Revista clinica espanola最新文献

{"title":"E-consults between primary care and internal medicine: implementation, accessibility, benefits, and implications","authors":"","doi":"10.1016/j.rceng.2024.06.007","DOIUrl":"10.1016/j.rceng.2024.06.007","url":null,"abstract":"<div><h3>Aim</h3><p>This work aims to evaluate whether electronic consultations (e-consults) are a clinically useful, safe tool for assessing patients between primary care<span> and internal medicine.</span></p></div><div><h3>Methods</h3><p>This is a retrospective cohort study<span> of all e-consults ordered by the Primary Care Department to the Internal Medicine Department between September 2019 and December 2023. The results of initial consultations, emergency department visits and subsequent admissions, and survival were assessed and complaints and claims filed were reviewed.</span></p></div><div><h3>Results</h3><p>A total of 11,434 e-consults were recorded (55.4% women) with a mean age of 62.1 (SD19.4) years and a wide range (15–102 years). The mean response time was 2.55 (SD 1.6) days. As a result of the e-consults, 5645 patients (49.4%) were given an in-person appointment. For the remaining 5789 (50.6%), a written response was provided. Among those given appointments, the time between the response and in-person appointment was less than five days (95% of cases). Compared to those not given appointments, in-person appointments were older (<em>p</em> &lt; 0.0001), visited the emergency department more times (one month: <em>p</em> = 0.04; three months: <em>p</em> = 0.001), were admitted to the hospital more times (one month: <em>p</em> = 0.0001; three months: <em>p</em> = 0.0001), and had higher mortality at one year (12.7% vs. 9.8% <em>p</em> = 0.0001). In the Cox analysis, only in-person appointments (RR = 1.11; <em>p</em> = 0.04)) and age (RR = 1.09; <em>p</em> &lt; 0.01) were independent factors of mortality. No complaints or claims of any kind were registered.</p></div><div><h3>Conclusions</h3><p>These data suggest that e-consults are a clinically useful, safe tool for assessing patients referred from primary care to internal medicine departments.</p></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 421-427"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141319422","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":"Counter reply in reference to “Prevalence of neutralizing antibodies against SARS-CoV-2 using a rapid serological test in health workers of a Spanish Department of Health in Alicante (Spain) before the booster dose of the vaccine”","authors":"","doi":"10.1016/j.rceng.2024.06.006","DOIUrl":"10.1016/j.rceng.2024.06.006","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 482-483"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297716","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":"The utility of 18F-FDG-PET/CT in detecting extracranial large vessel vasculitis in rheumatic polymyalgia or giant cell arteritis. A systematic review and meta-analysis","authors":"","doi":"10.1016/j.rceng.2024.06.005","DOIUrl":"10.1016/j.rceng.2024.06.005","url":null,"abstract":"<div><h3>Objective</h3><p><span>Systematic review<span> of current evidence to analyze the prevalence of extracranial large vessel vasculitis (LVV) using </span></span>¹⁸<span><span>F-FDG PET/CT in patients with polymyalgia rheumatica (PMR) or </span>giant cell arteritis (GCA).</span></p></div><div><h3>Materials and methods</h3><p>PubMed and EMBASE were searched and the results were screened by two reviewers. Study quality was assessed using a modified version of the Newcastle-Ottawa scale. Heterogeneity between studies was assessed using the I² statistic and the Q test. Further subgroup analyses were performed by disease type, study quality, and ¹⁸<span>F-FDG PET/CT uptake criteria. Publication bias was assessed by funnel plot and Egger's test.</span></p></div><div><h3>Results</h3><p>268 publications were identified, of which 17 met the selection criteria and were included in the meta-analysis. The overall pooled prevalence of extracranial LVV by ¹⁸F-FDG PET/CT was 54.5% [95% CI: 42.6%–66.1%]. In patients with GCA the prevalence was significantly higher than in patients with PMR (60.1% vs. 41.8%, <em>P</em> = 0.006). Likewise, studies with a lower risk of bias reported a higher prevalence of extracranial LVV (61.1% vs. 46.9%; <em>P</em> = 0.010). No publication bias was observed.</p></div><div><h3>Conclusions</h3><p>The ¹⁸F-FDG PET/CT test may be useful in the detection of extracranial LVV, both in patients with PMR or GCA. Such involvement is more frequent in patients with GCA, and may vary depending on the quality of the studies.</p></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 445-456"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297738","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":"Letter to the Editor about “Prevalence of neutralizing antibodies against SARS-CoV-2 using a rapid serological test in health workers before the booster dose of the vaccine”","authors":"","doi":"10.1016/j.rceng.2024.06.011","DOIUrl":"10.1016/j.rceng.2024.06.011","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Page 481"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141474414","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":"Bronchiectasis, lymphadenopathies related to BAFF overexpression and lymphoplasmacytic cystitis as adverse events associated with prolonged use of rituximab in systemic autoimmune rheumatic diseases","authors":"","doi":"10.1016/j.rceng.2024.06.001","DOIUrl":"10.1016/j.rceng.2024.06.001","url":null,"abstract":"<div><h3>Background</h3><p>The long-term use of rituximab<span><span> (RTX) has been gaining ground in the treatment of systemic autoimmune diseases. The </span>adverse events (AEs) associated with its use different to infections are being reported.