Executive summary of the consensus document for the training and development of clinical ultrasound in Internal Medicine: Recommendations from the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine (GTECO-SEMI).

INTRODUCTION: Given the increasing adoption of clinical ultrasound in medicine, it is essential to standardize its application, training, and research. OBJECTIVES AND METHODS: The purpose of this document is to provide consensus recommendations to address questions about the practice and operation of clinical ultrasound units. Nineteen experts and leaders from advanced clinical ultrasound units participated. A modified Delphi consensus method was used. RESULTS: A total of 137 consensus statements, based on evidence and expert opinion, were considered. The statements were distributed across 10 areas, and 99 recommendations achieved consensus. CONCLUSIONS: This consensus defines the most important aspects of clinical ultrasound in the field of Internal Medicine, with the aim of standardizing and promoting this healthcare advancement in its various aspects. The document has been prepared by the Clinical Ultrasound Working Group and endorsed by the Spanish Society of Internal Medicine.

Sample Treatment with Trypsin for RT-LAMP COVID-19 Diagnosis.

The SARS-CoV-2 coronavirus is responsible for the COVID-19 pandemic resulting in a global health emergency. Given its rapid spread and high number of infected individuals, a diagnostic tool for a rapid, simple, and cost-effective detection was essential. In this work, we developed a COVID-19 diagnostic test, that incorporates a human internal control, based on the Reverse Transcription Loop-Mediated Isothermal Amplification (RT-LAMP). When working with synthetic SARS-CoV-2 RNA, the optimized RT-LAMP assay has a sensitivity of 10 viral copies and can be detected by fluorescence in less than 15 min or by the naked eye in 25 min using colorimetric RT-LAMP. To avoid the RNA extraction step, a pre-treatment of the sample was optimized. Subsequently, a validation was performed on 268 trypsin treated samples (including nasopharyngeal, buccal, and nasal exudates) and amplified with colorimetric RT-LAMP to evaluate its sensitivity and specificity in comparison with RT-qPCR of extracted samples. The validation results showed a sensitivity and specificity of 100% for samples with Ct ≤ 30. The rapid, simple, and inexpensive RT-LAMP SARS-CoV-2 extraction-free procedure developed may be an alternative test that could be applied for the detection of SARS-CoV-2 or adapted to detect other viruses present in saliva or nasopharyngeal samples with higher sensitivity and specificity of the antibody test.

The nutritional status of the elderly patient infected with COVID-19: the forgotten risk factor?

BACKGROUND: Since the first cases of COVID-19 were reported in Wuhan, the nutritional status of individuals infected with the virus has not been included in the risk profiles prepared. However, nutritional status, along with other factors, is decisive in the evolution of patients with other infectious diseases. The nutritional status of individuals is considered an indicator of health status. Furthermore, optimal nutritional status transcends the individual, and poor diet in a population can be considered a group risk factor. Evidence exists on the influence that diet has on the immune system and susceptibility to disease. OBJECTIVE: To evaluate the nutritional status of patients older than 65 years who were admitted due to COVID-19 and how this has influenced the evolution of patients. DESIGN: This prospective and observational study was performed in patients with COVID-19 infection confirmed by real-time polymerase chain reaction. Data were collected from the first 24 h of admission. All patients admitted during one month to the wards assigned to COVID-19 infection were included. RESULTS: A total of 83 patients were studied. The statistical study of mortality showed associations with age (p = .005), living in a nursing home (p = .022), a high Charlson Comorbidity Index (p = .039), hypertension (p = .032), comorbidities of dementia (p = .019) and cerebral vascular disease (p = .041), and Barthel Index (p = .010). The analysis of the influence of the nutritional state on mortality revealed a statistical association between malnutrition and mortality in the pooled data analysis (p = .005) and analysis by degrees of malnutrition (p = .27). CONCLUSIONS: Malnutrition was a risk factor as powerful as others such as hypertension, age, and different comorbidities. We must evaluate and treat the nutritional status of elderly patients with COVID-19 infection since it directly affects their evolution.

La importancia de la dependencia en la valoración global del paciente hospitalizado / The Importance of Dependence in Global Assessment of Hospitalized Patient

No disponible

Evaluation and characterization of multimorbidity profiles, resource consumption and healthcare needs in extremely elderly people.

OBJECTIVES: Spanish population lifespan is one of the longest in the world. Moreover, it is known that elderly people have less chronic illnesses associated with aging. Our aims were to determine how Clinical Risk Group (CRG) predicts future use of healthcare resources in extremely elderly people without diabetes (T2DM) and to explore CRG correlation with health conditions. DESIGN: Prospective cross-sectional study. SETTING: Rio Hortega University Hospital. PARTICIPANTS: Hospitalized patients >80 years old without T2DM, during 2017. MAIN OUTCOME MEASURES: Mental status was evaluated using Pfeiffer test (SPMQS), Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) were estimated using the Older Americans Resources and Services questionnaire. Comorbidity was evaluated using Charlson index (CI) and health-related quality of life (HRQoL) with EuroQoL (EQ5D3L). CRG classification system was obtained from electronic clinical records. Data were analyzed using SPSS v.15.0. RESULTS: In total, 305 patients were identified (59% women), mean age 88 ± 5 and 38% were aged >90. Estimated HRQoL was 0.43 ± 0.33 for EQ5D3L-index-value. Mean dependence level was 6.2 ± 5 for BADLs and 9.2 ± 5 for IADLs. In total, 31.6% of patients had severe cognitive impairment with a mean score of 5.4 ± 3.6 in SPMQS. In total, 30.2% of patients were categorized as G3, and presented high comorbidity more frequently than the rest. Corrected CI mean score was 6.2 ± 1.7. Significant relationship was founded in survival time, number of admissions and CI score. CONCLUSIONS: Using predictive risk models like CRG is supposed to assess the complexity of morbidity but in our extremely elderly population partially fail in stratify and predict health resource consumption.

