Revista clinica espanola最新文献

{"title":"Basic action protocol for the outpatient management of chronic heart failure of the Spanish Society of Internal Medicine","authors":"J.M. Cerqueiro-González ,&nbsp;A. González-Franco ,&nbsp;J.M. Fernández-Rodríguez ,&nbsp;E. Martínez-Litago ,&nbsp;J. Pérez-Silvestre ,&nbsp;P. Salamanca-Bautista ,&nbsp;L. Morales-Rull ,&nbsp;A. Conde-Martel ,&nbsp;J. Casado ,&nbsp;O. Aramburu-Bodas ,&nbsp;L. Manzano-Espinosa","doi":"10.1016/j.rceng.2024.08.004","DOIUrl":"10.1016/j.rceng.2024.08.004","url":null,"abstract":"<div><div>Chronic heart failure (CHF) represents a challenge for the healthy system due to its high prevalence, high burden of morbidity and mortality, and high consumption of health resources.</div><div>To address this problem, it is necessary to develop efficient management strategies that include both hospital care and outpatient care. The primary objective is to stabilize the patient and prevent decompensation, with the consequent improvement in quality of life, reduction in hospital admissions and emergency department care, and, consequently, reduction in healthcare costs.</div><div>In this context, the heart failure and atrial fibrilation working group of the Spanish Society of Internal Medicine has developed a protocol for the management of outpatient CHF, that addresses, from the perspective of Internal medicine, all the problems suffered by the patient with CHF.</div><div>This protocol aims to optimize pharmacological treatment, control cardiovascular risk factors and various comorbidities, educate the patient and their environment about the disease, promote adherence to treatment and stablish follow-up adapted to their condition.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 679-693"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116801","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":"Measles in the emergency room: the enemy is still there","authors":"J. Ena","doi":"10.1016/j.rceng.2024.10.005","DOIUrl":"10.1016/j.rceng.2024.10.005","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 650-651"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485093","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":"Therapeutic approach to acute crises of hepatic porphyrias","authors":"M. Garrido Montes,&nbsp;R. Pertusa Mataix,&nbsp;J.S. Garcia Morillo","doi":"10.1016/j.rceng.2024.09.004","DOIUrl":"10.1016/j.rceng.2024.09.004","url":null,"abstract":"<div><div>Acute hepatic porphyria is a genetic disorder affecting enzymes involved in heme biosynthesis. The most common subtype is acute intermittent porphyria, accounting for 80% of cases. Other types include hereditary coproporphyria, variegate porphyria, and delta-aminolevulinic acid dehydratase deficiency.</div><div>Attacks in acute hepatic porphyria are triggered by the induction of hepatic ALA synthase 1, leading to the accumulation of neurotoxic heme intermediates, delta-aminolevulinic acid, and porphobilinogen. Women experience attacks more frequently than men.</div><div>Acute porphyria attacks are characterized by severe, diffuse abdominal pain, muscle weakness, autonomic neuropathy (including hypertension, tachycardia, nausea, vomiting, and constipation), and changes in mental status. Early recognition of the disease is crucial as it requires urgent medical attention and treatment. Management includes intravenous opioids, glucose, hemin, and the removal of triggering factors.</div><div>Preventive treatment options include hormone suppression therapy, off-label prophylactic hemin, Givosiran, and exceptionally liver transplantation.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 664-669"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309574","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":"Measles outbreak transmission in the ER waiting room: the role of vaccination","authors":"A. Hernández-Aceituno ,&nbsp;I. Falcón García ,&nbsp;E. Marrero Marichal ,&nbsp;D. Sanabria Curbelo ,&nbsp;Á. Torres Lana ,&nbsp;E. Larumbe-Zabala","doi":"10.1016/j.rceng.2024.10.002","DOIUrl":"10.1016/j.rceng.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Measles is one of the most contagious infectious diseases. Spain was declared free of endemic measles transmission in 2017. However, less than half of EU/EEA countries have achieved vaccination coverage goals and measles outbreaks have been reported recently, some of them in healthcare facilities. The aim of this study was to present an outbreak in the pediatric emergency (ER) waiting room affecting a vaccinated healthcare worker.