Revista clinica espanola最新文献

Objective: This study aimed to investigate the effects of age on the sensitivity, specificity, and accuracy of Light's criteria to differentiate exudative from transudative pleural effusion.

Methods: A testing cohort from China and a validation cohort from Spain were used for data analysis. The testing cohort included 302 patients (59 transudates and 243 exudates) with undiagnosed pleural effusion. The validation cohort comprised 400 patients (200 transudates and 200 exudates) divided into two groups according to age (200 patients aged 50-65 years and 200 patients aged 80-95 years). The effects of age on the sensitivity, specificity, and accuracy of Light's criteria were determined by sampling patients with different age limits.

Results: In the testing cohort, the sensitivity and specificity of Light's criteria for exudate were 0.91 and 0.73, respectively. In the validation cohort, the sensitivity was 0.99 and 0.97, and the specificity of Light's criteria for exudate was 0.73 and 0.68, respectively, by age group. The diagnostic accuracy metrics (sensitivity, specificity, and accuracy) of Light's criteria and its items tended to decrease with age.

Conclusion: Age should be considered when interpreting the Light's criteria.

Introduction: Alteration in pulmonary function tests and radiological abnormalities are present in a significant percentage of COVID-19 survivors. Our aim is to evaluate radiological findings and functional respiratory parameters involved in lung fibrosis at six months after SARS-CoV-2 pneumonia and use initial score of the predictive model to predict fibrotic-like changes at 6 months.

Material and methods: Prospective observational study including unvaccinated patients with COVID-19 pneumonia. Pulmonary function tests and chest CT were performed six months after acute pneumonia.

Results: 109 patients were included. Bilateral ground-glass opacities (94%) were the most frequent radiological finding, followed by bilateral consolidations (36%) and crazy paving patterns (28%). Ct tracking shows a significant decrease in bilateral ground glass, consolidations and bilateral crazy paving at 6 months. In contrast, architectural distortion tends to increase over time. The presence of bronchial dilatation, subpleural curved line and parenchymal bands on initial CT were associated with radiological signs of lung fibrosis at 6 months. An initial score of the predictive model > 0.6 predicts fibrotic-like changes at 6 months (AUC 77.8%; Specificity 85.4%; Sensitivity 58.1%). The proportion of patients with DLCO < 80% was 55%.

Conclusions: In 50 patients, 6 months CT detected signs of fibrotic-like changes. The presence of bronchial dilatation, subpleural curved line and parenchymal bands could be used as early predictors of fibrotic-like changes in patients with COVID-19 pneumonia. Initial score of the predictive model> 0,6 allows the selection of patients at risk of developing pulmonary fibrotic-like changes. DLCO was the one most frequently impaired at 6 months.

Objective: To investigate the incidence, sociodemographic characteristics, baseline status and evolution of elderly people living with HIV infection (PLHIV) attended in Spanish hospital emergency departments (ED).

Methods: Patients included in the EDEN (Emergency Department and Elder Needs) registry, which includes all patients aged 65 or older attended in 52 Spanish EDs during 7 consecutive days in 2019, were analyzed. Two groups were constructed according to whether or not they had known HIV infection (PLHIV and non-LHIV). We collected 6 sociodemographic factors and 8 referring to the patient's baseline situation. We recorded whether the episode of ED care required hospitalization, intensive care unit (ICU) admission, prolonged ED and inpatient stay, and in-hospital mortality, as well as reconsultation to the ED, rehospitalization, and death from any cause during the 3 years after discharge. The sociodemographic and baseline characteristics and the evolution of patients in the PLHIV and non-PLHIV groups were compared.

Results: Of 25,557 patients in the EDEN registry, 78 were PLHIV (0.30%, 95% CI 0.24% to 0.38%). The annual ED frequentation rate of PLHIV and non-PVHIV was 811 and 573 per 1000 population, respectively. The sociodemographic and baseline conditions were similar between PLHIV and non-PLHIV, with only age differing (younger PLHIV). Older PLHIV had severe comorbidity (27%), some type of functional limitation (27%) and cognitive impairment (11%). The most frequent ED diagnoses in PLHIV were pneumonia or lower respiratory tract infection (11%), heart failure or cardiogenic shock (8%) and joint and axial pain (6%), and in the non-HIV group there were no new diagnoses of HIV infection. 24.4% of PLHIV were hospitalized, 27.3% had a prolonged stay in the ED, 50% had prolonged hospitalization, 7.7% had in-hospital mortality, and reconsultation to the ED, hospitalization, and death during the 3 years post-discharge were 67%, 45.6%, and 21.7%, respectively. No outcome differed between PLHIV and non-PLHIV.

Conclusions: Older PLHIV have sociodemographic and baseline characteristics like the general population, but their rate of ED visits is higher. The severity of the episodes leading to this ED consultation is similar between PLHIV and non-PLHIV and long-term follow-up also shows no differences.

Objectives: To analyze the current situation of Healthcare Ethics Committees (HECs) in Spain, their composition and functions, as well as the implementation of Clinical Ethics Consultancy (CEC). Finally, to assess the involvement of internists in HECs.

Materials and methods: A cross-sectional descriptive study conducted through a self-administered online survey distributed between February and May 2025 to all identified HECs in the country.

Results: A total of 112 HECs (47.66%) out of the 235 accredited nationwide participated. The average number of members per committee was 16 (range: 6-29). The most represented professional profiles were nursing and medicine. In 99.1% of the committees, at least one member had postgraduate training in Bioethics. The most frequent range of meetings per year was between 7 and 12 (46.8%). Most HECs (91.1%) were involved in educational activities, and 58% had produced ethical documents. The majority reviewed between 1 and 5 cases annually (69.6%). The CEC role was established in 40.2% of HECs and in the process of implementation in 18.8%. Internists were present in 54% of HECs. In 65% of cases, the internist is part of the CEC.

Conclusions: HECs in Spain demonstrate significant involvement in educational activities and the development of ethical documents; however, they receive a relatively low number of annual consultations. Clinical Ethics Consultancy is gradually being integrated into the structure of HECs, which may enhance the management of ethical inquiries. Internists are members of more than half of the HECs and play a very active role in their operations.

Heart failure (HF) is associated with high morbidity and mortality. HF with preserved left ventricular ejection fraction (HF-pEF) accounts for up to 50% of all HF cases, being the most common in elderly patients. In addition, these subjects frequently present other comorbidities. For all these reasons, the diagnosis of patients with HF-pEF is complex and requires a careful approach. In addition, there are "secondary" or HF-pEF forms that must also be discarded. The treatment of HF-pEF has evolved very significantly in recent years due to evidence from clinical trials. Until a few years ago, the management was based on the treatment of congestive symptoms with diuretics and comorbidities, to this was added the indication of treatment with SGLT2 inhibitors, after being shown to reduce hospitalizations due to HF, and more recently new evidence of clinical benefit with other drugs such as finerenone, semaglutide or tirzepatide has been published. All this makes it necessary to update the recommendations regarding the management of patients with HF-pEF.