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Análisis de las características clínicas y pronóstico de los pacientes con amiloidosis cardiaca ingresados en los hospitales españoles (2016-2021) 西班牙医院收治的心脏淀粉样变性患者的临床特征和预后分析(2016-2021 年)。
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-19 DOI: 10.1016/j.rce.2024.10.007
A. Esteban-Fernández , M. Anguita-Sánchez , N. Rosillo , J.L. Bonilla-Palomas , J.L. Bernal Sobrino , N. del Prado , C. Fernández Pérez , L. Rodríguez Padial , F.J. Elola Somoza

Introduction and objectives

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.

Methods

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.

Results

A total of 5,739 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.
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).

Conclusions

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.
{"title":"Análisis de las características clínicas y pronóstico de los pacientes con amiloidosis cardiaca ingresados en los hospitales españoles (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.rce.2024.10.007","DOIUrl":"10.1016/j.rce.2024.10.007","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 5,739 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":21223,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 131-139"},"PeriodicalIF":2.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hospitalizaciones por el síndrome de Takotsubo en España. Datos del CMBD por comunidades autónomas (años 2008-2021) 西班牙塔克氏综合征住院病例。按自治区分列的 CMBD 数据(2008-2021 年)
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-07 DOI: 10.1016/j.rce.2024.10.009
N. Rosillo , N. del Prado , P. Pérez , J.L. Bernal , I. Núñez-Gil , Á. Gamarra , L. Vilches , J. Salamanca , J. Elola , F. Alfonso

Background and objectives

Takotsubo syndrome (TTS) is an infrequent cause of acute coronary syndrome much better diagnosed in recent years. This study sought to assess the clinical profile of patients admitted with TTS in Spain and to elucidate potential regional differences in admissions and in-hospital mortality between the years 2008 and 2021.

Methods

Retrospective observational study of patients admitted to acute general hospitals of the Spanish National Health System with a main or secondary diagnosis of STT, using the minimum basic data set.

Results

A total of 12.952 hospitalization for TTS were identified. The number of hospital admissions increased exponentially from 210 in the year 2008 to 1,918 in 2021. Most patients (79.1%) were women and mean age was 72.0 ± 12,5 years (72.5 ± 12,2 in female; 69.9 ± 13,4 in men; P<.001). Associated comorbidities were frequent (44.9% arterial hypertension, 31.2% heart failure) and differed in men and women. Overall, crude in-hospital mortality was 7%. Notably, admission and in-hospital mortality rates, adjusted by age and gender, were different among the different autonomous communities.

