Revista clinica espanola最新文献_第3页

Linfoma cutáneo primario anaplásico de célula grande: diagnóstico tras la evolución de lesiones cutáneas crónicas 间变性原发性大细胞皮肤淋巴瘤：慢性皮肤病变发展后的诊断

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-12-01 DOI: 10.1016/j.rce.2025.502395

A. Castillo Leonet , A.S. Collado Martín , I. Cabezón Estévanez

引用次数: 0

Encuesta para la evaluación de la utilidad del CEAS y análisis de los conflictos éticos más frecuentes en el Hospital Universitario Ramón y Cajal 对拉蒙和卡哈尔大学医院最常见的道德冲突进行调查，以评估该中心的效用和分析

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-12-01 DOI: 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}

引用次数: 0

Epidemiología de la infección por rinovirus/enterovirus en pacientes hospitalizados 住院患者中鼻病毒/肠道病毒感染的流行病学

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-12-01 DOI: 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}

引用次数: 0

Síndrome de realimentación en pacientes adultos y personas mayores: estudio retrospectivo en un hospital universitario 成人和老年人的反应性综合征：大学医院的回顾性研究

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-12-01 DOI: 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.

目的评估存在再喂养综合征（RS）风险或诊断为RS的成人和老年患者的患病率，并探讨其与住院期间年龄、合并症、抗生素使用和临床结果的潜在关联。方法采用回顾性、横断面研究方法，对住院成人和老年患者的电子病历进行分析。分析了三组：RS的中度风险（食物摄入量低于50%，未达到营养目标和/或体重指数在16至18.5 kg/m2之间）；严重风险（食物摄入量低于50%和/或体重指数<； 16 kg/m2）；RS（存在低磷血症、低镁血症和/或低钾血症）。结果121例患者共被评估，其中38.8%的患者出现RS，其中49.6%属于中度危险组，11.6%属于重度危险组。在年龄方面，62%是老年人，38%是成年人。结论成人与老年人RS患病率差异有统计学意义（χ2(1) = 7, p < 0.05），老年人RS患病率较高。60 ~ 74岁的老年人RS患病率高于74岁以上的老年人，差异有统计学意义。住院期间抗生素变化在RS中度危险组中更为普遍，RS风险与死亡率之间未发现显著关联。

{"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 18.5kg/m<sup>2</sup>); severe risk (food intake less than 50% and/or body mass index <16kg/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}

引用次数: 0

Carcinoma de paratiroides: crisis paratirotóxica como forma de presentación de una neoplasia poco frecuente 甲状旁腺癌：甲状旁腺毒性危机作为罕见肿瘤的表现形式

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-12-01 DOI: 10.1016/j.rce.2025.502394

B. Remezal Serrano, J.M. Navarro Rodríguez, J. Perez Legaz

引用次数: 0

Impacto de la insuficiencia cardiaca en la mortalidad intrahospitalaria durante el ingreso por otras patologías 心脏衰竭对其他疾病住院期间医院内死亡率的影响

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-12-01 DOI: 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.

背景与目的急性心力衰竭（acute heart failure， AHF）是一种常见的住院原因，已被广泛研究。然而，当它在其他病理入院时次要出现时，其特征就不那么明确了。本研究的目的是分析AHF的临床特点，预后因素和演变的其他原因住院的患者，诊断内科（IM）会诊。材料和方法一项观察性研究，纳入与IM会诊后诊断为AHF的患者（2020-2022）。收集患者的人口学和临床特征、入院原因、心脏病类型、诱发因素、住院死亡率及相关因素。结果1583例就诊中，347例（21.9%）诊断为AHF。平均年龄79.9（±10.3岁），女性184例（53%）。76%来自外科服务。最常见的合并症是高血压、血脂异常和心房颤动。大多数患者有高血压病因，并保留了射血分数（68.6%）。主要的诱因是感染、贫血和体液过量。在50%的病例中，AHF是HF的首次发病。住院死亡率为20.5%，1年随访时为26.4%，再入院率为39.7%。住院死亡率与年龄较大（p = 0.031）、NT-proBNP升高（p = 0.048）、血红蛋白（p = 0.004）和白蛋白（p = 0.006）水平降低有关。结论住院时因其他病理发生AHF的患者年龄大、合并症多、病死率高。早期发现诱发因素和确定预后因素有助于优化其管理和改善其预后。

{"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}

引用次数: 0

Prevalencia y toma de decisiones en demencia avanzada 晚期痴呆的患病率和决策

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-12-01 DOI: 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.