</span></p></div><div><h3>Methods</h3><p>A cohort of patients with SAIDs treated at a high-complexity center in Cali (southwestern Colombia) with follow-up from January 2008 to December 2022 were examined to search for potential AEs associated with prolonged use of RTX.</p></div><div><h3>Results</h3><p><span>From 178 patients with long-term use of RTX 3 (1.68%) had lymphadenopathies with </span>lymphoid follicular hyperplasia<span><span> related to BAFF<span> overexpression, 4 (2.24%) with bronchiectasis, and 4 (2.24%) with lymphoplasmacytic </span></span>cystitis.</span></p></div><div><h3>Conclusion</h3><p><span><span>Bronchiectasis, lymphoid follicular hyperplasia related to </span>BAFF overexpression, and lymphoplasmacytic </span>cystitis may be life-threatening long-term AEs in patients with prolonged use of RTX.</p></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 474-478"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141289096","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":"Oral anticoagulant treatment in atrial fibrillation: the AFIRMA real-world study using natural language processing and machine learning","authors":"","doi":"10.1016/j.rceng.2024.06.002","DOIUrl":"10.1016/j.rceng.2024.06.002","url":null,"abstract":"<div><h3>Introduction</h3><p>Oral anticoagulation<span><span> (OAC) is key in atrial fibrillation (AF) </span>thromboprophylaxis, but Spain lacks substantial real-world evidence. We aimed to analyze the prevalence, clinical characteristics, and treatment patterns among patients with AF undertaking OAC, using natural language processing (NLP) and machine learning (ML).</span></p></div><div><h3>Materials and methods</h3><p>This retrospective study included AF patients on OAC from 15 Spanish hospitals (2014–2020). Using EHRead® (including NLP and ML), and SNOMED_CT, we extracted and analyzed patient demographics, comorbidities, and OAC treatment from electronic health records. AF prevalence was estimated, and a descriptive analysis was conducted.</p></div><div><h3>Results</h3><p>Among 4,664,224 patients in our cohort, AF prevalence ranged from 1.9% to 2.9%. A total of 57,190 patients on OAC therapy<span><span> were included, 80.7% receiving Vitamin K antagonists<span><span> (VKA) and 19.3% Direct-acting OAC (DOAC). The median age was 78 and 76 years respectively, with males constituting 53% of the cohort. Comorbidities like hypertension (76.3%), diabetes (48.0%), heart failure (42.2%), and renal disease (18.7%) were common, and more frequent in VKA users. Over 50% had a high CHA2DS2-VASc score. The most frequent treatment switch was from DOAC to </span>acenocoumarol (58.6% to 70.2%). In switches from VKA to DOAC, </span></span>apixaban was the most chosen (35.2%).</span></p></div><div><h3>Conclusions</h3><p>Utilizing NLP and ML to extract RWD, we established the most comprehensive Spanish cohort of AF patients with OAC to date. Analysis revealed a high AF prevalence, patient complexity, and a marked VKA preference over DOAC. Importantly, in VKA to DOAC transitions, apixaban was the favored option.</p></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 428-436"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141289097","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":"The value of multi-modal ultrasound in the assessment of sarcopenia in maintenance hemodialysis patients","authors":"","doi":"10.1016/j.rceng.2024.06.003","DOIUrl":"10.1016/j.rceng.2024.06.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Sarcopenia is one of the common complications in maintenance hemodialysis (MHD) patients and is associated with poor prognosis. We aimed to study the validity and reliability of ultrasound in the assessment of sarcopenia in MHD patients.</p></div><div><h3>Methods</h3><p>MHD patients were categorized into the sarcopenia group and the non-sarcopenia group according to the diagnostic criteria of the Asian Working Group on Sarcopenia (AWGS) 2019. Ultrasonography of the left medial head of the gastrocnemius muscle was performed in MHD and healthy controls to obtain muscle thickness (MT), pinnation angle (PA), fascicle length (FL), cross-sectional area (CSA), echo intensity (EI), elastic modulus (E), shear wave velocity (SWV), and microvascular velocity (MV). Compare the differences in ultrasound parameters among different groups, and determine the cut-off values suitable for diagnosing sarcopenia in MHD patients.</p></div><div><h3>Results</h3><p>The MT, CSA, PA, and MV in the sarcopenia group were lower than those in the non-sarcopenia group and the control group; while the EI was higher, the FL of the sarcopenia group was lower than that of the non-sarcopenia group, while the E and SWV of the sarcopenia group were higher than those of the control group. Receiver operating characteristic curve analyses indicated that ultrasound combined index had a good diagnostic value, model <em>Y</em> = 13.511−0.121*MT-0.609*CSA-0.172*PA+0.011*EI-2.205*MV(<em>P</em> &lt; 0.05), with a cut-off value of 0.69.</p></div><div><h3>Conclusions</h3><p>Multi-modal ultrasound is a safe, non-invasive, and real-time imaging examination method, and can provide information on muscle structure, stiffness, and perfusion, which is expected to be a promising potential tool for predicting sarcopenia in MHD patients.