Pub Date : 2025-12-01DOI: 10.1016/j.rce.2025.502392
J.A. Peregrina Rivas , I.F. Aomar Millán , L.M. Beltrán Romero , L. Castilla Guerra
Obesity is a complex and heterogeneus disease, with metabolic risk that is not solely determined by body mass index. The distribution and functionality of adipose tissue-particularly that of white adipocytes- play a critical role in the development of insulin resistance, chronic inflammation and ectopic lipid deposition. Clinical ultrasound enables direct and reproducible characterization of the major fat compartments (epicardial, hepatic, perirenal, subcutaneous and intramuscular), of preperitoneal fat as an indirect marker of visceral adiposity and muscle mass, thereby overcoming the limitations of traditional anthropometric markers. These measurements have been associated with cardiovascular risk, renal dysfunction, hepatic steatosis, frailty and hospital-related complications, even among individuals with normal weight. Furthermore, ultrasound can be employed to monitor changes in these compartments following therapeutic interventions. Given its accessibility, low cost, and prognostic value, this technique serves as a valuable tool in the comprehensive evaluation of patients with obesity in Internal Medicine settings, contributing to a more precise, individualized and efficient approach to care.
{"title":"Ecografía clínica para la caracterización de la obesidad: más allá del índice de masa corporal","authors":"J.A. Peregrina Rivas , I.F. Aomar Millán , L.M. Beltrán Romero , L. Castilla Guerra","doi":"10.1016/j.rce.2025.502392","DOIUrl":"10.1016/j.rce.2025.502392","url":null,"abstract":"<div><div>Obesity is a complex and heterogeneus disease, with metabolic risk that is not solely determined by body mass index. The distribution and functionality of adipose tissue-particularly that of white adipocytes- play a critical role in the development of insulin resistance, chronic inflammation and ectopic lipid deposition. Clinical ultrasound enables direct and reproducible characterization of the major fat compartments (epicardial, hepatic, perirenal, subcutaneous and intramuscular), of preperitoneal fat as an indirect marker of visceral adiposity and muscle mass, thereby overcoming the limitations of traditional anthropometric markers. These measurements have been associated with cardiovascular risk, renal dysfunction, hepatic steatosis, frailty and hospital-related complications, even among individuals with normal weight. Furthermore, ultrasound can be employed to monitor changes in these compartments following therapeutic interventions. Given its accessibility, low cost, and prognostic value, this technique serves as a valuable tool in the comprehensive evaluation of patients with obesity in Internal Medicine settings, contributing to a more precise, individualized and efficient approach to care.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502392"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693268","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}
Pub Date : 2025-12-01DOI: 10.1016/j.rce.2025.502390
C. de la Pinta Alonso , A. Domínguez , V.M. Gallego Gasqué , M.E. Castillo , P. Fernández Martín , A. Helguera , P. Gómez Blasco , G. de los Santos
Introduction
The Ethics committee (EC) are an essential part of the health institutions, however, in many occasions their response capacity is slow, being organs perceived as distant from the clinical practice. This means that they receive limited consultations, leaving many decisions to the sole discretion of the physician in charge.
Material and methods
A prospective study was designed based on anonymous surveys for professionals, family members and patients attended at the Hospital Ramón y Cajal. The analysis included a description of demographic variables, information on knowledge of the EC and on ethical-health care conflicts.
Results
Between December 2023 and March 2024, 394 responses were received. A total of 108 patients and family members (52% patients, 48% family members) were included, of whom 46 were men and 62 were women with a median age of 64 (range 20-90). 84% considered the decision support provided by a CEAS team to be useful. 85% believed that this would improve the quality of their care. The professionals included 83 men, 202 women and 1 other (aged 23-54). The most represented groups were doctors (55%). 53% were not familiar with the CEAS. 9% had requested help from the CEAS and 19% had attended training. 48% were aware of clinical ethics consulting. 37% acknowledged facing ethical problems, resolving them by consulting a colleague (68%). 84% saw the usefulness of consulting with other professionals.
Conclusions
This work reflects knowledge about CEAS, the needs of patients, family members and professionals, and the most common ethical conflicts in our environment.
