Revista clinica espanola最新文献

{"title":"Diagnostic accuracy of procalcitonin for bacterial infection in the Emergency Department: a systematic review","authors":"A. Julián-Jiménez ,&nbsp;L. García de Guadiana-Romualdo ,&nbsp;G. Merinos-Sánchez ,&nbsp;D.E. García","doi":"10.1016/j.rceng.2024.05.006","DOIUrl":"10.1016/j.rceng.2024.05.006","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. Observational cohort studies were included. 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 twelve 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":94354,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 400-416"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180977","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":"Comparing pregnancy outcomes in patients with Systemic Lupus Erythematosus (SLE) and Undifferentiated Connective Tissue Disease (UCTD): a descriptive cohort study","authors":"Candido Muñoz Muñoz ,&nbsp;Filipa Farinha ,&nbsp;Thomas McDonnell ,&nbsp;Hajar J'bari ,&nbsp;Hanh Nguyen ,&nbsp;David Isenberg ,&nbsp;Anisur Rahman ,&nbsp;David Williams ,&nbsp;Jaume Alijotas-Reig ,&nbsp;Ian Giles","doi":"10.1016/j.rceng.2024.04.013","DOIUrl":"10.1016/j.rceng.2024.04.013","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 (p = 0.349). 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; p = 0.4237).</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":94354,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 357-365"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140763727","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":"Reply to editor’s letter “Executive summary of the consensus document on the management of perioperative anemia in Spain”","authors":"M. Muñoz,&nbsp;on behalf of the panel of the consensus document on the management of perioperative anemia in Spain","doi":"10.1016/j.rceng.2024.05.005","DOIUrl":"10.1016/j.rceng.2024.05.005","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 418-419"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094843","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":"Initial handgrip strength as a predictive factor for amputation risk in diabetic foot patients","authors":"E. Imre ,&nbsp;E. Imre ,&nbsp;S. Ozturk","doi":"10.1016/j.rceng.2024.04.011","DOIUrl":"10.1016/j.rceng.2024.04.011","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; &lt;0.001).</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":94354,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 346-356"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796899","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":"Adverse cardiovascular, obstetric and perinatal events during pregnancy and puerperium in patients with heart disease","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.rceng.2024.04.016","DOIUrl":"10.1016/j.rceng.2024.04.016","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 hospitalised with diagnosis of congenital or acquired heart disease. Adverse events (heart failure, stroke, acute pulmonary edema, maternal death, obstetric haemorrhage, 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 haemorrhage 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> = 0.006). Peripartum cardiomyopathy represented higher risk of pulmonary edema (adjusted OR 34; 95% CI: 6−194, <em>p</em> = 0.001) and heart failure (adjusted OR 16; 95% CI: 3−84, <em>p</em> = 0.001). An increased risk of obstetric haemorrhage was observed in patients with prosthetic valves (adjusted OR 30; 95% CI: 1.5−616, <em>p</em> = 0.025) and with the use of acetylsalicylic acid (adjusted OR 14; 95% CI: 1.2–16, <em>p</em> = 0.030). Furthermore, the latter was associated with perinatal death (adjusted OR 9; 95% CI: 1.4−68, <em>p</em> = 0.021).</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":94354,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 337-345"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2254887424000675/pdfft?md5=ccf4605611c0705ed39d127cf8db01a3&pid=1-s2.0-S2254887424000675-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860647","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":"Letter to the editor about the article \"How to detect non-institutionalized older patients at risk of malnutrition during their hospitalization? Comparison of 8 screening tools for malnutrition or nutritional risk\".","authors":"F J Teigell Muñoz","doi":"10.1016/j.rceng.2024.05.001","DOIUrl":"10.1016/j.rceng.2024.05.001","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"417"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961430","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":"Social determinants of health and their impact on internal medicine","authors":"M. Montserrat Chimeno Viñas ,&nbsp;P. Pérez-Martínez","doi":"10.1016/j.rceng.2024.05.003","DOIUrl":"10.1016/j.rceng.2024.05.003","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 398-399"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141034001","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 the article “How to detect non-institutionalized older patients at risk of malnutrition during their hospitalization? Comparison of 8 screening tools for malnutrition or nutritional risk”","authors":"Teigell Muñoz F.J.","doi":"10.1016/j.rceng.2024.05.001","DOIUrl":"10.1016/j.rceng.2024.05.001","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Page 417"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141041423","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":"Time dedicated to physical activity among medical residents: are there differences based on gender or specialty type?","authors":"O. Pujol ,&nbsp;L. Vila-Castillo ,&nbsp;C. Álvaro ,&nbsp;M. Aguilar ,&nbsp;N. Joshi ,&nbsp;J. Minguell","doi":"10.1016/j.rceng.2024.04.014","DOIUrl":"10.1016/j.rceng.2024.04.014","url":null,"abstract":"<div><h3>Introduction</h3><p>Physical activity (PA) is associated with positive health outcomes such as prevention of chronic diseases, psychological well-being and improved work performance. Medical residents are subjected to sleep deprivation, extended work schedule and high burnout prevalence. These conditions may lead to the neglect of personal health and the restriction of time dedicated to PA. The objective of the present study was to analyze the time dedicated to PA of medical residents, comparing women vs men residents and surgical vs clinical residents.</p></div><div><h3>Methods</h3><p>It is a cross-sectional study performed in a Spanish third-level university hospital. All medical residents from our institution were invited to voluntarily participate in the study answering a web-based questionnaire on June 2022. Data regarding demographics, residency and PA practice was recorded.</p></div><div><h3>Results</h3><p>The response rate was 20.73% (114/550). The 32.5% of the residents considered themselves to be physically inactive and mean time dedicated to PA in a regular week was 3.62 ± 2.22 h. Men residents dedicated more time to PA than women residents (4.23 ± 2.42 h vs 3.14 ± 1.95 h, p = 0.012) and surgical residents dedicated more time than clinical residents (4.33 ± 2.36 h vs 3.23 ± 2.05 h, p = 0.01).</p></div><div><h3>Conclusions</h3><p>One third of the medical residents consider themself physically inactive. Women and clinical residents practice PA less time than men and surgical residents. Efforts should be made to encourage PA among residents, especially in women and non-surgeons.</p></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Pages 387-392"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857957","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 the article “Executive summary of the consensus document on the management of perioperative anemia in Spain”","authors":"Teigell Muñoz F.J.,&nbsp;Mateos-González M.","doi":"10.1016/j.rceng.2024.05.002","DOIUrl":"10.1016/j.rceng.2024.05.002","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 6","pages":"Page 418"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961429","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}