Revista clinica espanola最新文献

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.

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.

Introduction and objectives: Cardiac amyloidosis (CA) is a prevalent yet underdiagnosed heart condition characterized by the abnormal accumulation of amyloid fibres, frequently resulting in heart failure (HF), particularly in older people. Despite advancements in non-invasive diagnostic techniques and treatments, the epidemiology of CA patients remains inadequately understood. This nationwide retrospective observational study sought to comprehensively investigate CA patients' characteristics, mortality, and readmission patterns.

Methods: A retrospective observational study encompassed all patients hospitalized with CA between 2016 and 2021 across Spanish hospitals. Standardized incidence rates were calculated using age and sex-adjusted methods, utilizing the Spanish population as the reference. The investigation delved into demographic variables, comorbidities, mortality during the index episode, and 30 and 365-day readmissions for circulatory system diseases. Predictors of readmission were also examined.

Results: A total of 5739 index episodes were identified, with CA being the primary cause of admission in 14.1% of cases. The mean age was 81.4 ± 9.9 years, predominantly males (70.3%). The age and sex-standardized hospital attendance rate was 3.90 admissions per 100,000 population (95% CI: 3.82-3.98), higher in males. Common comorbidities included HF (96.4%), atrial fibrillation (46.3%), and renal failure (44.4%). The mortality rate during the index episode was 11.7%, with cardiogenic shock (OR: 9.03; 95% CI: 4.22-19.32) and major psychiatric disorders (OR: 3.36; 95% CI: 1.42-7.94) identified as predictors. Over the follow-up period, 13.1% were readmitted at 30 days and 36.6% at 365. Nephritis (IRR: 2.05; 95% CI: 1.42-2.96) and asthma (IRR: 1.52; 95% CI 1.11-2.07) were associated with increased 30-day readmissions, while renal failure (IRR: 1.43; 95% CI: 1.28-1.59) and chronic pulmonary disease (IRR: 1.40; 95% CI: 1.18-1.67) were linked to higher 365-day readmissions. Predictors of mortality risk in 365-day readmissions included advanced cancer (HR: 1.31; 95% CI: 1.00-1.71), cardiogenic shock in the index episode (HR: 2.72; 95% CI: 1.33-5.57), and a higher number of readmissions during that period (HR: 1.64; 95% CI: 1.56-1.73).

Conclusions: This study contributes valuable insights into the significant prevalence of CA, which is often overlooked and underestimated. Afflicting predominantly elderly males with concomitant HF and multiple comorbidities, CA poses a significant clinical challenge. The findings underscore the need for enhanced awareness, early detection, and a multidisciplinary approach to manage this complex cardiac condition.

Pulmonary embolism (PE) is a disease with a rising incidence rate. This article presents the recommendations for the diagnosis and treatment of PE of the Thromboembolic Disease Group of the Spanish Society of Internal Medicine (SEMI). The main objective is to facilitate decision making to improve the diagnostic and therapeutic approach based on published evidence. The final justification of the document is to improve the comprehensive care of the patient with PE.

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.

Background and objectives: Takotsubo syndrome (TTS) is an infrequent cause of acute coronary syndrome much better diagnosed in recent years. This study sought to assess the clinical profile of patients admitted with TTS in Spain and to elucidate potential regional differences in admissions and in-hospital mortality between the years 2008 and 2021.

Methods: Retrospective observational study of patients admitted to acute general hospitals of the Spanish National Health System with a main or secondary diagnosis of STT, using the minimum basic data set.

Results: A total of 12,952 hospitalization for TTS were identified. The number of hospital admissions increased exponentially from 210 in the year 2008 to 1918 in 2021. Most patients (79.1%) were women and mean age was 72.0 ± 12.5 years (72.5 ± 12.2 in female; 69.9 ± 13.4 in men; p < 0.001). Associated comorbidities were frequent (44.9% arterial hypertension, 31.2% heart failure) and differed in men and women. Overall, crude in-hospital mortality was 7%. Notably, admission and in-hospital mortality rates, adjusted by age and gender, were different among the different autonomous communities.

Conclusions: TTS usually presents in elderly women with associated comorbidities and has a significant in-hospital mortality. Age and comorbidities differ between men and women. Relevant regional differences exist regarding admission and in-hospital mortality rates.

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 = 0.020) and long-acting muscarinic antagonist use (84.6% vs. 47.1%, p = 0.009).

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.

Introduction: Anti-NOR90 antibodies were initially described in patients with autoimmune diseases based on staining of a nucleolar region known as the nucleolar organizer region (NOR). This study aims to explore the clinical aspects of anti-NOR90 antibodies in patients with systemic autoimmune diseases.

Methods: Observational study of patients with positive anti-NOR90 antibodies using the EUROLINE Systemic Sclerosis profile (IgG) kit (Euroimmun, Germany). Data on demographics, comorbidities, autoimmune diseases, treatment, and clinical manifestations were collected.

Results: Fifteen Patients with positive anti-NOR90 antibodies were included. Majority were female (86.7%), with median age of 54 years. Most common clinical manifestations were Raynaud's phenomenon, dryness, and interstitial lung disease (ILD). Some patients had hematological or solid organ neoplasms. EPID was prevalent, with one case showing rapid progression requiring aggressive treatment.

Discussion and conclusion: This study highlights the association between anti-NOR90 antibodies and systemic autoimmune diseases, particularly SS and ES. EPID was a notable feature, suggesting its consideration in IPAF diagnosis for anti-NOR90 positive patients. Further multicenter studies are needed for better understanding and detection methods optimization.

Background and objectives: Blood donation is suggested to increase the risk of restless legs syndrome (RLS). This study aims to assess the prevalence of RLS in Spanish blood donors and determined its potential correlation with iron metabolism parameters.

Materials and methods: Prospective cohort study of 129 blood donors (54.3% men, 39.44 years ± 11.0) that underwent a physical examination, blood analysis (hemoglobin, ferritin, transferrin saturation index and soluble transferrin receptor) and a RLS screening questionnaire followed by a prospective follow-up study including a clinical phone interview. A multivariate logistic regression model was performed to examine the association between RLS and other variables.

Results: Eighty-four (65.1%) participants were repeat blood donors (mean of 2.11 donations/year) at inclusion and 61 (47.4%) at follow-up (mean of 2.09 donations/year). Non-anemic iron deficiency (ferritin < 50 µg/l) was high in women p < 0.001 and in repeat donors (p = 0.003). The prevalence of RLS was 14.1% at inclusion increasing prospectively (19.5%; p = 0.065). On multivariate analysis, gender was the only variable significantly associated with a RLS diagnosis, being higher in women (OR 5.1; 95% CI 1.71-15.3; p = 0.003).

Conclusions: Despite the high prevalence of non-anemic iron deficiency there was no association between ferritin, transferrin saturation index, soluble transferrin receptor concentration values and RLS diagnosis. Gender was associated with RLS diagnosis regardless of other variables.

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).