伦理委员会（EC）是卫生机构的重要组成部分，然而，在许多情况下，他们的反应能力很慢，被认为是远离临床实践的器官。这意味着他们接受的咨询有限，许多决定都由负责的医生自行决定。材料和方法一项前瞻性研究是在匿名调查的基础上设计的，对象是在Ramón y Cajal医院就诊的专业人员、家庭成员和患者。分析包括对人口变量的描述、关于欧共体知识的信息以及关于伦理-保健冲突的信息。结果在2023年12月至2024年3月期间，共收到394份回复。共纳入108例患者及家属（52%患者，48%家属），其中男性46例，女性62例，中位年龄64岁（范围20-90岁）。84%的人认为CEAS团队提供的决策支持是有用的。85%的人认为这将提高他们的护理质量。专业人员包括83名男性，202名女性和1名其他（23-54岁）。最具代表性的群体是医生（55%）。53%不熟悉CEAS。9%的人曾向行政咨询中心寻求帮助，19%的人曾参加培训。48%的受访者了解临床伦理咨询。37%的人承认面临道德问题，并通过咨询同事来解决问题（68%）。84%的人认为与其他专业人士进行咨询很有用。这项工作反映了对CEAS的了解，患者、家庭成员和专业人员的需求，以及我们环境中最常见的伦理冲突。
{"title":"Encuesta para la evaluación de la utilidad del CEAS y análisis de los conflictos éticos más frecuentes en el Hospital Universitario Ramón y Cajal","authors":"C. de la Pinta Alonso , A. Domínguez , V.M. Gallego Gasqué , M.E. Castillo , P. Fernández Martín , A. Helguera , P. Gómez Blasco , G. de los Santos","doi":"10.1016/j.rce.2025.502390","DOIUrl":"10.1016/j.rce.2025.502390","url":null,"abstract":"<div><h3>Introduction</h3><div>The Ethics committee (EC) are an essential part of the health institutions, however, in many occasions their response capacity is slow, being organs perceived as distant from the clinical practice. This means that they receive limited consultations, leaving many decisions to the sole discretion of the physician in charge.</div></div><div><h3>Material and methods</h3><div>A prospective study was designed based on anonymous surveys for professionals, family members and patients attended at the Hospital Ramón y Cajal. The analysis included a description of demographic variables, information on knowledge of the EC and on ethical-health care conflicts.</div></div><div><h3>Results</h3><div>Between December 2023 and March 2024, 394 responses were received. A total of 108 patients and family members (52% patients, 48% family members) were included, of whom 46 were men and 62 were women with a median age of 64 (range 20-90). 84% considered the decision support provided by a CEAS team to be useful. 85% believed that this would improve the quality of their care. The professionals included 83 men, 202 women and 1 other (aged 23-54). The most represented groups were doctors (55%). 53% were not familiar with the CEAS. 9% had requested help from the CEAS and 19% had attended training. 48% were aware of clinical ethics consulting. 37% acknowledged facing ethical problems, resolving them by consulting a colleague (68%). 84% saw the usefulness of consulting with other professionals.</div></div><div><h3>Conclusions</h3><div>This work reflects knowledge about CEAS, the needs of patients, family members and professionals, and the most common ethical conflicts in our environment.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502390"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693251","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}
Pub Date : 2025-12-01DOI: 10.1016/j.rce.2025.502391
B. Lopez-Villalba , L. Tejedor-Cantero , M. Toquero-Asensio , V. Fernández-Espinilla , C. Hernán-García , S. Rojo-Rello , C. Prada-García , J.M. Eiros-Bouza , J. Castrodeza-Sanz
Background and objective
Rhinovirus/enterovirus (RV/EV), commonly known for causing mild colds, has emerged as a significant cause of hospitalization. The objective of the study is to analyze the characteristics of patients hospitalized for viral respiratory infections, with an emphasis on RV/EV.
Methodology
This retrospective study was conducted between 2019 and 2022 at the University Clinical Hospital of Valladolid. Data from 1,528 cases were analyzed, sourced from medical records and microbiological tests (Biofire Respiratory y NxTAG respiratory panel).
