Revista clinica espanola最新文献

Objectives: To describe temporal trends and spatial distribution of sarcoidosis-related mortality in mainland Spain between 2009 and 2023, with a focus on sex-specific differences and high-risk clusters.

Methods: An ecological study was conducted using mortality data from the Spanish National Statistics Institute (INE) for deaths coded as ICD-10 D86. Age-adjusted mortality rates were calculated using direct standardization to the European Standard Population 2013. Temporal trends were assessed with joinpoint regression, and spatial patterns were analyzed at the provincial level using standardized mortality ratios (SMRs), Bayesian-smoothed relative risks (RRs), and posterior probabilities via the Besag-York-Mollié model. Global and local clustering was evaluated with spatial scan statistics, Moran's I, and Local Indicators of Spatial Association (LISA).

Results: Between 2009 and 2023, 709 sarcoidosis-related deaths were recorded (417 women, 292 men). Mortality increased significantly in men (average annual percentage change (AAPC) 4.5%, 95% CI 1.6-7.4%) but not in women (AAPC 1.0%, 95% CI -1.3-3.5%). Geographic analysis revealed persistent high-risk clusters in northwestern provinces, particularly Galicia and Castilla y León, whereas central and Mediterranean provinces exhibited lower-than-expected mortality. Sex-specific clustering patterns were evident, with women showing more widespread high-risk regions. Bayesian-smoothed relative risks and posterior probabilities corroborated these findings, indicating true excess risk rather than random variation.

Conclusions: Sarcoidosis mortality in mainland Spain demonstrates marked geographic heterogeneity and sex-specific patterns, with persistent high-risk clusters in the northwest. These results are suggestive of the interplay of genetic, environmental, and healthcare-related factors, providing a foundation for targeted surveillance, preventive strategies, and resource allocation.

Introduction: Since 2021, sickle cell disease (SCD) has been included in all 17 neonatal screening programmes in Spain. The carrier state for haemoglobin S (HbS) is also detected collaterally; although clinically benign, it appears to increase the risk of certain complications, with genetic counselling being the main reason for its recognition. The Red Cells Disorders Working Group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP) conducted this study to examine current practices in the management of its detection.

Materials and methods: A survey was carried out among representatives from the reference or follow-up clinical units in each autonomous community.

Results: In all programmes, HbS and haemoglobin C (HbC) carrier status is reported, and most also report other structural variants (94.1%). High-performance liquid chromatography (HPLC) is the most frequently used screening method (64.7%). In most regions, testing is repeated on a second sample (82.4%), generally obtained by venepuncture and analysed by capillary electrophoresis. Families are mainly informed by the pediatrician or hematologist in the follow-up unit (76.5%). None of the regions have implemented strategies to recall carrier status at reproductive age.

Conclusions: Families are informed of HbS/HbC carrier status, but the approach is variable and requires review and harmonization. Obtaining a second venous sample in carriers is considered excessive according to international consensus.

Introduction and objectives: Although it is known that malnourished patients have a higher risk of death during hospitalization, the diagnosis is not always reflected in discharge reports, and underreporting is common. The aim of this study is to analyze the notification of malnutrition in internal medicine departments and to assess whether the presence of this diagnosis correlates with a higher risk of death.

Material and methods: Data from the Minimum Basic Data Set (MBDS) of patients discharged from internal medicine departments in Spain between 2018 and 2022 were analyzed. Patients with a diagnosis of malnutrition (ICD-10-ES: moderate or mild malnutrition E44.x, E46, severe malnutrition E40.x, E41.x, E42.x, E43.x, R64) were identified, and their demographic and clinical characteristics were analyzed.

Results: 3.8% of discharges from internal medicine services have a recorded diagnosis of malnutrition, being more frequent in men (54.4%) and in older patients (81 vs. 80 years). The registration rate has increased over the years of the study (from 3.5% in 2018 to 4.5% in 2022; p < 0.001 for trend). The unadjusted mortality rate was 19.7% for patients with mild malnutrition and 32.5% for those with severe malnutrition codes, compared to 11.45% for patients without malnutrition. After adjusting for comorbidities, patients with severe malnutrition have 3.8 times higher odds of dying.

Conclusions: Malnutrition notification in internal medicine is low and is associated with increased morbidity, mortality, and costs.