</div></div><div><h3>Methods</h3><div>Descriptive study of an outbreak whose transmission occurred in the pediatric ER waiting room of a tertiary level hospital on the island of Tenerife (Canary Islands) in April 2024.</div></div><div><h3>Results</h3><div>Between April 23 and May 12, 2024, four PCR-confirmed measles cases were identified, resulting in 407 contacts in healthcare center waiting rooms. One of the cases was a 26-year-old male nurse who had been correctly vaccinated with two doses of measles, mumps, and rubella vaccine during childhood. Between May 7 and 10, during his infective period, he took two two-and-a-half-hour flights and lived together with nine people during a trip. No evidence of infection has been identified among the individuals with whom he lived neither the passengers and crew of the two flights.</div></div><div><h3>Conclusions</h3><div>In the emergency waiting room, an unvaccinated girl gave measles to two infants who were not yet old enough to be vaccinated and to a nurse who had been properly vaccinated as an infant. Despite generating more than 300 close contacts, the nurse did not infect anyone, suggesting that vaccination may help prevent both infection and transmission of measles.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 646-649"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378773","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 point-of-care ultrasound implementation: recommendations from the Clinical Ultrasound Working Groups of SEMI, SEDAR, SEGG, SEMERGEN, SEMES, SEMFYC, and SEMG","authors":"Y. Tung-Chen","doi":"10.1016/j.rceng.2024.10.001","DOIUrl":"10.1016/j.rceng.2024.10.001","url":null,"abstract":"<div><div>Point-of-Care Ultrasound has significantly evolved, establishing itself as an essential tool in daily medical practice, especially in various clinical contexts. This consensus document, supported by several Spanish medical societies, proposes guidelines for the effective integration of ultrasound in healthcare, promoting its standardization and ensuring the quality and systematic application of this technique. The working groups, composed of experts from different specialties, conducted a comprehensive review of the literature in MEDLINE and extensively discussed recommendations to formulate a coherent and practical set of guidelines for different application areas: hospital and out-of-hospital emergencies and critical care, primary care, and outpatient hospital care, hospitalization.</div><div>The methodology included virtual meetings and confidential voting to reach a consensus on the relevant recommendations. Ultrasound was highlighted as fundamental in the initial approach to various pathologies, such as abdominal, thoracic, and musculoskeletal issues, facilitating quick and accurate diagnoses, and reducing the need for unnecessary referrals. Furthermore, this technique has proven valuable in emergencies and critical care, guiding procedures and enhancing the safety and efficiency of clinical interventions.</div><div>These guidelines not only serve as a framework for clinical practice, education, and research but also aim to ensure that professionals are adequately trained and that ultrasound evaluations are performed to a standard of excellence. The purpose of these recommendations is to standardize and facilitate the adoption of this clinical tool in the daily practice of healthcare, thus improving the quality of the services provided in its various possible applications.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 670-678"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378772","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 features, management in the emergency department and mortality of acute heart failure episodes in patients with chronic obstructive pulmonary disease","authors":"N. Ivars ,&nbsp;Pere Llorens ,&nbsp;A. Alquézar ,&nbsp;J. Jacob ,&nbsp;B. Rodríguez ,&nbsp;M. Guzmán ,&nbsp;L. Serrano Lázaro ,&nbsp;M.C. Martínez Picón ,&nbsp;L. Cuevas Jiménez ,&nbsp;Ò. Miró ,&nbsp;on behalf of ICA SEMES research group","doi":"10.1016/j.rceng.2024.10.003","DOIUrl":"10.1016/j.rceng.2024.10.003","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to analyse differences in clinical and therapeutic management for patients with chronic obstructive pulmonary disease (COPD) who present to the emergency department with acute heart failure (AHF). Additionally, it examines mortality rates during such episodes.