Results
RV/EV was the most common respiratory virus (42.6%). There was a slight predominance of cases in males. 44.6% had a hospital stay of 2 to 7 days. The average hospitalization incidence was 3 per 1,000 adults per year. Children aged 0 to 15 years are at higher risk of RV/EV infection, with a 1.5 times higher probability in single infections (OR 1.496; 95% CI 1.147-1.952; p = 0.003), 7 times in coinfections with other respiratory viruses (OR 6.887; 95% CI 3.928-12.045; p< 0.01), and 8 times in coinfections with RSV (OR 8.580; 95% CI 3.866-19.041; p< 0.01). RV/EV is associated with a higher risk of asthma exacerbation (OR 2.545; 95% CI 1.336-4.851; p = 0.005) and COPD exacerbation (OR 1.781; 95% CI 1.022-3.103; p = 0.042), but a lower probability of bronchiolitis (OR 0.236; 95% CI 0.117-0.474; p< 0.01).
Conclusion
This study identifies RV/EV as the main respiratory virus in hospitalized patients, with a greater impact on those under 15 years and over 60 years. Seasonality and the coexistence of multiple viruses complicate its behaviour. These findings underscore the importance of preventive strategies and the need for continued research on its health impact.
背景和目的通常以引起轻度感冒而闻名的疱疹病毒/肠道病毒（RV/EV）已成为住院治疗的重要原因。本研究的目的是分析病毒性呼吸道感染住院患者的特征，重点是RV/EV。该回顾性研究于2019年至2022年在巴利亚多利德大学临床医院进行。分析了1,528例病例的数据，这些数据来自医疗记录和微生物测试（Biofire Respiratory y NxTAG呼吸面板）。结果rv /EV是最常见的呼吸道病毒（42.6%）。病例中男性略占优势。44.6%住院时间为2 ~ 7天。每年平均住院率为千分之三。0 ~ 15岁儿童感染RV/EV的风险较高，单次感染的概率为1.5倍（OR 1.496; 95% CI 1.147 ~ 1.952; p = 0.003），与其他呼吸道病毒共感染的概率为7倍（OR 6.887; 95% CI 3.928 ~ 12.045; p< 0.01），与RSV共感染的概率为8倍（OR 8.580; 95% CI 3.866 ~ 19.041; p< 0.01）。RV/EV与较高的哮喘加重风险（OR 2.545; 95% CI 1.336-4.851; p = 0.005）和COPD加重风险（OR 1.781; 95% CI 1.022-3.103; p = 0.042）相关，但与较低的毛细支气管炎风险相关（OR 0.236; 95% CI 0.117-0.474; p< 0.01）。结论本研究确定RV/EV是住院患者中主要的呼吸道病毒，在15岁以下和60岁以上患者中影响较大。季节性和多种病毒的共存使其行为复杂化。这些发现强调了预防战略的重要性以及继续研究其对健康影响的必要性。
{"title":"Epidemiología de la infección por rinovirus/enterovirus en pacientes hospitalizados","authors":"B. Lopez-Villalba , L. Tejedor-Cantero , M. Toquero-Asensio , V. Fernández-Espinilla , C. Hernán-García , S. Rojo-Rello , C. Prada-García , J.M. Eiros-Bouza , J. Castrodeza-Sanz","doi":"10.1016/j.rce.2025.502391","DOIUrl":"10.1016/j.rce.2025.502391","url":null,"abstract":"<div><h3>Background and objective</h3><div>Rhinovirus/enterovirus (RV/EV), commonly known for causing mild colds, has emerged as a significant cause of hospitalization. The objective of the study is to analyze the characteristics of patients hospitalized for viral respiratory infections, with an emphasis on RV/EV.</div></div><div><h3>Methodology</h3><div>This retrospective study was conducted between 2019 and 2022 at the University Clinical Hospital of Valladolid. Data from 1,528 cases were analyzed, sourced from medical records and microbiological tests (Biofire Respiratory y NxTAG respiratory panel).</div></div><div><h3>Results</h3><div>RV/EV was the most common respiratory virus (42.6%). There was a slight predominance of cases in males. 