Revista clinica espanola最新文献

{"title":"Ecological study to estimate the prevalence of patients with acid sphingomyelinase deficiency in Spain. PREVASMD study","authors":"J. Villarrubia ,&nbsp;M. Morales ,&nbsp;L. Ceberio ,&nbsp;I. Vitoria ,&nbsp;M. Bellusci ,&nbsp;I. Quiñones ,&nbsp;L. Peña-Quintana ,&nbsp;M. Ruiz de Valbuena ,&nbsp;M. O’Callaghan","doi":"10.1016/j.rceng.2024.11.007","DOIUrl":"10.1016/j.rceng.2024.11.007","url":null,"abstract":"<div><h3>Background and objective</h3><div>Prevalence studies of acid sphingomyelinase deficiency (ASMD) are scarce and different in Spain. The objective of the present study was to determine the estimated prevalence of patients diagnosed with ASMD (types A/B and B) in Spain.</div></div><div><h3>Material and methods</h3><div>PREVASMD was a descriptive, multicenter, and ecological study involving 21 physicians from different specialties (mainly Internal Medicine, Paediatrics and Hematology), of different autonomous communities, with experience in ASMD management.</div></div><div><h3>Results</h3><div>Between March and April 2022, specialists were attending a total of 34 patients with ASMD diagnosis, 10 paediatric patients under 18 years of age (29.4%) and 24 adult patients (70.6%). The estimated prevalence of patients (paediatric and adult) diagnosed with ASMD was 0.7 per 1,000,000 inhabitants (95% confidence interval, 95% CI: 0.5-1.0), 1.2 per 1,000,000 (95% CI: 0.6–2.3) in the paediatric population and 0.6 per 1,000,000 inhabitants (95% CI: 0.4–0.9) in the adult population. The most frequent symptoms that led to suspicion of ASMD were: splenomegaly (reported by 100.0% of specialists), hepatomegaly (66.7%), interstitial lung disease (57.1%), and thrombocytopenia (57.1%). According to the specialists, laboratory and routine tests, and assistance in Primary Care were the most relevant healthcare resources in the management of ASMD.</div></div><div><h3>Conclusions</h3><div>This first study carried out in Spain shows an estimated prevalence of patients of 0.7 per 1,000,000 inhabitants: 1.2 per 1,000,000 inhabitants in the paediatric population and 0.6 per 1,000,000 inhabitants in the adult population.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 70-77"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756078","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":"Which one is a better predictor of prognosis in COVID-19: analytical biomarkers or PaO2/FiO2?","authors":"M. Rubio-Rivas ,&nbsp;J.M. Mora-Luján ,&nbsp;A. Montero Sáez ,&nbsp;M.D. Martín-Escalante ,&nbsp;V. Giner Galvañ ,&nbsp;G. Maestro de la Calle ,&nbsp;M.L. Taboada Martínez ,&nbsp;A. Muiño Míguez ,&nbsp;C. Lumbreras-Bermejo ,&nbsp;J.-M. Antón-Santos ,&nbsp;on behalf of the SEMI-COVID-19 Network","doi":"10.1016/j.rceng.2024.11.003","DOIUrl":"10.1016/j.rceng.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>The study aimed to describe patient characteristics and outcomes by PaO2/FiO2 (PAFI) and degree of inflammation.</div></div><div><h3>Methods</h3><div>Retrospective cohort study with data on patients collected from March 1st, 2020 to March 1st, 2023, from the Spanish SEMI-COVID-19 Registry. Non-nosocomial patients with data on PAFI (&lt;100 vs. 100−200 vs. 200−300 vs. &gt;300) who received corticosteroids (CS) for COVID-19 in the first 48 h of admission were included in the study. 5314 patients met the inclusion criteria for the present study. The primary outcome was in-hospital mortality.</div></div><div><h3>Results</h3><div>Higher in-hospital mortality was found in the groups with PAFI &lt; 100 (51.5% vs. 41.2% vs. 25.8% vs. 12.3%, <em>P</em> &lt; .001). They also required more NIMV, IMV, and ICU admission, and had longer hospital stays. Those patients with PAFI &gt; 300 and 4–5 high-risk criteria presented higher mortality than the patients with PAFI 200−300 and only 1−2 criteria of analytical inflammation. Risk factors associated with higher in-hospital mortality were age [OR = 1.06 (1.05−1.06)], moderate [OR = 1.87 (1.49−2.33)] and severe [OR = 2.64 (1.96−3.55)] degree of dependency, dyslipidemia [OR = 1.20 (1.03−1.39)], higher Charlson index [OR = 1.19 (1.14−1.24)], tachypnea on admission [2.23 (1.91−2.61)], the higher number of high-risk criteria on admission, and lower PAFI on admission. Female gender [OR = 0.77 (0.65−0.90)] and the use of RDSV [OR = 0.72 (0.56−0.93)] were found to be protective factors.