Revista clinica espanola最新文献_第10页

La desnutrición en la insuficiencia cardíaca. La importancia de evaluar la congestión y la sarcopenia 心力衰竭中的营养不良。评估充血和骨骼肌减少症的重要性

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

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.

目的探讨心力衰竭（HF）住院患者营养与肌肉减少症的关系。它还旨在评估与营养和肌肉减少症相关的住院和短期预后相关的因素。方法收集同一中心内科病房连续收治的心衰患者的资料。患者于2021年5月和10月招募。营养不良通过迷你营养评估简表（MNA-SF）确定，肌肉减少症通过筛选试验、SARC-F量表和握力测试确定。结果分析190例患者，平均年龄82.1（±8.2）岁，女性54.2%，中位随访106天。根据MNA-SF评分将患者分为3组：1组（12-14分，无风险）50例，2组（8-12分，营养不良高风险）81例，3组（0-7分，营养不良）59例。第3组有明显更多的炎症（较低的白蛋白和较高的c反应蛋白（CRP））和充血（通过NT-ProBNP水平测量）。住院死亡率与肌肉功能差、CRP和nt - probnp有关，但与营养不良无关。最糟糕的短期结果与营养不良和合并症有关。然而，当引入肌肉功能变量时，它可能作为与CRP和NT-ProBNP相关的不良预后因素，而CRP和NT-ProBNP是生存的主要决定因素。结论在营养不良的心衰患者中，炎症和充血与住院死亡率有关。营养不良与合并症可能在降低短期生存率中起作用。通过积极的营养和功能筛查进行早期识别应该是评估心衰患者的关键因素。

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引用次数: 0

Estudio ecológico para estimar la prevalencia de pacientes con déficit de esfingomielinasa ácida en España. Estudio PREVASMD 一项生态学研究，估计西班牙酸鞘磷脂酶缺乏症患者的患病率。研究PREVASMD

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

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.

背景与目的酸性鞘磷脂酶缺乏症（ASMD）的患病率研究在西班牙缺乏且存在差异。本研究的目的是确定西班牙诊断为ASMD （A/B型和B型）的患者的估计患病率。材料和方法sprevasmd是一项描述性、多中心、生态学研究，涉及来自不同自治区不同专业（主要是内科、儿科和血液）的21名具有ASMD管理经验的医生。结果在2022年3月至4月期间，专家共接诊了34例ASMD患者，其中18岁以下儿童患者10例（29.4%），成人患者24例（70.6%）。诊断为ASMD的患者（儿童和成人）的估计患病率为每100万居民0.7例（95%置信区间，95% CI: 0.5-1.0），儿科人群为每100万居民1.2例（95% CI: 0.6-2.3），成人人群为每100万居民0.6例（95% CI: 0.4-0.9）。导致怀疑ASMD的最常见症状是：脾肿大（100.0%的专家报告）、肝肿大（66.7%）、间质性肺疾病（57.1%）和血小板减少（57.1%）。专家认为，实验室和常规检查以及初级保健援助是ASMD管理中最相关的医疗资源。在西班牙进行的第一项研究显示，患者的患病率估计为每100万居民0.7例：儿童人口为每100万居民1.2例，成人人口为每100万居民0.6例。

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引用次数: 0

¿Qué factor predice mejor el pronóstico en pacientes con COVID-19: los biomarcadores analíticos o la relación PaO2/FiO2? 分析性生物标志物还是PaO2/FiO2比率更能预测2019冠状病毒病患者的预后？

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

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 1^st, 2020 to March 1^st,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.