44.6% had a hospital stay of 2 to 7 days. The average hospitalization incidence was 3 per 1,000 adults per year. Children aged 0 to 15 years are at higher risk of RV/EV infection, with a 1.5 times higher probability in single infections (OR 1.496; 95% <span>C</span>I 1.147-1.952; p<!--> <!-->=<!--> <!-->0.003), 7 times in coinfections with other respiratory viruses (OR 6.887; 95% CI 3.928-12.045; p<<!--> <!-->0.01), and 8 times in coinfections with RSV (OR 8.580; 95% CI 3.866-19.041; p<<!--> <!-->0.01). RV/EV is associated with a higher risk of asthma exacerbation (OR 2.545; 95% CI 1.336-4.851; p<!--> <!-->=<!--> <!-->0.005) and COPD exacerbation (OR 1.781; 95% CI 1.022-3.103; p<!--> <!-->=<!--> <!-->0.042), but a lower probability of bronchiolitis (OR 0.236; 95% CI 0.117-0.474; p<<!--> <!-->0.01).</div></div><div><h3>Conclusion</h3><div>This study identifies RV/EV as the main respiratory virus in hospitalized patients, with a greater impact on those under 15 years and over 60 years. Seasonality and the coexistence of multiple viruses complicate its behaviour. These findings underscore the importance of preventive strategies and the need for continued research on its health impact.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502391"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693264","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}
Pub Date : 2025-12-01DOI: 10.1016/j.rce.2025.502386
M.V. Vieira Neves Soares, P. de Oliveira Vasconcelos Filho, E. Gomes da Silva, L. Cândido de Souza, T. Mazzu do Nascimento, D. Nogueira Evangelista, G. Zani
Objective
To estimate the prevalence of adult and elderly patients at risk of or diagnosed with refeeding syndrome (RS), as well as to explore potential associations with age, comorbidities, antibiotic use, and clinical outcomes during hospitalization.
Method
This is a retrospective, cross-sectional study conducted through the analysis of electronic medical records of hospitalized adult and elderly patients. Three groups were analyzed: moderate risk for RS (food intake less than 50% and not reaching nutritional goals and/or body mass index between 16 and 18.5 kg/m2); severe risk (food intake less than 50% and/or body mass index < 16 kg/m2); and RS (presence of hypophosphatemia, hypomagnesemia, and/or hypokalemia).
Results
A total of 121 patients were evaluated, of whom 38.8% presented with RS, 49.6% belonged to the moderate-risk group and 11.6% to the severe-risk group. Regarding age, 62% were elderly and 38% were adults.
Conclusion
Significant differences were observed in the prevalence of RS risk between adults and elderly individuals (χ2(1) = 7, p < 0.05), with a higher prevalence among the elderly. The prevalence of RS was higher in elderly individuals aged 60 to 74 years compared to those over 74 years, and this difference was statistically significant. Antibiotic changes during hospitalization were more prevalent in the moderate-risk group for RS. No significant association was found between RS risk and mortality.