</div></div><div><h3>Conclusions</h3><div>The lower the PAFI and the higher the degree of inflammation in COVID-19, the higher the in-hospital mortality. Inflammatory escalation precedes respiratory deterioration and should serve as an early predictor of severity to deciding the use of anti-inflammatory/immunosuppressive therapy.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 57-69"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142694054","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 difficult relationship between research and clinical practice: a survey of Spanish internists","authors":"J.C. Trullàs ,&nbsp;A. Maestre","doi":"10.1016/j.rceng.2025.01.009","DOIUrl":"10.1016/j.rceng.2025.01.009","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 176-177"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082991","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":"Alkaptonuria. Description of 2 cases of a rare entity","authors":"A. Rosales-Castillo,&nbsp;A. Bustos-Merlo,&nbsp;J. Escobar Sevilla","doi":"10.1016/j.rceng.2025.01.008","DOIUrl":"10.1016/j.rceng.2025.01.008","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 177-178"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076679","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":"Diabetic foot infections in Internal Medicine services in Spain (2018–2022)","authors":"C. Fuentes Santos ,&nbsp;J.A. Rueda Camino ,&nbsp;Á. Asenjo Mota ,&nbsp;A. Castaneda Pastor ,&nbsp;A. Zapatero Gaviria ,&nbsp;J. Canora Lebrato ,&nbsp;R. Barba-Martín","doi":"10.1016/j.rceng.2025.01.006","DOIUrl":"10.1016/j.rceng.2025.01.006","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>15,402 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":94354,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 125-130"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049246","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":"External validation of the \"HOSPITAL simplified\" scale as a predictor of 30-day readmission after hospitalisation in OSI Araba Medical Services","authors":"N. García-Perotti ,&nbsp;S. García de Garayo-Díaz ,&nbsp;J. Regalado-De Los Cobos","doi":"10.1016/j.rceng.2025.01.007","DOIUrl":"10.1016/j.rceng.2025.01.007","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 (P &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":94354,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 117-124"},"PeriodicalIF":0.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054667","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":"Position statement on the use of point-of-care ultrasound in heart failure: recommendations from the Heart Failure and Atrial Fibrillation, and Clinical Ultrasound Working Groups of the Spanish Society of Internal Medicine (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.rceng.2025.01.003","DOIUrl":"10.1016/j.rceng.2025.01.003","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":94354,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 148-156"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044016","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":"Analysis of clinical features and prognosis in cardiac amyloidosis patients from Spanish hospitals (2016–2021)","authors":"A. Esteban-Fernández ,&nbsp;M. Anguita-Sánchez ,&nbsp;N. Rosillo ,&nbsp;J.L. Bonilla-Palomas ,&nbsp;J.L. Bernal Sobrino ,&nbsp;N. Del Prado ,&nbsp;C. Fernández Pérez ,&nbsp;L. Rodríguez Padial ,&nbsp;F.J. Elola Somoza","doi":"10.1016/j.rceng.2025.01.001","DOIUrl":"10.1016/j.rceng.2025.01.001","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Cardiac amyloidosis (CA) is a prevalent yet underdiagnosed heart condition characterized by the abnormal accumulation of amyloid fibres, frequently resulting in heart failure (HF), particularly in older people. Despite advancements in non-invasive diagnostic techniques and treatments, the epidemiology of CA patients remains inadequately understood. This nationwide retrospective observational study sought to comprehensively investigate CA patients’ characteristics, mortality, and readmission patterns.