Revista clinica espanola最新文献

英文中文

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

Validación externa de la escala «HOSPITAL simplificada» como predictor de reingreso a 30 días tras hospitalización en servicios médicos de OSI Araba 将 "简化医院 "量表作为 OSI Araba 医疗服务机构住院后 30 天再入院的预测指标进行外部验证。

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-01-27 DOI: 10.1016/j.rce.2024.10.010

N. García-Perotti , S. García de Garayo-Díaz , J. Regalado-De Los Cobos

Background

A readmission is defined as a new admission to hospital for at least one night in the 30 days following a discharge. Some are caused by events unrelated to the reason for the initial admission (unavoidable) and others caused by the same pathology (related). Different predictive models allow the identification of patients at higher risk of readmission. The “HOSPITAL simplified” score stands out for its performance and simplicity.

Aim

To validate the “HOSPITAL simplified” scale in a cohort of patients at the University Hospital of Alava.

Method

Review of patients discharged from OSI Araba Medical Services in June and November 2023. The scale was applied to each of them and re-admission was studied in the 30 days following discharge. The Brier score, discrimination and calibration capacity were analysed, using the guidelines of the TRIPOD declaration.

Results

In 1849 discharges there were 240 unscheduled readmissions: 73 for causes unrelated to the previous admission and 151 related. For predicting related readmissions the scale obtained a Brier score = 0.0703. The mean score for cases with related readmission was 4.7 versus 2.66 for cases without readmission (P < 0.001). The area under the ROC curve = 0.747. Related readmission occurred in 29.3% of patients at high risk, compared to 17.3% predicted by the scale.

Conclusions

The “HOSPITAL simplified” scale showed in OSI Araba a higher discrimination capacity than the original series although it underestimated the real risk. The scale offers good portability.

背景再入院是指出院后 30 天内再次入院至少一晚。再次入院的原因有很多，有些是与首次入院原因无关的事件（不可避免的），有些则是由相同的病理原因引起的（相关的）。通过不同的预测模型，可以识别出再次入院风险较高的患者。目的在阿拉瓦大学医院的一组患者中验证 "HOSPITAL简化 "量表。方法回顾2023年6月至11月从OSI阿拉瓦医疗服务机构出院的患者。对每位患者都使用了该量表，并对出院后 30 天内的再次入院情况进行了研究。根据 TRIPOD 声明的指导原则，对布赖尔评分、区分度和校准能力进行了分析：结果在 1849 名出院者中，有 240 名非计划再入院者：73 人的原因与前一次入院无关，151 人与前一次入院有关。在预测相关再入院方面，该量表的布赖尔得分 = 0.0703。有相关再入院病例的平均得分为 4.7，而无相关再入院病例的平均得分为 2.66（P < 0.001）。ROC 曲线下面积 = 0.747。结论 "HOSPITAL简化 "量表在OSI Araba中显示出比原始系列更高的辨别能力，尽管它低估了实际风险。该量表具有良好的便携性。

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引用次数: 0

Alcaptonuria. Descripción de 2 casos de una rara entidad 蛋白尿。2 例罕见病例的描述

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-01-27 DOI: 10.1016/j.rce.2025.01.001

A. Rosales-Castillo, A. Bustos-Merlo, J. Escobar Sevilla

引用次数: 0

Presentación clínica del feocromocitoma y recomendaciones de cribado 染色细胞瘤的临床介绍和筛查建议

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-01-27 DOI: 10.1016/j.rce.2024.10.008

O.F. Arroyo Ripoll , E. Achote , M. Araujo-Castro

Pheochromocytomas are neuroendocrine tumors that derive from sympathetic adrenomedullary chromaffin tissue and produce catecholamines. Due to the excess release of catecholamines, they can produce arterial hypertension, tachycardia, sweating, headache and a large number of other clinical manifestations secondary to the stimulation of α and β adrenoreceptors. Screening for pheochromocytoma is recommended in patients with paroxysmal, resistant or early-onset arterial hypertension, in cases with symptoms suggestive of catecholamine hypersecretion, patients with hereditary syndromes associated with pheochromocytomas, diabetes mellitus of atypical presentation and in adrenal incidentalomas with radiological characteristics not typical of adenoma (with > 10 Hounsfield Units on non-contrast CT). In this article we present an exhaustive review of the clinical data and complications that can be associated with pheochromocytomas, and we summarize the main indications for pheochromocytoma screening.

嗜铬细胞瘤是一种神经内分泌肿瘤，起源于交感肾上腺髓质嗜铬组织并产生儿茶酚胺。由于儿茶酚胺的过量释放，可产生继发于α、β肾上腺素受体刺激的动脉性高血压、心动过速、出汗、头痛等大量临床表现。建议对以下患者进行嗜铬细胞瘤筛查：阵发性、顽固性或早发性动脉高血压，有儿茶酚胺高分泌症状的患者，嗜铬细胞瘤相关遗传综合征患者，不典型表现的糖尿病患者，以及放射学特征不典型腺瘤的肾上腺偶发瘤(有>；10 Hounsfield单位（非对比CT）。在这篇文章中，我们提出了一个详尽的回顾临床资料和并发症，可以与嗜铬细胞瘤，我们总结了嗜铬细胞瘤筛查的主要适应症。

引用次数: 0

Inteligencia artificial en la práctica clínica: calidad y evidencia 临床实践中的人工智能：质量和证据