{"title":"Síndrome de realimentación en pacientes adultos y personas mayores: estudio retrospectivo en un hospital universitario","authors":"M.V. Vieira Neves Soares, P. de Oliveira Vasconcelos Filho, E. Gomes da Silva, L. Cândido de Souza, T. Mazzu do Nascimento, D. Nogueira Evangelista, G. Zani","doi":"10.1016/j.rce.2025.502386","DOIUrl":"10.1016/j.rce.2025.502386","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate the prevalence of adult and elderly patients at risk of or diagnosed with refeeding syndrome (RS), as well as to explore potential associations with age, comorbidities, antibiotic use, and clinical outcomes during hospitalization.</div></div><div><h3>Method</h3><div>This is a retrospective, cross-sectional study conducted through the analysis of electronic medical records of hospitalized adult and elderly patients. Three groups were analyzed: moderate risk for RS (food intake less than 50% and not reaching nutritional goals and/or body mass index between 16 and 18.5<!--> <!-->kg/m<sup>2</sup>); severe risk (food intake less than 50% and/or body mass index <<!--> <!-->16<!--> <!-->kg/m<sup>2</sup>); and RS (presence of hypophosphatemia, hypomagnesemia, and/or hypokalemia).</div></div><div><h3>Results</h3><div>A total of 121 patients were evaluated, of whom 38.8% presented with RS, 49.6% belonged to the moderate-risk group and 11.6% to the severe-risk group. Regarding age, 62% were elderly and 38% were adults.</div></div><div><h3>Conclusion</h3><div>Significant differences were observed in the prevalence of RS risk between adults and elderly individuals (χ<sup>2</sup>(1)<!--> <!-->=<!--> <!-->7, p <<!--> <!-->0.05), with a higher prevalence among the elderly. The prevalence of RS was higher in elderly individuals aged 60 to 74 years compared to those over 74 years, and this difference was statistically significant. Antibiotic changes during hospitalization were more prevalent in the moderate-risk group for RS. No significant association was found between RS risk and mortality.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502386"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693250","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}
Pub Date : 2025-12-01DOI: 10.1016/j.rce.2025.502394
B. Remezal Serrano, J.M. Navarro Rodríguez, J. Perez Legaz
{"title":"Carcinoma de paratiroides: crisis paratirotóxica como forma de presentación de una neoplasia poco frecuente","authors":"B. Remezal Serrano, J.M. Navarro Rodríguez, J. Perez Legaz","doi":"10.1016/j.rce.2025.502394","DOIUrl":"10.1016/j.rce.2025.502394","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502394"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693373","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}
Pub Date : 2025-12-01DOI: 10.1016/j.rce.2025.502387
J.M. García Vallejo , C. Martel Vera , S. González Sosa , A. Santana García , S. Blanco Tajes , M.N. Sánchez Vadillo , A. Conde Martel
Background and objective
Acute heart failure (AHF) is a frequent cause of hospitalization and has been extensively studied. However, its characteristics when it appears secondarily during admission for other pathologies are less well defined. The aim of this study was to analyze the clinical characteristics, prognostic factors and evolution of AHF in patients hospitalized for other causes, diagnosed by interconsultation to Internal Medicine (IM).
Materials and methods
Observational study that included patients diagnosed with AHF after consultation with IM (2020-2022). Demographic and clinical characteristics, admission reasons, type of heart disease, triggering factors, in-hospital mortality and associated factors were collected.
Results
Of 1583 consultations, 347 patients (21.9%) were diagnosed with AHF. The mean age was 79.9 (±10.3 years) and 184 (53%) were female. 76% came from surgical services. The most frequent comorbidities were hypertension, dyslipidemia and atrial fibrillation. Most patients had hypertensive etiology and preserved ejection fraction (68.6%). The main triggers were infections, anemia and fluid overload. In 50% of the cases, AHF was the debut of HF. In-hospital mortality was 20.5%, 26.4% at one-year follow up, and 39.7% were readmitted. In-hospital mortality was associated with older age (p = 0.031), elevated NT-proBNP (p = 0.048) and lower hemoglobin (p = 0.004) and albumin (p = 0.006) levels.
Conclusions
Patients who develop AHF during admission for other pathologies present advanced age, multiple comorbidities and high mortality. Early detection of triggering factors and identification of prognostic factors could help to optimize their management and improve their outcome.