Conclusions

TTS usually presents in elderly women with associated comorbidities and has a significant in-hospital mortality. Age and comorbidities differ between men and women. Relevant regional differences exist regarding admission and in-hospital mortality rates.
{"title":"Hospitalizaciones por el síndrome de Takotsubo en España. Datos del CMBD por comunidades autónomas (años 2008-2021)","authors":"N. Rosillo ,&nbsp;N. del Prado ,&nbsp;P. Pérez ,&nbsp;J.L. Bernal ,&nbsp;I. Núñez-Gil ,&nbsp;Á. Gamarra ,&nbsp;L. Vilches ,&nbsp;J. Salamanca ,&nbsp;J. Elola ,&nbsp;F. Alfonso","doi":"10.1016/j.rce.2024.10.009","DOIUrl":"10.1016/j.rce.2024.10.009","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Takotsubo syndrome (TTS) is an infrequent cause of acute coronary syndrome much better diagnosed in recent years. This study sought to assess the clinical profile of patients admitted with TTS in Spain and to elucidate potential regional differences in admissions and in-hospital mortality between the years 2008 and 2021.</div></div><div><h3>Methods</h3><div>Retrospective observational study of patients admitted to acute general hospitals of the Spanish National Health System with a main or secondary diagnosis of STT, using the minimum basic data set.</div></div><div><h3>Results</h3><div>A total of 12.952 hospitalization for TTS were identified. The number of hospital admissions increased exponentially from 210 in the year 2008 to 1,918 in 2021. Most patients (79.1%) were women and mean age was 72.0<!--> <!-->±<!--> <!-->12,5 years (72.5<!--> <!-->±<!--> <!-->12,2 in female; 69.9<!--> <!-->±<!--> <!-->13,4 in men; <em>P</em>&lt;.001). Associated comorbidities were frequent (44.9% arterial hypertension, 31.2% heart failure) and differed in men and women. Overall, crude in-hospital mortality was 7%. Notably, admission and in-hospital mortality rates, adjusted by age and gender, were different among the different autonomous communities.</div></div><div><h3>Conclusions</h3><div>TTS usually presents in elderly women with associated comorbidities and has a significant in-hospital mortality. Age and comorbidities differ between men and women. Relevant regional differences exist regarding admission and in-hospital mortality rates.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 140-147"},"PeriodicalIF":2.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Diagnóstico y tratamiento de la embolia pulmonar. Recomendaciones del Grupo de Enfermedad Tromboembólica de la Sociedad Española de Medicina Interna 2024 肺栓塞的诊断和治疗。西班牙内科医学会血栓栓塞性疾病小组的建议 2024
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-06 DOI: 10.1016/j.rce.2024.08.007
M.A. Fidalgo Fernández , O. Madridano Cobo , C. Sánchez del Hoyo , A. Rodríguez Iglesias , A.N. Muñoz-Rivas , M. Martín Asenjo
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.
肺栓塞(PE)是一种发病率不断上升的疾病。本文介绍了西班牙内科医学会(SEMI)血栓栓塞性疾病小组对肺栓塞诊断和治疗的建议。其主要目的是促进决策制定,以便根据已发表的证据改进诊断和治疗方法。该文件的最终目的是改善对 PE 患者的综合治疗。
{"title":"Diagnóstico y tratamiento de la embolia pulmonar. Recomendaciones del Grupo de Enfermedad Tromboembólica de la Sociedad Española de Medicina Interna 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.rce.2024.08.007","DOIUrl":"10.1016/j.rce.2024.08.007","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":21223,"journal":{"name":"Revista clinica espanola","volume":"225 3","pages":"Pages 168-175"},"PeriodicalIF":2.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fracaso en la consecución de los objetivos de c-LDL e infrautilización de tratamientos hipolipemiantes en pacientes con riesgo cardiovascular alto y muy alto: subpoblación española del estudio europeo SANTORINI
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.09.004
J.M. Mostaza , L. García-Ortiz , M.A. Suárez Tembra , P. Talavera Calle , J. Chimeno García , V. Escolar Pérez , J.L. Díaz-Díaz , L. Manzano-Espinosa , A.L. Catapano , K.K. Ray , G. Díaz Moya , J. Pedro-Botet Montoya , en representación del grupo de investigadores de SANTORINI España

Introduction

There are very few studies evaluating lipid-lowering treatments (LLTs) and low-density lipoprotein-cholesterol (LDL-C) goal attainment after the release of the 2019 guidelines of the European Societies of Cardiology (ESC) and Atherosclerosis (EAS). This manuscript shows baseline data of the Spanish subset from SANTORINI study (namely SANTORINI Spain) on LDL-C goal attainment and use of LLTs in patients at high and very high cardiovascular risk.

Methods

SANTORINI was a multinational, prospective, observational study involving patients at high and very high cardiovascular risk from 14 European countries in primary care and specialized healthcare settings. Sociodemographic data, blood lipid levels, and lipid treatments from the 1018 Spanish participants, were separately analyzed and were put into perspective with the European cohort without Spanish participants.

Results

According to physicians, 295 (29.0%) subjects were classified as high, and 723 (71.0%) as very high cardiovascular risk. Overall, 26.5% attained risk-based LDL-C targets recommended by 2019 European guidelines, with 23.1% of patients at high cardiovascular risk and 27.9% at very high cardiovascular risk. High-intensity statin therapy in monotherapy was used in 21.8%, LLT combination therapy in 41.2%, and 10.7% were not receiving any LLT.

