Pub Date : 2025-12-01DOI: 10.1016/j.rceng.2025.502392
J.A. Peregrina Rivas , I.F. Aomar Millán , L.M. Beltrán Romero , L. Castilla Guerra
Obesity is a complex and heterogeneus disease, with metabolic risk that is not solely determined by body mass index. The distribution and functionality of adipose tissue– particularly that of white adipocytes– play a critical role in the development of insulin resistance, chronic inflammation and ectopic lipid deposition. Clinical ultrasound enables direct and reproducible characterization of the major fat compartments (epicardial, hepatic, perirenal, subcutaneous and intramuscular), of preperitoneal fat as an indirect marker of visceral adiposity and muscle mass, thereby overcoming the limitations of traditional anthropometric markers. These measurements have been associated with cardiovascular risk, renal dysfunction, hepatic steatosis, frailty and hospital-related complications, even among individuals with normal weight. Furthermore, ultrasound can be employed to monitor changes in these compartments following therapeutic interventions. Given its accessibility, low cost, and prognostic value, this technique serves as a valuable tool in the comprehensive evaluation of patients with obesity in Internal Medicine settings, contributing to a more precise, individualized and efficient approach to care.
{"title":"Clinical ultrasound for the characterisation of obesity: beyond the body mass index","authors":"J.A. Peregrina Rivas , I.F. Aomar Millán , L.M. Beltrán Romero , L. Castilla Guerra","doi":"10.1016/j.rceng.2025.502392","DOIUrl":"10.1016/j.rceng.2025.502392","url":null,"abstract":"<div><div>Obesity is a complex and heterogeneus disease, with metabolic risk that is not solely determined by body mass index. The distribution and functionality of adipose tissue– particularly that of white adipocytes– play a critical role in the development of insulin resistance, chronic inflammation and ectopic lipid deposition. Clinical ultrasound enables direct and reproducible characterization of the major fat compartments (epicardial, hepatic, perirenal, subcutaneous and intramuscular), of preperitoneal fat as an indirect marker of visceral adiposity and muscle mass, thereby overcoming the limitations of traditional anthropometric markers. These measurements have been associated with cardiovascular risk, renal dysfunction, hepatic steatosis, frailty and hospital-related complications, even among individuals with normal weight. Furthermore, ultrasound can be employed to monitor changes in these compartments following therapeutic interventions. Given its accessibility, low cost, and prognostic value, this technique serves as a valuable tool in the comprehensive evaluation of patients with obesity in Internal Medicine settings, contributing to a more precise, individualized and efficient approach to care.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502392"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.rceng.2025.502393
I. Martínez de Narvajas Urra, S. Arnedo Hernández, D. Aguiar Cano, M. Ruiz Castellano, J. Oteiza Olaso
Introduction and objectives
In the last few years, the use of point-of-care ultrasound has become widespread on the Internal Medicine Units. However, the literature on its use in Hospital-at-Home (HaH) is insufficient. The objective of the research is to quantify and evaluate the use of point-of-care ultrasound in HaH.
Material and methods
A descriptive observational study of point-of-care ultrasound performed in a HaH Unit between July and December 2022.
Results
85 ultrasounds were performed on 72 patients. The type of ultrasound most frequently performed was multi-organ 71.8% and the most common reason for performing it was the monitoring of patients admitted for heart failure 68%. Hospital displacement was avoided in 72.8% of the situations.
Conclusions
Point-of-care ultrasound is a useful tool in the HaH Unit considering it allows optimizing patient follow-up, improving clinical decision-making, and even avoiding the displacement of patients to the hospital.
{"title":"Point-of-care ultrasound in a Hospital-at-Home Unit: use and limitations","authors":"I. Martínez de Narvajas Urra, S. Arnedo Hernández, D. Aguiar Cano, M. Ruiz Castellano, J. Oteiza Olaso","doi":"10.1016/j.rceng.2025.502393","DOIUrl":"10.1016/j.rceng.2025.502393","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>In the last few years, the use of point-of-care ultrasound has become widespread on the Internal Medicine Units. However, the literature on its use in Hospital-at-Home (HaH) is insufficient. The objective of the research is to quantify and evaluate the use of point-of-care ultrasound in HaH.</div></div><div><h3>Material and methods</h3><div>A descriptive observational study of point-of-care ultrasound performed in a HaH Unit between July and December 2022.</div></div><div><h3>Results</h3><div>85 ultrasounds were performed on 72 patients. The type of ultrasound most frequently performed was multi-organ 71.8% and the most common reason for performing it was the monitoring of patients admitted for heart failure 68%. Hospital displacement was avoided in 72.8% of the situations.</div></div><div><h3>Conclusions</h3><div>Point-of-care ultrasound is a useful tool in the HaH Unit considering it allows optimizing patient follow-up, improving clinical decision-making, and even avoiding the displacement of patients to the hospital.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502393"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145484593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.rceng.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.
{"title":"Prevalence and decision-making in advanced dementia","authors":"A. Castellano Candalija , L. Díez Porres , H. Notario Leo , A. Roca Martiartu , N. Mayoral Canalejas , A. Alonso Babarro","doi":"10.1016/j.rceng.2025.502388","DOIUrl":"10.1016/j.rceng.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":94354,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502388"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.rceng.2025.502386
Miguel Vinicius Vieira Neves Soares, Paulo de Oliveira Vasconcelos Filho, Elaine Gomes da Silva, Leandro Cândido de Souza, Thiago Mazzu do Nascimento, Danilo Nogueira Evangelista, Gustavo 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：评估有再喂养综合征（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：通过对住院成人和老年患者的电子病历进行回顾性、横断面研究。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）；结果：共评估121例患者，其中38.8%出现RS， 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（χ 2 (1) = 7, p . 592）
{"title":"Refeeding syndrome in adult and elderly patients: Retrospective study in a university hospital","authors":"Miguel Vinicius Vieira Neves Soares, Paulo de Oliveira Vasconcelos Filho, Elaine Gomes da Silva, Leandro Cândido de Souza, Thiago Mazzu do Nascimento, Danilo Nogueira Evangelista, Gustavo Zani","doi":"10.1016/j.rceng.2025.502386","DOIUrl":"10.1016/j.rceng.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 18.5 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).</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 (χ²(1) = 7, <em>p</em> < 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":94354,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502386"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.rceng.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.
{"title":"Impact of heart failure on in-hospital mortality during admissions for other conditions","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.rceng.2025.502387","DOIUrl":"10.1016/j.rceng.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 (<em>p</em> = 0.031), elevated NT-proBNP (<em>p</em> = 0.048) and lower hemoglobin (<em>p</em> = 0.004) and albumin (<em>p</em> = 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":94354,"journal":{"name":"Revista clinica espanola","volume":"225 10","pages":"Article 502387"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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