{"title":"Impacto de la insuficiencia cardiaca en la mortalidad intrahospitalaria durante el ingreso por otras patologías","authors":"J.M. García Vallejo , C. Martel Vera , S. González Sosa , A. Santana García , S. Blanco Tajes , M.N. Sánchez Vadillo , A. Conde Martel","doi":"10.1016/j.rce.2025.502387","DOIUrl":"10.1016/j.rce.2025.502387","url":null,"abstract":"<div><h3>Background and objective</h3><div>Acute heart failure (AHF) is a frequent cause of hospitalization and has been extensively studied. However, its characteristics when it appears secondarily during admission for other pathologies are less well defined. The aim of this study was to analyze the clinical characteristics, prognostic factors and evolution of AHF in patients hospitalized for other causes, diagnosed by interconsultation to Internal Medicine (IM).</div></div><div><h3>Materials and methods</h3><div>Observational study that included patients diagnosed with AHF after consultation with IM (2020-2022). Demographic and clinical characteristics, admission reasons, type of heart disease, triggering factors, in-hospital mortality and associated factors were collected.</div></div><div><h3>Results</h3><div>Of 1583 consultations, 347 patients (21.9%) were diagnosed with AHF. The mean age was 79.9 (±10.3 years) and 184 (53%) were female. 76% came from surgical services. The most frequent comorbidities were hypertension, dyslipidemia and atrial fibrillation. Most patients had hypertensive etiology and preserved ejection fraction (68.6%). The main triggers were infections, anemia and fluid overload. In 50% of the cases, AHF was the debut of HF. In-hospital mortality was 20.5%, 26.4% at one-year follow up, and 39.7% were readmitted. In-hospital mortality was associated with older age (p<!--> <!-->=<!--> <!-->0.031), elevated NT-proBNP (p<!--> <!-->=<!--> <!-->0.048) and lower hemoglobin (p<!--> <!-->=<!--> <!-->0.004) and albumin (p<!--> <!-->=<!--> <!-->0.006) levels.</div></div><div><h3>Conclusions</h3><div>Patients who develop AHF during admission for other pathologies present advanced age, multiple comorbidities and high mortality. Early detection of triggering factors and identification of prognostic factors could help to optimize their management and improve their outcome.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502387"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693265","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}
Pub Date : 2025-12-01DOI: 10.1016/j.rce.2025.502388
A. Castellano Candalija , L. Díez Porres , H. Notario Leo , A. Roca Martiartu , N. Mayoral Canalejas , A. Alonso Babarro
Introduction
Dementia is a chronic neurodegenerative disease with a high prevalence and economic cost. Our objective was to evaluate the prevalence of advanced dementia (AD) in patients hospitalized in the Internal Medicine service; to analyze the therapeutic and diagnostic measures implemented, the degree of adequacy of the therapeutic effort and the information of the family.
Methodology
Descriptive study that included a retrospective analysis of medical records and a telephone interview with family. Patients with GDS 6-7 dementia admitted to Internal Medicine were included, for 3 weeks in 3 different months.
Results
194 (22%) patients with dementia were included. The prevalence of admissions with AD was 11%. The median age was 87.5 years (QR 81.75-93), 65% women. 45% came from residence for the elderly. The most frequent etiology was Alzheimer's (48%). The most frequent cause of admission was infection (72%). 37% died. Regarding the measures implemented: 100% were treatment intravenous; 89% received anticoagulation; 26% received artificial nutrition; 81% received pharmacological restraint and 63% physical restraint; and 48% underwent invasive diagnostic tests. Regarding adequacy: lipid-lowering treatment was withdrawn in 19%, antidementia drugs in 23%, anticoagulation in 21%; cardiopulmonary resuscitation was not performed in 30%, adequacy of care in 34%, and 13% were assessed by Palliative Care. A telephone interview was conducted with 55 patients. 42% were not aware of any complications. Care planning was carried out in 2 patients.
Conclusions
The prevalence of admission to AD is high, and almost half of the patients come from residence for the elderly. Associated mortality is high and therapeutic adequacy and planning are very scarce.