本研究旨在通过PaO2/FiO2 （PAFI）和炎症程度描述患者的特征和结局。方法回顾性队列研究，收集2020年3月1日至2023年3月1日来自西班牙半covid -19登记处的患者数据。在入院前48小时内接受糖皮质激素（CS）治疗COVID-19的PAFI数据（<100 vs. 100-200 vs. 200-300 vs. >300）的非院内患者被纳入研究。5314例患者符合本研究的纳入标准。主要终点是住院死亡率。结果pafi组住院死亡率较高；100(51.5%比41.2% vs 25.8%比12.3%,术中;措施)。他们还需要更多的NIMV、IMV和ICU住院，并且住院时间更长。PAFI>；300和4-5高危标准的患者死亡率高于PAFI 200-300和1-2分析性炎症标准的患者。与较高住院死亡率相关的危险因素有：年龄(OR = 1.06；1.05-1.06)，中度(OR = 1.87；1.49-2.33)和重度(OR = 2.64；1.96-3.55)依赖度、血脂异常(OR = 1.20；1.03-1.39)，较高的Charlson指数(OR = 1.19；1.14-1.24)，入院时呼吸急促(2.23；1.91-2.61)，入院时高危标准数较高，入院时PAFI较低。女性(OR = 0.77；0.65-0.90)和RDSV的使用(OR = 0.72；0.56 ~ 0.93)为保护因素。结论PAFI越低，COVID-19患者炎症程度越高，住院死亡率越高。炎症升级先于呼吸恶化，应作为决定使用抗炎/免疫抑制治疗的严重程度的早期预测因子。

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引用次数: 0

Insuficiencia suprarrenal secundaria debida al tratamiento con ipilimumab/nivolumab por cáncer renal metastásico 因ipilimumab/nivolumab治疗转移性肾癌引起的继发性肾上腺功能不全

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

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

引用次数: 0

¿Cuál es la formación en bioética de los residentes de Medicina Interna en España? 西班牙内科居民的生物伦理学培训是什么？

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

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

引用次数: 0

Papel de la ecografía pulmonar en el seguimiento ambulatorio de pacientes tras COVID-19. Revisión sistemática de la literatura 肺超声在COVID-19后患者门诊随访中的作用。系统的文献审查

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

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.

目前，肺部超声在SARS-CoV-2肺炎患者出院后随访中的作用尚不清楚。本系统综述的主要目的是调查COVID-19肺炎患者肺部超声改变的持久性。方法根据2020年1月至2023年5月在PubMed、EMBASE、Web of Science和谷歌Scholar数据库中的PRISMA规定，使用MeSH术语组合：“肺超声”、“超声”、“肺改变”、“持续性”、“随访”、“后果”、“出院”、“COVID”、“COVID-19”、“SARS-CoV-2”进行系统综述。我们选择了描述COVID-19肺炎患者肺部超声改变的研究。使用JBI关键评估工具评估研究的偏倚风险。没有进行meta分析技术，结果被叙述比较。结果新型冠状病毒肺炎后2 ~ 6个月，肺部超声异常频繁出现，且与首发发作强度成正比。最常见的异常是胸膜线不规则，B线和/或胸膜下实变，主要发生在胸基底区。这些发现似乎与胸部CT的结果有关。结论超声在新冠肺炎患者出院后的研究中具有技术和经济优势。

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引用次数: 0

Estudio comparativo de la efectividad de tolvaptán frente a urea en pacientes con hiponatremia causada por SIADH 托伐坦与尿素在多动症引起的低血症患者中的疗效比较研究

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-02-01 DOI: 10.1016/j.rce.2024.08.005

Á. Martínez González , M. González Nunes , P. Rodeiro Escobar , J. Llópiz Castedo , A. Cabaleiro Loureiro , R.P. Martínez Espinosa , R. Ruades Patiño , G. Lorenzo Canda , J. Aguayo Arjona , S. Rodríguez Zorrilla

Background and objectives

Hyponatraemia is common in elderly and hospitalised patients, often caused by the syndrome of inappropriate antidiuretic hormone secretion (SIADH). This study evaluates the efficacy and safety of tolvaptan and urea in patients with hyponatraemia and SIADH.

Materials and methods

An observational cohort study was conducted on 198 patients with SIADH and hyponatraemia (Na+ < 135 mmol/L) at the Complejo Hospitalario Universitario de Pontevedra (January 2015-May 2022). Of these, 86 were treated with tolvaptan (average dose of 7.5 mg) and 112 with urea (average dose of 15 g). The primary outcome was the normalisation of sodium levels (Na+ ≥ 135 mmol/L).