</p></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 437-444"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2254887424000821/pdfft?md5=a0c3c97314799d9991c3f3ee011e5206&pid=1-s2.0-S2254887424000821-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141289098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The young internist at the leading edge of clinical research","authors":"","doi":"10.1016/j.rceng.2024.06.004","DOIUrl":"10.1016/j.rceng.2024.06.004","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 479-480"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141294040","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":"Prevalence and characteristics of anemia in patients with diabetes mellitus aged 50 or older in health unit area of Cadiz (Spain)","authors":"","doi":"10.1016/j.rceng.2024.06.008","DOIUrl":"10.1016/j.rceng.2024.06.008","url":null,"abstract":"<div><h3>Background</h3><p>Anemia is a common comorbidity in patients with diabetes mellitus (DM), particularly in older adults. However, there is a lack of data on the prevalence and the characteristics of anemia in this population in Spain.</p></div><div><h3>Objective</h3><p>To describe the prevalence and the characteristics of anemia in patients with DM aged 50 or older (PDM50) in a healthcare district in the province of Cádiz.</p></div><div><h3>Methods</h3><p>A retrospective cross-sectional study was conducted that included outpatient’s laboratory tests (OLT) performed over 30 months at PDM50.</p></div><div><h3>Results</h3><p>The prevalence of anemia was 29.9% (95% CI: 28.7%–31.1%), predominating in women (33.3% vs 26.7%; <em>P</em> &lt; 0.01), in older people stratified by decades (61.7% in 9th decade vs 12% in 5th decade; <em>P</em><span> &lt; 0.01), and in those with kidney disease (44.7% vs 28%; </span><em>P</em><span><span><span> &lt; 0.01). Most cases were mild (68.3%), normocytic (78.7%), and hypochromic (52%). Similarly, moderate-to-severe anemia was more frequent in women (39% vs 23%), their prevalence increased with age (45% in the 9th decade vs 24% in the 5th decade), and with the progression of kidney damage, either measured by a decreased </span>glomerular filtration rate (GFR) (49% in G4 vs 25% in G1), or the presence of </span>albuminuria (</span><em>P</em><span> &lt; 0.01). No association was found between DM control, based on glycated hemoglobin (HbA1c), and anemia in either sex (</span><em>P</em> = 0.887).</p></div><div><h3>Conclusion</h3><p>This study describes a high prevalence of anemia in PDM50, particularly in women, in the most advantageous people and in the presence of kidney disease, even in early stages, highlighting the clinical importance of this coexistence.</p></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 457-465"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141328264","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":"Etiological spectrum and diagnostic challenges of short-duration fever in West Bengal (India). A cross-sectional tertiary care study","authors":"","doi":"10.1016/j.rceng.2024.06.009","DOIUrl":"10.1016/j.rceng.2024.06.009","url":null,"abstract":"<div><h3>Introduction</h3><p>The scarcity of epidemiological data on acute febrile illnesses from South Asia impairs evidence-based clinical decision-making. Our study aimed to explore the etiological spectrum of short-duration fever in patients admitted to a tertiary care hospital in West Bengal, India.</p></div><div><h3>Methods</h3><p>We conducted a cross-sectional study from May 2021 to April 2022 involving 150 adult patients presenting with a fever lasting less than two weeks at Burdwan Medical College and Hospital (West Bengal, India). We performed comprehensive clinical assessments, including microbiological, serological, and other specific investigations, to identify the causes of the fever.</p></div><div><h3>Results</h3><p><span><span>The demographic profile predominantly included individuals aged 21–40 years, with a male-to-female ratio of 1.9:1; 60.7% of participants were from rural areas. The primary etiological agents identified were scrub typhus<span> (25.3%), dengue (15.3%), and </span></span>enteric fever (13.3%). Notably, 80% of patients presented with non-localizing symptoms, while 14.7% had respiratory symptoms. Blood cultures pinpointed </span><span><span>Salmonella typhi</span></span> and <span><span>Staphylococcus aureus</span></span> in a minority of cases (3.3%); malaria, primarily <span><span>Plasmodium vivax</span></span>, was diagnosed in 12% of the cases.</p></div><div><h3>Conclusion</h3><p><span>Our findings highlight the complexity of diagnosing short-duration fevers, dominated by a wide range of etiological agents, with a notable prevalence of scrub typhus<span>. These results underscore the urgent need for enhanced diagnostic facilities, including the availability of scrub typhus testing at primary healthcare centers. We recommend empirical </span></span>doxycycline<span> therapy for suspected cases and emphasize the need for further research to develop management guidelines for acute febrile illnesses. This study also highlights the importance of raising both community and clinician awareness to prevent irrational antibiotic use.</span></p></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 7","pages":"Pages 466-473"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437958","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}