Conclusions

Baseline data from SANTORINI Spain population show that only about one-fourth of patients attain LDL-C targets recommended by the 2019 ESC/EAS guidelines in patients at high and very high risk. Despite their cardiovascular risk, patients appear to be not adequately treated, and high-intensity and combination LLT seem to be underused for cardiovascular disease prevention in the real-world setting. ClinicalTrials.gov Identifier: NCT04271280.
{"title":"Fracaso en la consecución de los objetivos de c-LDL e infrautilización de tratamientos hipolipemiantes en pacientes con riesgo cardiovascular alto y muy alto: subpoblación española del estudio europeo SANTORINI","authors":"J.M. Mostaza ,&nbsp;L. García-Ortiz ,&nbsp;M.A. Suárez Tembra ,&nbsp;P. Talavera Calle ,&nbsp;J. Chimeno García ,&nbsp;V. Escolar Pérez ,&nbsp;J.L. Díaz-Díaz ,&nbsp;L. Manzano-Espinosa ,&nbsp;A.L. Catapano ,&nbsp;K.K. Ray ,&nbsp;G. Díaz Moya ,&nbsp;J. Pedro-Botet Montoya ,&nbsp;en representación del grupo de investigadores de SANTORINI España","doi":"10.1016/j.rce.2024.09.004","DOIUrl":"10.1016/j.rce.2024.09.004","url":null,"abstract":"<div><h3>Introduction</h3><div>There are very few studies evaluating lipid-lowering treatments (LLTs) and low-density lipoprotein-cholesterol (LDL-C) goal attainment after the release of the 2019 guidelines of the European Societies of Cardiology (ESC) and Atherosclerosis (EAS). This manuscript shows baseline data of the Spanish subset from SANTORINI study (namely SANTORINI Spain) on LDL-C goal attainment and use of LLTs in patients at high and very high cardiovascular risk.</div></div><div><h3>Methods</h3><div>SANTORINI was a multinational, prospective, observational study involving patients at high and very high cardiovascular risk from 14 European countries in primary care and specialized healthcare settings. Sociodemographic data, blood lipid levels, and lipid treatments from the 1018 Spanish participants, were separately analyzed and were put into perspective with the European cohort without Spanish participants.</div></div><div><h3>Results</h3><div>According to physicians, 295 (29.0%) subjects were classified as high, and 723 (71.0%) as very high cardiovascular risk. Overall, 26.5% attained risk-based LDL-C targets recommended by 2019 European guidelines, with 23.1% of patients at high cardiovascular risk and 27.9% at very high cardiovascular risk. High-intensity statin therapy in monotherapy was used in 21.8%, LLT combination therapy in 41.2%, and 10.7% were not receiving any LLT.</div></div><div><h3>Conclusions</h3><div>Baseline data from SANTORINI Spain population show that only about one-fourth of patients attain LDL-C targets recommended by the 2019 ESC/EAS guidelines in patients at high and very high risk. Despite their cardiovascular risk, patients appear to be not adequately treated, and high-intensity and combination LLT seem to be underused for cardiovascular disease prevention in the real-world setting. ClinicalTrials.gov Identifier: <span><span>NCT04271280</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 78-84"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Estudio ecológico para estimar la prevalencia de pacientes con déficit de esfingomielinasa ácida en España. Estudio PREVASMD
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.10.003
J. Villarrubia , M. Morales , L. Ceberio , I. Vitoria , M. Bellusci , I. Quiñones , L. Peña , M. Ruiz de Valbuena , M. O’Callaghan , en representación del grupo de estudio PREVASMD

Background and objective

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.

Material and methods

PREVASMD was a descriptive, multicenter, and ecological study involving 21 physicians from different specialties (mainly Internal Medicine, Pediatrics and Hematology), of different autonomous communities, with experience in ASMD management.

Results

Between March and April 2022, specialists were attending a total of 34 patients with ASMD diagnosis, 10 pediatric patients under 18 years of age (29.4%) and 24 adult patients (70.6%). The estimated prevalence of patients (pediatric 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 pediatric 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.