Results

The tolvaptan group showed higher sodium concentrations at the end of therapy compared to the urea group (ME = 136, IQR = 135-137 vs. ME = 134, IQR = 132-137; p < 0.001). The time to normalise sodium was shorter with tolvaptan (4 ± 3.4 days) compared to urea (6 ± 3.6 days; p = 0.03). A higher percentage of patients achieved sodium normalisation with tolvaptan (83.72 vs. 59.82%; p = 0.005). Tolvaptan had more adverse effects, such as dry mouth, thirst, and sodium overcorrection, while urea caused dysgeusia, abdominal pain, and diarrhea. There were no significant differences in mortality between the groups.

Conclusions

Tolvaptan was more effective and quicker than urea in normalising sodium levels, though it showed a higher percentage of adverse effects, which did not require discontinuation of the drug.

背景和目的低钠血症常见于老年和住院患者，通常由抗利尿激素分泌不当综合征（SIADH）引起。本研究评价托伐普坦和尿素在低钠血症和SIADH患者中的疗效和安全性。材料与方法对198例SIADH合并低钠血症(Na+ <；（2015年1月至2022年5月）在Pontevedra Universitario Complejo Hospitalario de Pontevedra。其中86例接受托伐普坦治疗（平均剂量为7.5 mg）， 112例接受尿素治疗（平均剂量为15 g）。主要结局是钠水平正常化（Na+≥135 mmol/L）。结果托伐普坦组治疗结束时钠浓度高于尿素组(ME = 136, IQR = 135 ~ 137 vs ME = 134, IQR = 132 ~ 137；p & lt;0.001)。托伐普坦使钠恢复正常所需时间（4±3.4天）短于尿素（6±3.6天）；p = 0.03)。使用托伐普坦后钠恢复正常的患者比例更高(83.72 vs 59.82%；p = 0.005)。托伐普坦有更多的不良反应，如口干、口渴和钠矫治过度，而尿素则引起吞咽困难、腹痛和腹泻。两组之间的死亡率没有显著差异。结论与尿素相比，伐他坦在钠水平正常化方面更有效、更快，但其不良反应比例更高，不需要停药。

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引用次数: 0

Infecciones de pie de diabético en los servicios de Medicina Interna de España (2018-2022) 西班牙内科服务中的糖尿病足感染（2018-2022 年）

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-01-29 DOI: 10.1016/j.rce.2024.08.008

C. Fuentes Santos , J.A. Rueda Camino , Á. Asenjo Mota , A. Castañeda Pastor , A. Zapatero Gaviria , J. Canora Lebrato , R. Barba-Martín

Introduction

Diabetic foot infections represent a common and serious complication of diabetes mellitus, with a wide range of clinical presentations. Despite their significance, uncertainties persist regarding their management and impact on Internal Medicine services.

Materials and methods

A retrospective cohort study was conducted using data from the Registry of Specialized Healthcare Activity (RAE-CMBD) over a five-year period (2018-22). Patients discharged from Internal Medicine with a diagnosis of diabetic foot were included. Demographic, clinical, and activity data were collected, and the cumulative incidence of diabetic foot, in-hospital mortality, need for amputation, and associated costs of hospitalization were analyzed.

Results

15402 episodes with a diagnosis of diabetic foot were identified, representing 0.41% of Internal Medicine, which implies an age-adjusted incidence rate of between 2 and 3 cases per 1000 admissions in these services. These patients had a high in-hospital mortality rate (16%) and a significant percentage required amputation (8.25%). Advanced age, the presence of comorbidities, and complications during admission were associated with a higher risk of mortality and amputation. The average cost per admission is over €6000.

Conclusions

Diabetic foot is a pathology with a high impact on Internal Medicine services, both due to the volume of activity and the high mortality and cost generated by this condition.