痴呆是一种慢性神经退行性疾病，发病率高，经济成本高。我们的目的是评估内科住院患者中晚期痴呆（AD）的患病率；分析实施的治疗和诊断措施、治疗努力的充分程度和家庭信息。方法：描述性研究，包括对医疗记录的回顾性分析和对家属的电话访谈。纳入了在3个不同月份住院的GDS 6-7痴呆患者，为期3周。结果纳入194例（22%）痴呆患者。阿尔茨海默病入院率为11%。中位年龄87.5岁（QR 81.75-93）， 65%为女性。45%来自养老院。最常见的病因是阿尔茨海默病（48%）。最常见的入院原因是感染（72%）。37%死亡。实施措施方面：100%为静脉治疗；89%接受抗凝治疗；26%接受人工营养；81%接受药物约束，63%接受物理约束；48%的人接受了侵入性诊断测试。关于充分性：19%的降脂治疗停药，23%停药，21%停药；30%的患者没有进行心肺复苏，34%的患者护理充足，13%的患者通过姑息治疗进行评估。对55例患者进行了电话访谈。42%的患者未意识到任何并发症。对2例患者进行护理计划。结论阿尔茨海默病住院率高，近半数患者来自老年住院者。相关的死亡率很高，治疗的适当性和计划非常缺乏。

{"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}

引用次数: 0

Impacto de la hipertensión arterial en la isquemia vascular ocular 高血压对眼部血管性缺血的影响

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-12-01 DOI: 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.

在眼水平，高血压可引起视网膜、脉络膜和视神经病变，并可并发阻塞性和缺血性现象。我们开始评估高血压对不同类型的眼部血管缺血的影响。患者与方法血管危险会诊患者的回顾性病例对照研究。所有患者均行脉搏波速度（PWV）、ABI及颈动脉多普勒超声检查。结果共纳入187例患者，其中视网膜静脉闭塞（RVO） 76例，视网膜动脉闭塞（RAO） 21例，非动脉性缺血性神经病（NAION） 28例，无眼缺血（CP）的高血压对照组62例。RVO、RAO、NAION、PC的平均年龄分别为64（±11）岁、68（±10）岁、61（±10）岁、56（±11）岁（P= 0.92）。RVOs组高血压（71.4%）、血脂异常（55%）和糖尿病（47.6%）的发生率分别高于对照组（P= 0.001、P= 0.001和P= 0.028）。与亚临床器官损害相关，RVO患者的PWV为10.7 m/s (P= 0.004)，脉压为66 mmHg (P= 0.009)，血管年龄为66.4岁（P= 0.005），而IMT、颈动脉斑块或ITB的存在无差异。眼部缺血的发生与年龄（P= 0.009）、DM2 （P= 0.027）、血脂异常（P= 0.047）、斑块存在（P= 0.019）相关。结论高血压是血管性眼缺血病理的常见病，在RVO中动脉硬化对其影响较大。年龄、糖尿病、血脂异常和斑块的存在都会增加眼缺血的出现。

{"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 66mmHg (<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}

引用次数: 0

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 家庭住院中心力衰竭的实际管理：西班牙内科学会和西班牙家庭住院学会的建议

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-12-01 DOI: 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.

心力衰竭（HF）是世界范围内发病率、死亡率和住院率的主要原因。家庭住院（HaH）已成为一种有效的替代方案，可加强患者护理并优化医疗保健资源。这份专家共识文件由西班牙内科学会（SEMI）和西班牙家庭住院学会（SEHAD）批准，为在医院环境中管理心衰提供了实用建议。它概述了患者的选择标准、评估充血的参数和治疗方案。该文件强调使用远程监测和即时超声（POCUS）。治疗优化、临床随访和患者教育是基础。它还涉及合并症管理和姑息治疗的整合。心衰护理单位的认证和加强跨学科合作是提高医疗保健质量的关键。体外循环是一种有效的心衰综合治疗策略，可减少与医院相关的并发症，促进以患者为中心的护理。

{"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}

引用次数: 0

Carta al editor «La controversia en torno al hierro sucrosomado» 给编辑的信《蔗糖铁的争议》

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-12-01 DOI: 10.1016/j.rce.2025.502396

F.J. Teigell Muñoz, M. Mateos González

引用次数: 0