{"title":"Prevalencia y toma de decisiones en demencia avanzada","authors":"A. Castellano Candalija , L. Díez Porres , H. Notario Leo , A. Roca Martiartu , N. Mayoral Canalejas , A. Alonso Babarro","doi":"10.1016/j.rce.2025.502388","DOIUrl":"10.1016/j.rce.2025.502388","url":null,"abstract":"<div><h3>Introduction</h3><div>Dementia is a chronic neurodegenerative disease with a high prevalence and economic cost. Our objective was to evaluate the prevalence of advanced dementia (AD) in patients hospitalized in the Internal Medicine service; to analyze the therapeutic and diagnostic measures implemented, the degree of adequacy of the therapeutic effort and the information of the family.</div></div><div><h3>Methodology</h3><div>Descriptive study that included a retrospective analysis of medical records and a telephone interview with family. Patients with GDS 6-7 dementia admitted to Internal Medicine were included, for 3 weeks in 3 different months.</div></div><div><h3>Results</h3><div>194 (22%) patients with dementia were included. The prevalence of admissions with AD was 11%. The median age was 87.5 years (QR 81.75-93), 65% women. 45% came from residence for the elderly. The most frequent etiology was Alzheimer's (48%). The most frequent cause of admission was infection (72%). 37% died. Regarding the measures implemented: 100% were treatment intravenous; 89% received anticoagulation; 26% received artificial nutrition; 81% received pharmacological restraint and 63% physical restraint; and 48% underwent invasive diagnostic tests. Regarding adequacy: lipid-lowering treatment was withdrawn in 19%, antidementia drugs in 23%, anticoagulation in 21%; cardiopulmonary resuscitation was not performed in 30%, adequacy of care in 34%, and 13% were assessed by Palliative Care. A telephone interview was conducted with 55 patients. 42% were not aware of any complications. Care planning was carried out in 2 patients.</div></div><div><h3>Conclusions</h3><div>The prevalence of admission to AD is high, and almost half of the patients come from residence for the elderly. Associated mortality is high and therapeutic adequacy and planning are very scarce.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502388"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693266","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}
Pub Date : 2025-12-01DOI: 10.1016/j.rce.2025.502389
L. Castilla-Guerra , A.J. Gómez-Escobar , E. Gutiérrez-Sánchez , P. Luque-Linero , R. Dominguez Álvarez , M. Gandullo Moro , M.Á. Rico-Corral
Introduction
At the ocular level, hypertension causes retinal, choroidal and optic nerve lesions, and can be complicated by obstructive and ischaemic phenomena. We set out to assess the impact of hypertension on the different types of ocular vascular ischemia.
Patients and methods
Retrospective case-control study of patients seen in a vascular risk consultation. All patients underwent pulse wave velocity (PWV), ABI and carotid Doppler ultrasound.
Results
One hundred eighty-seven patients were included, 76 retinal venous occlusions (RVO), 21 retinal arterial occlusions (RAO), 28 non-arteritic ischaemic neuropathies (NAION) and 62 hypertensive controls without ocular ischaemia (CP). Mean age was 64 (±11), 68 (±10), 61 (±10) and 56 (±11) years in RVO, RAO, NAION, and PC respectively (P=.92). RVOs had a higher frequency of hypertension (71.4%), dyslipidaemia (55%) and diabetes (47.6%) (P=.001, P=.001 and P=.028 respectively) compared to the other groups. In relation to subclinical organ damage, patients with RVO had higher PWV 10.7 m/s (P=.004), pulse pressure 66 mmHg (P=.009), and vascular age 66.4 years (P=.005), with no differences in IMT, presence of carotid plaques or ITB. The occurrence of ocular ischaemia correlated with age (P=.009), DM2 (P=.027), dyslipidaemia (P=.047) and presence of plaques (P=.019).
Conclusions
Hypertension is a constant in vascular ocular ischaemic pathology, having a greater impact due to arterial stiffness in RVO. Age, diabetes, dyslipidaemia and the presence of plaques will increase the appearance of ocular ischemia.