糖尿病足部感染是糖尿病常见且严重的并发症，具有广泛的临床表现。尽管它们具有重要意义，但它们的管理和对内科服务的影响仍然存在不确定性。材料和方法利用专业医疗活动登记处（RAE-CMBD） 5年（2018- 2022年）的数据进行了一项回顾性队列研究。本研究纳入了诊断为糖尿病足的内科出院患者。收集了人口统计学、临床和活动数据，并分析了糖尿病足的累积发病率、住院死亡率、截肢需求和相关的住院费用。结果15402例诊断为糖尿病足，占内科的0.41%，这意味着这些服务中每1000名入院患者中年龄调整后的发病率在2至3例之间。这些患者的住院死亡率很高（16%），需要截肢的比例很高（8.25%）。高龄、合并症的存在和入院时的并发症与较高的死亡率和截肢风险相关。每次入场的平均费用超过6000欧元。结论糖尿病足是一种对内科服务有很大影响的病理，既因为活动量大，也因为这种疾病产生的高死亡率和高费用。

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引用次数: 0

La difícil relación entre la investigación y la asistencia: una encuesta a internistas españoles 研究与护理之间的困难关系：对西班牙内科医生的调查

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-01-29 DOI: 10.1016/j.rce.2024.11.001

J.C. Trullàs , A. Maestre

引用次数: 0

Documento de posicionamiento sobre la realización de ecografía clínica en la insuficiencia cardíaca: recomendaciones desde los Grupos de Trabajo de Insuficiencia Cardíaca y Fibrilación Auricular, y de Ecografía Clínica de la Sociedad Española de Medicina Interna (SEMI) 关于心脏衰竭临床超声检查的立场文件：心脏衰竭和心房颤动工作组和西班牙内科学会（SEMI）临床超声检查的建议

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-01-27 DOI: 10.1016/j.rce.2024.08.006

Y. Tung-Chen , M. Beltrán Robles , J. Rubio Gracia , G. García de Casasola Sánchez , P. Llàcer Iborra , S. García Rubio , M. Méndez Bailón , E. Montero Hernández , M. Sánchez Marteles , M. Torres Arrese , J. Torres Macho , J. Pérez Silvestre

This document provides a comprehensive analysis of the use of point-of-care ultrasound in heart failure (HF), offering detailed recommendations on echocardiography, lung ultrasound, and venous ultrasound. These advanced imaging techniques allow for an accurate, detailed, and non-invasive evaluation of heart failure, facilitating rapid and effective clinical decision-making.

Echocardiography enables a rapid assessment of cardiac function at the point of care, enhancing traditional physical examination and being essential for the management of heart failure (HF). Lung ultrasound provides a detailed view of the pulmonary status, crucial for diagnosing pulmonary congestion without using ionizing radiation, ideal for continuous monitoring. Venous ultrasound evaluates systemic congestion by measuring the inferior vena cava and other parameters, aiding in the estimation of right atrial pressure and monitoring pressure and volume overload, improving patient understanding and prognosis.

Together, the use of these ultrasound modalities not only complements but enriches the traditional physical examination, establishing themselves as indispensable tools in the comprehensive and effective management of patients with heart failure. By incorporating these techniques into clinical practice, healthcare professionals can achieve better evaluation, diagnosis, and treatment, resulting in more personalized management of these patients.

本文全面分析了心衰（HF）中即时超声的应用，并对超声心动图、肺超声和静脉超声提供了详细的建议。这些先进的成像技术允许对心力衰竭进行准确、详细和无创的评估，促进快速有效的临床决策。超声心动图能够在护理点快速评估心功能，增强传统的身体检查，对心力衰竭（HF）的管理至关重要。肺超声提供肺状态的详细视图，对诊断肺充血至关重要，不使用电离辐射，理想的连续监测。静脉超声通过测量下腔静脉等参数来评估全身充血，帮助估计右心房压力，监测压力和容量过载，提高患者的认识和预后。总之，这些超声方式的使用不仅补充而且丰富了传统的体检，使其成为全面有效地管理心力衰竭患者不可或缺的工具。通过将这些技术纳入临床实践，医疗保健专业人员可以实现更好的评估、诊断和治疗，从而对这些患者进行更个性化的管理。

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引用次数: 0