</div></div><div><h3>Methods</h3><div>We included patients diagnosed with AHF at 50 Spanish emergency departments from 2012 to 2022 who also had COPD. We compared their baseline characteristics, decompensation episodes, and emergency department management with those of AHF patients without COPD during the same period. We collected data on in-hospital and 30-day all-cause mortality, investigating differences between the two groups using crude and adjusted logistic regression models.</div></div><div><h3>Results</h3><div>A total of 21,694 AHF patients were analysed (median age = 83 years, 56% female), including 4,942 (23%) with COPD. COPD patients were generally younger and more frequently male, with a higher prevalence of comorbidities (excluding valve disease and dementia, which were more common in non-COPD patients). They exhibited a worse respiratory functional class (NYHA) but a better overall functional capacity (Barthel Index). Decompensation in COPD patients was more often triggered by infection and less frequently by tachyarrhythmia, hypertensive crisis, or acute coronary syndrome. While there were differences in clinical findings in the emergency department, the severity assessed by the MEESSI-AHF Scale was similar across both groups. In terms of emergency department management, a higher proportion of COPD patients received oxygen therapy, non-invasive ventilation, bronchodilators, corticosteroids, and antibiotics, while fewer received intravenous nitroglycerin, and they were hospitalized more frequently. In-hospital mortality rates were 8.1% for patients with COPD and 7.5% for those without (OR = 1.088, 95% CI = 0.968–1.224), with 30-day mortality rates of 11.0% and 10.0%, respectively (OR = 1.111, 95% CI = 1.002–1.231). After adjusting for clinical characteristics, decompensation episodes, and emergency department management, these odds ratios decreased to 1.040 (95% CI = 0.905–1.195) and 1.080 (95% CI = 0.957–1.219), respectively.</div></div><div><h3>Conclusion</h3><div>Patients with AHF and COPD exhibit distinct clinical and therapeutic management characteristics in the emergency department and require more frequent hospitalization. Although they show higher crude 30-day mortality, this is attributable to their differing clinical profiles rather than the presence of COPD itself.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 634-645"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407373","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":"Association between autoimmune diseases and Alzheimer’s disease: analysis using big data tools","authors":"A.M. Diezma-Martín ,&nbsp;M.I. Morales-Casado ,&nbsp;L. Jiménez-Díaz ,&nbsp;J.D. Navarro-López ,&nbsp;B. Mondéjar-Marín ,&nbsp;J. Parra-Serrano ,&nbsp;A. Vadillo-Bermejo ,&nbsp;C. Marsal-Alonso ,&nbsp;P. Beneyto-Martín","doi":"10.1016/j.rceng.2024.09.003","DOIUrl":"10.1016/j.rceng.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>The objective is to analyze the prevalence of Alzheimer's disease in patients with and without a diagnosis of different autoimmune diseases and the possible association between both pathologies.</div></div><div><h3>Patients and methods</h3><div>A multicenter, retrospective, cohort study was conducted to study the prevalence of Alzheimer’s disease among patients diagnosed with various autoimmune diseases compared to the general population. Data from electronic medical records from the Castilla-La Mancha healthcare system were analyzed using Natural Language Processing through the Savana Manager® artificial intelligence clinical platform. A total of 1,028,356 patients were analyzed, including 28,920 individuals with Alzheimer's disease and 999,436 control patients.</div></div><div><h3>Results</h3><div>Out of the 12 autoimmune diseases analyzed, 5 showed a significant association with Alzheimer's disease with p &lt; 0.05. Myasthenia gravis had an increased prevalence of AD with OR 1.49 (95% CI 1.11–2), systemic lupus erythematosus with OR 2.42 (95% CI 2.02–2.88), rheumatoid arthritis with OR 1.38 (95% CI 1.24–1.54), polymyalgia rheumatica with OR 2.01 (95% CI 1.08–2.23), and pernicious anemia with OR 2.06 (95% CI 1.59–2.66). The remaining autoimmune diseases analyzed did not show a higher prevalence of Alzheimer's disease compared to the general population.