{"title":"Impacto de la hipertensión arterial en la isquemia vascular ocular","authors":"L. Castilla-Guerra , A.J. Gómez-Escobar , E. Gutiérrez-Sánchez , P. Luque-Linero , R. Dominguez Álvarez , M. Gandullo Moro , M.Á. Rico-Corral","doi":"10.1016/j.rce.2025.502389","DOIUrl":"10.1016/j.rce.2025.502389","url":null,"abstract":"<div><h3>Introduction</h3><div>At the ocular level, hypertension causes retinal, choroidal and optic nerve lesions, and can be complicated by obstructive and ischaemic phenomena. We set out to assess the impact of hypertension on the different types of ocular vascular ischemia.</div></div><div><h3>Patients and methods</h3><div>Retrospective case-control study of patients seen in a vascular risk consultation. All patients underwent pulse wave velocity (PWV), ABI and carotid Doppler ultrasound.</div></div><div><h3>Results</h3><div>One hundred eighty-seven patients were included, 76 retinal venous occlusions (RVO), 21 retinal arterial occlusions (RAO), 28 non-arteritic ischaemic neuropathies (NAION) and 62 hypertensive controls without ocular ischaemia (CP). Mean age was 64 (±11), 68 (±10), 61 (±10) and 56 (±11) years in RVO, RAO, NAION, and PC respectively (<em>P</em>=.92). RVOs had a higher frequency of hypertension (71.4%), dyslipidaemia (55%) and diabetes (47.6%) (<em>P</em>=.001, <em>P</em>=.001 and <em>P</em>=.028 respectively) compared to the other groups. In relation to subclinical organ damage, patients with RVO had higher PWV 10.7 m/s (<em>P</em>=.004), pulse pressure 66<!--> <!-->mmHg (<em>P</em>=.009), and vascular age 66.4 years (<em>P</em>=.005), with no differences in IMT, presence of carotid plaques or ITB. The occurrence of ocular ischaemia correlated with age (<em>P</em>=.009), DM2 (<em>P</em>=.027), dyslipidaemia (<em>P</em>=.047) and presence of plaques (<em>P</em>=.019).</div></div><div><h3>Conclusions</h3><div>Hypertension is a constant in vascular ocular ischaemic pathology, having a greater impact due to arterial stiffness in RVO. Age, diabetes, dyslipidaemia and the presence of plaques will increase the appearance of ocular ischemia.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502389"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693267","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}
Pub Date : 2025-12-01DOI: 10.1016/j.rce.2025.502399
M. Ruiz Castellano , D. Aguiar Cano , F. Aguilar Rodríguez , P. Cubo Romano , G. Flox Benitez , J.M. Murcia Zaragoza , E. Coloma Bazán , V.M. Gracia Lorenzo , C. Vicente Martin , P. Salamanca Bautista
Heart failure (HF) is a major cause of morbidity, mortality, and hospital admissions worldwide. Home hospitalization (HaH) has emerged as an effective alternative, enhancing patient care and optimizing healthcare resources. This expert consensus document, endorsed by the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Home Hospitalization (SEHAD), provides practical recommendations for the management of HF in HaH settings. It outlines patient selection criteria, parameters for assessing congestion, and treatment protocols. The document emphasizes the use of telemonitoring and point-of-care ultrasound (POCUS). Therapeutic optimization, clinical follow-up, and patient education are fundamental. It also addresses comorbidity management and the integration of palliative care. Certification of HF care units and the strengthening of interdisciplinary collaboration are key to improving healthcare quality. HaH presents itself as an effective strategy for the comprehensive management of HF, reducing hospital-related complications and promoting patient-centered care.
{"title":"Manejo práctico de la insuficiencia cardiaca en hospitalización a domicilio: recomendaciones de la Sociedad Española de Medicina Interna y la Sociedad Española de Hospitalización a Domicilio","authors":"M. Ruiz Castellano , D. Aguiar Cano , F. Aguilar Rodríguez , P. Cubo Romano , G. Flox Benitez , J.M. Murcia Zaragoza , E. Coloma Bazán , V.M. Gracia Lorenzo , C. Vicente Martin , P. Salamanca Bautista","doi":"10.1016/j.rce.2025.502399","DOIUrl":"10.1016/j.rce.2025.502399","url":null,"abstract":"<div><div>Heart failure (HF) is a major cause of morbidity, mortality, and hospital admissions worldwide. Home hospitalization (HaH) has emerged as an effective alternative, enhancing patient care and optimizing healthcare resources. This expert consensus document, endorsed by the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Home Hospitalization (SEHAD), provides practical recommendations for the management of HF in HaH settings. It outlines patient selection criteria, parameters for assessing congestion, and treatment protocols. The document emphasizes the use of telemonitoring and point-of-care ultrasound (POCUS). Therapeutic optimization, clinical follow-up, and patient education are fundamental. It also addresses comorbidity management and the integration of palliative care. Certification of HF care units and the strengthening of interdisciplinary collaboration are key to improving healthcare quality. HaH presents itself as an effective strategy for the comprehensive management of HF, reducing hospital-related complications and promoting patient-centered care.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502399"},"PeriodicalIF":1.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693269","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}
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