Conclusions

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 pediatric population and 0.6 per 1,000,000 inhabitants in the adult population.
{"title":"Estudio ecológico para estimar la prevalencia de pacientes con déficit de esfingomielinasa ácida en España. Estudio PREVASMD","authors":"J. Villarrubia ,&nbsp;M. Morales ,&nbsp;L. Ceberio ,&nbsp;I. Vitoria ,&nbsp;M. Bellusci ,&nbsp;I. Quiñones ,&nbsp;L. Peña ,&nbsp;M. Ruiz de Valbuena ,&nbsp;M. O’Callaghan ,&nbsp;en representación del grupo de estudio PREVASMD","doi":"10.1016/j.rce.2024.10.003","DOIUrl":"10.1016/j.rce.2024.10.003","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, Pediatrics 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 pediatric patients under 18 years of age (29.4%) and 24 adult patients (70.6%). The estimated prevalence of patients (pediatric 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 pediatric 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 pediatric population and 0.6 per 1,000,000 inhabitants in the adult population.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 70-77"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
La desnutrición en la insuficiencia cardíaca. La importancia de evaluar la congestión y la sarcopenia
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.09.005
J. Carretero Gómez , T.F. Galeano Fernández , A.S. Vidal Ríos , S. Tolosa Álvarez , M. Sánchez Herrera , C. García Carrasco , F.J. Monreal Periañez , P. González González , J.C. Arévalo Lorido

Objective

This work aims to describe nutrition and sarcopenia in inpatients with heart failure (HF). It also aims to assess factors associated with in-hospital and short-term prognosis related to nutrition and sarcopenia.

Methods

We collected data on consecutive HF patients admitted to a single center's internal medicine ward. Patients were recruited in May and October 2021. Malnutrition was determined by the Mini Nutritional Assessment-Short Form (MNA-SF) and sarcopenia by the screening test, SARC-F scale, and handgrip strength test.

Results

190 patients were analyzed, mean age 82.1 (± 8.2), 54.2% women, median follow up 106 days. Patients were classified into three groups based on MNA-SF score: group 1 (12-14 points, no risk) included 50 patients, group 2 (8-12 points, high risk of malnutrition) included 81 patients, group 3 (0-7 points, malnourished) included 59 patients. Group 3 had significantly more inflammation (lower albumin and higher C-reactive Protein (CRP)) and congestion (mea-sured by NT-ProBNP levels). In-hospital mortality was related to poor muscle function, CRP, andNT-ProBNP, but not to malnutrition. The poorest short-term outcomes were related to malnutrition and comorbidity. However, when the variable of muscle function was introduced, it could act as a poor prognostic factor related to CRP and NT-ProBNP, which were the main determinantsof survival.