</div></div><div><h3>Conclusions</h3><div>There may be an association between certain systemic autoimmune diseases and Alzheimer's disease. Further studies are needed to confirm our findings, establish causality, and explore the underlying mechanisms of this association.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 627-633"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309572","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":"Anemia of inflammation and iron metabolism in chronic diseases","authors":"S. Conde Díez ,&nbsp;R. de las Cuevas Allende ,&nbsp;E. Conde García","doi":"10.1016/j.rceng.2024.09.002","DOIUrl":"10.1016/j.rceng.2024.09.002","url":null,"abstract":"<div><div>Anemia of Inflammation begins with the activation of the immune system and the subsequent release of cytokines that lead to an elevation of hepcidin, responsible for hypoferremia, and a suppression of erythropoiesis due to lack of iron. The anemia is usually mild/moderate, normocytic/normochromic and is the most prevalent, after iron deficiency anemia, and is the most common in patients with chronic diseases, in the elderly and in hospitalized patients. Anemia can influence the patient’s quality of life and have a negative impact on survival. Treatment should be aimed at improving the underlying disease and correcting the anemia. Intravenous iron, erythropoietin and prolyl hydroxylase inhibitors are the current basis of treatment, but future therapy is directed against hepcidin, which is ultimately responsible for anemia.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 598-608"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142279","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 perspective of anti-HMGCR immune-mediated necrotizing myopathy: analysis of three cases","authors":"J.P. de la Fuente Peñaloza ,&nbsp;L. Quintana Cabezas ,&nbsp;M.C. Yubini Lagos","doi":"10.1016/j.rceng.2024.08.005","DOIUrl":"10.1016/j.rceng.2024.08.005","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 623-625"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116802","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":"Soluble receptor for advanced glycation end-products positively correlated to kidney injury with coronary heart disease","authors":"Lu Chen ,&nbsp;Xiang-Jun Zeng ,&nbsp;Xin-Ying Guo ,&nbsp;Jian Liu ,&nbsp;Feng-He Du ,&nbsp;Cai-Xia Guo","doi":"10.1016/j.rceng.2024.08.001","DOIUrl":"10.1016/j.rceng.2024.08.001","url":null,"abstract":"<div><h3>Aims</h3><div>Coronary heart disease (CHD) patients with changed serum soluble receptor for advanced glycation end products (sRAGE) will experience microalbuminuria and even kidney dysfunction. However, the role of sRAGE for microalbuminuria in CHD is still not established. This study aimed to evaluate the association between sRAGE and early kidney dysfunction in CHD patients.</div></div><div><h3>Materials and methods</h3><div>In this cross-sectional study, sRAGE and urinary albumin-to-creatinine ratio (uACR) were measured in hospitalized CHD patients who have undergone coronary arteriography to evaluate the distinction and correlation between sRAGE and uACR.</div></div><div><h3>Results</h3><div>There were 127 CHD patients (mean age: 63.06 ± 10.93 years, 93 males) in the study, whose sRAGE were 1.83 ± 0.64 μg/L. The sRAGE level was higher in kidney injury group (uACR ≥ 30 mg/g) compared with no kidney injury group (uACR &lt; 30 mg/g) [(2.08 ± 0.70 vs. 1.75 ± 0.61) μg/L, <em>P</em> &lt; 0.05]. Moreover, the positive correlation between serum sRAGE and uACR was significant in CHD patients (<em>r</em> = 0.196, <em>P</em> &lt; 0.05). Binary logistic regression suggests sRAGE as a predictor for microalbuminuria in CHD patients [Odd Ratio = 2.62 (1.12–6.15), <em>P</em> &lt; 0.05)]. The area under the receiver operating characteristic curve (AUC) of sRAGE is higher than that of the traditional indicators of renal function such as creatinine and estimated glomerular filtration rate, indicating sRAGE might have a good performance in evaluating early kidney injury in CHD patients [AUC is 0.660 (0.543–0.778), <em>P</em> &lt; 0.01)].</div></div><div><h3>Conclusions</h3><div>Serum sRAGE was positively correlated to uACR and might serve as a potential marker to predict early kidney injury in CHD patients.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 580-587"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915012","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}