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-01-01 DOI: 10.1016/j.rce.2024.07.009

R. Puchades , L. Ramos-Ruperto , en nombre del Grupo de Trabajo de Medicina Digital de la SEMI

A revolution is taking place within the field of artificial intelligence (AI) with the emergence of generative AI. Although we are in an early phase at the clinical level, there is an exponential increase in the number of scientific articles that use AI (discriminative and generative) in their methodology. According to the current situation, we may be in an «AI bubble» stage; requiring filters and tools to evaluate its application, based on the quality and evidence provided. In this sense, initiatives have been developed to determine standards and guidelines for the use of discriminative AI (CONSORT AI, STARD AI and others), and more recently for generative AI (the CHART collaborative). As a new technology, AI requires scientific regulation to guarantee the efficacy and safety of its applications, while maintaining the quality of care; an evidence-based AI (IABE).

随着生成式人工智能的出现，人工智能领域正在发生一场革命。尽管我们在临床层面还处于早期阶段，但在方法论中使用人工智能（判别和生成）的科学文章数量呈指数级增长。根据目前的情况，我们可能处于“人工智能泡沫”阶段；需要过滤器和工具来评估其应用，基于所提供的质量和证据。从这个意义上说，已经制定了一些计划，以确定使用判别人工智能（CONSORT人工智能、STARD人工智能等）的标准和指南，最近还制定了用于生成人工智能（CHART协作）的标准和指南。作为一项新技术，人工智能需要科学的监管，以保证其应用的有效性和安全性，同时保持护理质量；循证人工智能（IABE）。

引用次数: 0

Patrón circadiano de presión arterial en pacientes con EPOC estable 慢性阻塞性肺病患者的血压循环模式

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-01-01 DOI: 10.1016/j.rce.2024.08.004

J. Díez-Manglano , J.A. Díaz-Peromingo , R. Boixeda-Viu

Objective

To describe the circadian blood pressure (BP) pattern in stable COPD patients.

Methods

We included stable COPD patients from Internal Medicine Departments. Office BP and ambulatory BP monitoring were performed. Patients were classified as BP reducers (dipper or extreme dipper) or non-reducers (non-dipper or riser).

Results

We included 43 patients (5 women, mean age 69.5 ± 9.5 years). Among them, 11 had sustained normotension, 13 sustained hypertension, 2 white coat hypertension, and 17 masked hypertension. Arterial stiffness was observed in 12 (27.9%) patients. Overall, 26 (60.5%) exhibited a non-reducer BP profile. Non-reducers had a higher frequency of previous major cardiovascular events (50% vs. 11.8%, P = .020) and long-acting muscarinic antagonist use (84.6% vs. 47.1%, P = .009).

Conclusions

Hypertension is often masked in COPD patients, who frequently display an altered circadian BP pattern. Longitudinal studies with larger samples are needed to evaluate the impact of these patterns on COPD progression.

目的探讨稳定期COPD患者的昼夜血压变化规律。方法纳入内科稳定期COPD患者。进行办公室血压和动态血压监测。患者被分为血压降低者（侧倾者或极侧倾者）和非血压降低者（非侧倾者或上升者）。结果纳入43例患者（女性5例，平均年龄69.5±9.5岁）。其中血压正常11例，高血压13例，白大衣高血压2例，隐匿性高血压17例。12例（27.9%）患者出现动脉硬化。总体而言，26个（60.5%）表现出非减速器BP剖面。未减量者既往发生主要心血管事件的频率更高（50%比11.8%,P = 0.020），使用长效毒蕈碱拮抗剂的频率更高（84.6%比47.1%,P = 0.009）。结论：慢性阻塞性肺病患者的高血压常被掩盖，他们经常表现出改变的昼夜血压模式。需要更大样本的纵向研究来评估这些模式对COPD进展的影响。

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引用次数: 0

Los derechos e intereses de los participantes como límites de los ensayos clínicos 作为临床试验限制的参与者权益

IF 2.3 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2025-01-01 DOI: 10.1016/j.rce.2024.10.001

R. Dal-Ré

Point 8 of the Declaration of Helsinki requires that the rights and interests of research participants must always prevail over the scientific interests of the research. Recently, it has been proposed that point 8 be modified to indicate the opposite, that is, that it is acceptable for scientific interests to prevail over the interests of the participants. This article argues against this change. What happened with the masked placebo-controlled trials of experimental vaccines against SARS-CoV-2 is held up as an example. When the high efficacy of the vaccines became evident, questions arose as to what should be done, whether to keep the trials masked until data on long-term efficacy, immunogenicity, and safety were obtained or to unmask the trials and offer the vaccine that had been shown to be efficacious to participants who received the placebo. The latter was the correct approach, which translates point 8 into practice.

《赫尔辛基宣言》第8点要求研究参与者的权利和利益必须始终优先于研究的科学利益。最近，有人提议对第8点进行修改，以表明相反的情况，即科学利益优于参与者的利益是可以接受的。本文反对这种变化。针对SARS-CoV-2的实验性疫苗的蒙面安慰剂对照试验就是一个例子。当疫苗的高有效性变得明显时，问题就出现了，应该做些什么，是隐瞒试验直到获得长期疗效、免疫原性和安全性的数据，还是揭开试验的面纱，向接受安慰剂的参与者提供已被证明有效的疫苗。后者是正确的做法，它将第8点付诸实践。

引用次数: 0

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