arterial Hypertension (SHE-LELHA)","authors":"E. Moya Mateo ,&nbsp;R. García Alonso ,&nbsp;C. Sánchez Sánchez ,&nbsp;Y. Tung-Chen ,&nbsp;E. Rodilla ,&nbsp;L. Beltrán Romero ,&nbsp;J.A. García-Donaire ,&nbsp;M.V. Bonilla-Hernández ,&nbsp;N. Muñoz-Rivas ,&nbsp;L. Castilla-Guerra","doi":"10.1016/j.rceng.2024.11.008","DOIUrl":"10.1016/j.rceng.2024.11.008","url":null,"abstract":"<div><div>Atherosclerosis is the underlying disease in the entire spectrum of atherosclerotic vascular disease. Point of care ultrasound is a useful tool for its detection. Current guidelines recommend the use of scales such as SCORE 2 and SCORE 2OP in apparently healthy individuals and in those at intermediate-low risk, they recognize the role of the arterial plaque by ultrasound to refine risk stratification and the need for more aggressive preventive strategies. However, the way to evaluate the vascular territories in which there is presence of plaque, the amount or load of plaque is not homogeneous nor is it well protocolized. In this document, 2 protocols are proposed for the evaluation of vascular risk, VASUS and VASUS+, including the presence of ventricular hypertrophy with the objective of homogenizing clinical ultrasound in the assessment of vascular risk in clinical practice.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 223-230"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of point-of-care ultrasound (POCUS) in hospitalized patients with acute confusional syndrome of unclear etiology","authors":"S. Carrasco-Molina ,&nbsp;Á. Robles-Marhuenda ,&nbsp;J.J. Ríos-Blanco ,&nbsp;Y. Tung-Chen","doi":"10.1016/j.rceng.2025.02.002","DOIUrl":"10.1016/j.rceng.2025.02.002","url":null,"abstract":"<div><div>Acute confusional syndrome (ACS) is a disruption of cognitive function and attention that affects up to 42% of hospitalised patients, most commonly in those over the age of 65. It is typically triggered by one or more precipitating factors in predisposed patients. Point-of-care ultrasound (POCUS) emerges as a tool that could be used to provide quick and accurate information in the diagnosis of patients with ACS, potentially reducing the waiting time for critical interventions, decreasing the need for invasive procedures, and possibly improving clinical outcomes. To date, no articles have been published describing the utility of POCUS in patients with ACS.</div><div>Therefore, this work presents a review of the utility of POCUS in various pathologies that may be related to the development of ACS. Additionally, we propose an action algorithm that integrates clinical evaluation with bedside ultrasound, which could be useful for allowing quick and accurate identification of the underlying causes of ACS and the guidance of appropriate treatment, although prospective studies are needed to confirm this utility.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 231-239"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Present and future of internists in the Spanish public health system","authors":"N. Ramírez-Perea ,&nbsp;D. Orozco-Beltrán","doi":"10.1016/j.rceng.2025.02.005","DOIUrl":"10.1016/j.rceng.2025.02.005","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 250-251"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Helicobacter pylori infection in patients with chronic obstructive pulmonary disease. A systematic review and meta-analysis","authors":"A. González-Saitz ,&nbsp;J. Díez-Manglano","doi":"10.1016/j.rceng.2024.12.004","DOIUrl":"10.1016/j.rceng.2024.12.004","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the association of HP infection with COPD, assessing its prevalence and influence on symptoms, lung function, quality of life, exacerbations, hospitalizations, mortality, and healthcare costs.</div></div><div><h3>Methods</h3><div>We performed a systematic review and meta-analysis after conducting a systematic literature search in PubMed, Embase, Cochrane Library, Virtual Health Library, ScienceDirect, Scopus, Researchgate, and GoogleScholar, from database inception to 31/12/2022. We used the Der Simonian-Laird method to calculate pooled HP prevalence, the Mantel-Haenszel model to determine the association of HP with COPD, and the inverse variance method to compare the pulmonary function tests between infected and uninfected patients, always with a fixed-effect model.</div></div><div><h3>Results</h3><div>Twenty-eight studies included a total of 8647 patients with COPD. The pooled prevalence of HP infection was 29.8% (95%CI 29.0–30.7%). The more severe stage of COPD lesser the prevalence of HP (<em>p</em> &lt; 0.001). HP infection was associated with COPD, estimated odds ratio 1.90 (95%CI 1.71, 2.12), <em>p</em> &lt; 0.001. The mean differences for p%FEV₁, p%FVC and FEV₁/FVC ratio between HP infected and uninfected patients with COPD were −13.06 (95%CI −14.54, −11.58), −3.72 (95%CI −5.64, −1.79) and -0.01 (95%CI −0.02, −0.00) respectively.</div></div><div><h3>Conclusion</h3><div>Our meta-analysis suggests an appreciable relationship between HP infection and COPD. Further longitudinal studies considerating confounders and investigating causality are required.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 193-203"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A prediction model for complications caused by portal hypertension or liver cancer in a Spanish cohort of chronic hepatitis B patients","authors":"P. Gavilán ,&nbsp;J.-C. Gavilán ,&nbsp;E. Clavijo ,&nbsp;I. Viciana ,&nbsp;J.-A. Gonzalez-Correa","doi":"10.1016/j.rceng.2024.11.009","DOIUrl":"10.1016/j.rceng.2024.11.009","url":null,"abstract":"<div><h3>Background aims</h3><div>To identify risk factors associated with liver complications in patients with chronic hepatitis B infection in an unselected cohort of hepatitis B patients in southern Spain.</div></div><div><h3>Methods</h3><div>A prospective open-cohort study was conducted on 437 patients with uncomplicated chronic hepatitis B infection in two hospitals in Málaga, southern Spain. The follow-up time ranged from 0.5 to 31.5 years (mean: 13.8<!--> <!-->±<!--> <!-->9.5 years; median: 11.4 years). The aim of this study was to evaluate the occurrence of the initial liver complication during follow-up, which is defined as the emergence of liver cancer or complications resulting from portal hypertension. Survival curves were obtained using a time-to-event method through Kaplan-Meier analysis. Multivariate Cox regression was conducted to estimate the hazard ratios of risk factors associated with complications after adjusting for multiple variables. The follow-up of the patients was carried out under conditions of usual clinical practice.</div><div>Based on the weighted adjustment of these factors, we developed a Hepatitis B Complication Score (HBCS) from which it was possible to identify patients with low and high risk of complications during follow-up.</div></div><div><h3>Results</h3><div>33 out of 437 patients (7.55%) experienced liver complications, 12 (36.3%) were secondary to portal hypertension, and 21 patients (63.7%) developed liver cancer. A Multivariate Cox regression identified the following independent risk factor: Age above 45 years: HR 7.10 (2.9–17.3); low platelet count: HR 4.88 (2.1–10.9); hepatitis C coinfection: HR 4.68 (2.0–10.9); Male gender: HR 4.64 (1.5–14.2); alkaline phosphatase above 147 UI/mL: HR 4.33 (2.0–8.9); and Child score above 5 points: HR 3.83 (1.7–8.4). The Risk of Complications Score (HBCS) was developed with a high predictive capacity AUROC 0.92 (0.87−0.97).</div></div><div><h3>Conclusion</h3><div>An HBCS score greater than 3.07 points identifies patients at high risk of developing complications and with an increased risk of liver and all-cause mortality.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 4","pages":"Pages 184-192"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}