Conclusion

In malnourished patients with HF, inflammation and congestion were related to in-hospital mortality. Malnutrition along with comorbidity may play a role in decreasing short-term survival. Early identification through proactive nutritional and functional screenings should be a key element of assessing HF patients.
{"title":"La desnutrición en la insuficiencia cardíaca. La importancia de evaluar la congestión y la sarcopenia","authors":"J. Carretero Gómez ,&nbsp;T.F. Galeano Fernández ,&nbsp;A.S. Vidal Ríos ,&nbsp;S. Tolosa Álvarez ,&nbsp;M. Sánchez Herrera ,&nbsp;C. García Carrasco ,&nbsp;F.J. Monreal Periañez ,&nbsp;P. González González ,&nbsp;J.C. Arévalo Lorido","doi":"10.1016/j.rce.2024.09.005","DOIUrl":"10.1016/j.rce.2024.09.005","url":null,"abstract":"<div><h3>Objective</h3><div>This work aims to describe nutrition and sarcopenia in inpatients with heart failure (HF). It also aims to assess factors associated with in-hospital and short-term prognosis related to nutrition and sarcopenia.</div></div><div><h3>Methods</h3><div>We collected data on consecutive HF patients admitted to a single center's internal medicine ward. Patients were recruited in May and October 2021. Malnutrition was determined by the Mini Nutritional Assessment-Short Form (MNA-SF) and sarcopenia by the screening test, SARC-F scale, and handgrip strength test.</div></div><div><h3>Results</h3><div>190 patients were analyzed, mean age 82.1 (±<!--> <!-->8.2), 54.2% women, median follow up 106 days. Patients were classified into three groups based on MNA-SF score: group 1 (12-14 points, no risk) included 50 patients, group 2 (8-12 points, high risk of malnutrition) included 81 patients, group 3 (0-7 points, malnourished) included 59 patients. Group 3 had significantly more inflammation (lower albumin and higher C-reactive Protein (CRP)) and congestion (mea-sured by NT-ProBNP levels). In-hospital mortality was related to poor muscle function, CRP, andNT-ProBNP, but not to malnutrition. The poorest short-term outcomes were related to malnutrition and comorbidity. However, when the variable of muscle function was introduced, it could act as a poor prognostic factor related to CRP and NT-ProBNP, which were the main determinantsof survival.</div></div><div><h3>Conclusion</h3><div>In malnourished patients with HF, inflammation and congestion were related to in-hospital mortality. Malnutrition along with comorbidity may play a role in decreasing short-term survival. Early identification through proactive nutritional and functional screenings should be a key element of assessing HF patients.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 92-100"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
¿Qué factor predice mejor el pronóstico en pacientes con COVID-19: los biomarcadores analíticos o la relación PaO2/FiO2?
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.10.002
M. Rubio-Rivas , J.M. Mora-Luján , A. Montero Sáez , M.D. Martín-Escalante , V. Giner Galvañ , G. Maestro de la Calle , M.L. Taboada Martínez , A. Muiño Míguez , C. Lumbreras-Bermejo , J.M. Antón-Santos , on behalf of the SEMI-COVID-19 Network

Background

The study aimed to describe patient characteristics and outcomes by PaO2/FiO2 (PAFI) and degree of inflammation.

Methods

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 (<100 vs. 100-200 vs. 200-300 vs. >300) who received corticosteroids (CS) for COVID-19 in the first 48 h of admission were included in the study. 5,314 patients met the inclusion criteria for the present study. The primary outcome was in-hospital mortality.

Results

Higher in-hospital mortality was found in the groups with PAFI< 100 (51.5% vs. 41.2% vs. 25.8% vs. 12.3%, P<.001). They also required more NIMV, IMV, and ICU admission, and had longer hospital stays. Those patients with PAFI>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.

Conclusions

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.
{"title":"¿Qué factor predice mejor el pronóstico en pacientes con COVID-19: los biomarcadores analíticos o la relación 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.rce.2024.10.002","DOIUrl":"10.1016/j.rce.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>The study aimed to describe patient characteristics and outcomes by PaO<sub>2</sub>/FiO<sub>2</sub> (PAFI) and degree of inflammation.</div></div><div><h3>Methods</h3><div>Retrospective cohort study with data on patients collected from March 1<sup>st</sup>, 2020 to March 1<sup>st</sup>,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. 5,314 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":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 57-69"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Insuficiencia suprarrenal secundaria debida al tratamiento con ipilimumab/nivolumab por cáncer renal metastásico
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.10.004
D. Rico-López , A. Ortiz-Parra , F. Vázquez-Alonso , R. Roa-Chamorro
{"title":"Insuficiencia suprarrenal secundaria debida al tratamiento con ipilimumab/nivolumab por cáncer renal metastásico","authors":"D. Rico-López ,&nbsp;A. Ortiz-Parra ,&nbsp;F. Vázquez-Alonso ,&nbsp;R. Roa-Chamorro","doi":"10.1016/j.rce.2024.10.004","DOIUrl":"10.1016/j.rce.2024.10.004","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 111-113"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
¿Cuál es la formación en bioética de los residentes de Medicina Interna en España?
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.10.005
P. Martínez de la Cruz , C. Font Puig , S. Ibáñez Barceló , A. Blanco Portillo
{"title":"¿Cuál es la formación en bioética de los residentes de Medicina Interna en España?","authors":"P. Martínez de la Cruz ,&nbsp;C. Font Puig ,&nbsp;S. Ibáñez Barceló ,&nbsp;A. Blanco Portillo","doi":"10.1016/j.rce.2024.10.005","DOIUrl":"10.1016/j.rce.2024.10.005","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 114-116"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Papel de la ecografía pulmonar en el seguimiento ambulatorio de pacientes tras COVID-19. Revisión sistemática de la literatura
IF 2.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.10.006
F. Navarro Romero , J. Olalla Sierra , M.D. Martín Escalante