</div></div><div><h3>Methods</h3><div>A retrospective observational study encompassed all patients hospitalized with CA between 2016 and 2021 across Spanish hospitals. Standardized incidence rates were calculated using age and sex-adjusted methods, utilizing the Spanish population as the reference. The investigation delved into demographic variables, comorbidities, mortality during the index episode, and 30 and 365-day readmissions for circulatory system diseases. Predictors of readmission were also examined.</div></div><div><h3>Results</h3><div>A total of 5739 index episodes were identified, with CA being the primary cause of admission in 14.1% of cases. The mean age was 81.4 ± 9.9 years, predominantly males (70.3%). The age and sex-standardized hospital attendance rate was 3.90 admissions per 100,000 population (95% CI: 3.82–3.98), higher in males. Common comorbidities included HF (96.4%), atrial fibrillation (46.3%), and renal failure (44.4%). The mortality rate during the index episode was 11.7%, with cardiogenic shock (OR: 9.03; 95% CI: 4.22–19.32) and major psychiatric disorders (OR: 3.36; 95% CI: 1.42–7.94) identified as predictors.</div><div>Over the follow-up period, 13.1% were readmitted at 30 days and 36.6% at 365. Nephritis (IRR: 2.05; 95% CI: 1.42–2.96) and asthma (IRR: 1.52; 95% CI 1.11–2.07) were associated with increased 30-day readmissions, while renal failure (IRR: 1.43; 95% CI: 1.28–1.59) and chronic pulmonary disease (IRR: 1.40; 95% CI: 1.18–1.67) were linked to higher 365-day readmissions. Predictors of mortality risk in 365-day readmissions included advanced cancer (HR: 1.31; 95% CI: 1.00–1.71), cardiogenic shock in the index episode (HR: 2.72; 95% CI: 1.33–5.57), and a higher number of readmissions during that period (HR: 1.64; 95% CI: 1.56–1.73).</div></div><div><h3>Conclusions</h3><div>This study contributes valuable insights into the significant prevalence of CA, which is often overlooked and underestimated. Afflicting predominantly elderly males with concomitant HF and multiple comorbidities, CA poses a significant clinical challenge. The findings underscore the need for enhanced awareness, early detection, and a multidisciplinary approach to manage this complex cardiac condition.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 131-139"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044012","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":"Diagnosis and treatment of pulmonary embolism. Recommendations of the Thromboembolic Disease Group of the Spanish Society of Internal Medicine 2024","authors":"M.A. Fidalgo Fernández ,&nbsp;O. Madridano Cobo ,&nbsp;C. Sánchez del Hoyo ,&nbsp;A. Rodríguez Iglesias ,&nbsp;A.N. Muñoz-Rivas ,&nbsp;M. Martín Asenjo","doi":"10.1016/j.rceng.2025.01.005","DOIUrl":"10.1016/j.rceng.2025.01.005","url":null,"abstract":"<div><div>Pulmonary embolism (PE) is a disease with a rising incidence rate. This article presents the recommendations for the diagnosis and treatment of PE of the Thromboembolic Disease Group of the Spanish Society of Internal Medicine (SEMI). The main objective is to facilitate decision making to improve the diagnostic and therapeutic approach based on published evidence. The final justification of the document is to improve the comprehensive care of the patient with PE.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 168-175"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044014","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 presentation of pheochromocytoma and screening recommendations","authors":"O.F. Arroyo Ripoll ,&nbsp;E. Achote ,&nbsp;M. Araujo-Castro","doi":"10.1016/j.rceng.2025.01.004","DOIUrl":"10.1016/j.rceng.2025.01.004","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":94354,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 157-167"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044013","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}