Introduction and aim

Currently, the usefulness of lung ultrasound in the follow-up of patients after hospital discharge for SARS-CoV-2 pneumonia is not well known. The main objective of this systematic review is to investigate the persistence of alterations in lung ultrasound of patients who have had COVID-19 pneumonia.

Methods

A systematic review has been carried out following the PRISMA regulations in the PubMed, EMBASE, Web of Science and Google Scholar database from January 2020 to May 2023 using the combination of MeSH terms: «lung ultrasound», «ultrasonography», «lung alterations», «persistence», «follow-up», «consequences», «hospital discharge», «COVID», «COVID-19», «SARS-CoV-2». Studies were selected that described alterations in the lung ultrasound of patients after having suffered from COVID-19 pneumonia. The JBI Critical Appraisal Tools were used to assess the risk of bias of the studies. No meta-analysis techniques were performed, the results being compared narratively.

Results

From two to six months after COVID-19 pneumonia, pulmonary ultrasound abnormalities appear frequently and are proportional to the intensity of the initial episode. The most frequent anomalies are irregularities in the pleural line, the presence of B lines and/or subpleural consolidations, predominantly in the basal regions of the thorax. These findings seem to correlate with those of the chest CT.

Conclusions

Lung ultrasound offers technical and economic advantages that should be considered for the study of patients after hospital discharge for COVID-19.
{"title":"Papel de la ecografía pulmonar en el seguimiento ambulatorio de pacientes tras COVID-19. Revisión sistemática de la literatura","authors":"F. Navarro Romero ,&nbsp;J. Olalla Sierra ,&nbsp;M.D. Martín Escalante","doi":"10.1016/j.rce.2024.10.006","DOIUrl":"10.1016/j.rce.2024.10.006","url":null,"abstract":"<div><h3>Introduction and aim</h3><div>Currently, the usefulness of lung ultrasound in the follow-up of patients after hospital discharge for SARS-CoV-2 pneumonia is not well known. The main objective of this systematic review is to investigate the persistence of alterations in lung ultrasound of patients who have had COVID-19 pneumonia.</div></div><div><h3>Methods</h3><div>A systematic review has been carried out following the PRISMA regulations in the PubMed, EMBASE, Web of Science and Google Scholar database from January 2020 to May 2023 using the combination of MeSH terms: «lung ultrasound», «ultrasonography», «lung alterations», «persistence», «follow-up», «consequences», «hospital discharge», «COVID», «COVID-19», «SARS-CoV-2». Studies were selected that described alterations in the lung ultrasound of patients after having suffered from COVID-19 pneumonia. The JBI Critical Appraisal Tools were used to assess the risk of bias of the studies. No meta-analysis techniques were performed, the results being compared narratively.</div></div><div><h3>Results</h3><div>From two to six months after COVID-19 pneumonia, pulmonary ultrasound abnormalities appear frequently and are proportional to the intensity of the initial episode. The most frequent anomalies are irregularities in the pleural line, the presence of B lines and/or subpleural consolidations, predominantly in the basal regions of the thorax. These findings seem to correlate with those of the chest CT.</div></div><div><h3>Conclusions</h3><div>Lung ultrasound offers technical and economic advantages that should be considered for the study of patients after hospital discharge for COVID-19.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 2","pages":"Pages 101-110"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Revista clinica espanola
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