Respiratory chain polymorphisms and obesity in the Spanish population, a cross-sectional study.

OBJECTIVE: To study the association of genes involved in the mitochondrial respiratory chain (MRC) pathway with body mass index (BMI) and obesity risk. DESIGN: This work studies three cross-sectional populations from Spain, representing three provinces: HORTEGA (Valladolid, Northwest/Centre), SEGOVIA (Segovia, Northwest/centre) and PIZARRA (Malaga,South). SETTING: Forty-eight single nucleotide polymorphisms (SNPs) from MRC genes were selected and genotyped by SNPlex method. Association studies with BMI and obesity risk were performed for each population. These associations were then verified by analysis of the studied population as a whole (3731 samples). PARTICIPANTS: A total of 3731 Caucasian individuals: 1502 samples from HORTEGA, 988 from PIZARRA and 1241 from SEGOVIA. RESULTS: rs4600063 (SDHC), rs11205591 (NDUFS5) and rs10891319 (SDHD) SNPs were associated with BMI and obesity risk (p values for BMI were 0.04, 0.0011 and 0.0004, respectively, and for obesity risk, 0.0072, 0.039 and 0.0038). However, associations between rs4600063 and BMI and between these three SNPs and obesity risk are not significant if Bonferroni correction is considered. In addition, rs11205591 and rs10891319 polymorphisms showed an additive interaction with BMI and obesity risk. CONCLUSIONS: Several polymorphisms from genes coding MRC proteins may be involved in BMI variability and could be related to the risk to become obese in the Spanish general population.

A gene-environment interaction analysis of plasma selenium with prevalent and incident diabetes: The Hortega study.

BACKGROUND: Selenium and single-nucleotide-polymorphisms in selenoprotein genes have been associated to diabetes. However, the interaction of selenium with genetic variation in diabetes and oxidative stress-related genes has not been evaluated as a potential determinant of diabetes risk. METHODS: We evaluated the cross-sectional and prospective associations of plasma selenium concentrations with type 2 diabetes, and the interaction of selenium concentrations with genetic variation in candidate polymorphisms, in a representative sample of 1452 men and women aged 18-85 years from Spain. RESULTS: The geometric mean of plasma selenium levels in the study sample was 84.2µg/L. 120 participants had diabetes at baseline. Among diabetes-free participants who were not lost during the follow-up (N=1234), 75 developed diabetes over time. The multivariable adjusted odds ratios (95% confidence interval) for diabetes prevalence comparing the second and third to the first tertiles of plasma selenium levels were 1.80 (1.03, 3.14) and 1.97 (1.14, 3.41), respectively. The corresponding hazard ratios (95% CI) for diabetes incidence were 1.76 (0.96, 3.22) and 1.80 (0.98, 3.31), respectively. In addition, we observed significant interactions between selenium and polymorphisms in PPARGC1A, and in genes encoding mitochondrial proteins, such as BCS1L and SDHA, and suggestive interactions of selenium with other genes related to selenoproteins and redox metabolism. CONCLUSIONS: Plasma selenium was positively associated with prevalent and incident diabetes. While the statistical interactions of selenium with polymorphisms involved in regulation of redox and insulin signaling pathways provide biological plausibility to the positive associations of selenium with diabetes, further research is needed to elucidate the causal pathways underlying these associations.

Grado de satisfacción e importancia de los cuidados durante la fase final de la vida / Satisfaction and importance of care during the final stage of life

OBJETIVO: Conocer la importancia otorgada a diferentes aspectos de la atención recibida y el grado de satisfacción de los familiares de pacientes durante la fase final de la vida. Material y MÉTODO: Estudio prospectivo mediante cuestionario postal que se envió a los familiares de los éxitus ocurridos en los Servicios de Oncología, Medicina Interna y Hospitalización a Domicilio. RESULTADOS: La tasa de respuesta fue baja (32%) pero similar a la de otros trabajos relacionados. La mayor satisfacción se obtuvo con el alivio del dolor (87,5%) y la disponibilidad de las enfermeras (91,4%), sin embargo, la disponibilidad de los médicos fue uno de los aspectos peor valorados a pesar de ser considerado muy importante (17,2% grupo insatisfechos). El mayor porcentaje de insatisfacción se obtuvo en las cuestiones relacionadas con la información proporcionada por el personal médico. CONCLUSIONES: Aunque muchos de los aspectos de la atención fueron valorados satisfactoriamente, la comunicación con el paciente y sus familiares es una asignatura pendiente común a otros trabajos, favorecerla va a mejorar el grado de satisfacción y, por lo tanto, la calidad del cuidado

AIMS: To determine the level of satisfaction of patient families, and the importance given to different care aspects during the final stage of life. MATERIAL AND METHODS: A prospective study using a postal questionnaire sent to the families of patients that died in the care of Medical Oncology, Internal Medicine, and Home Care Services. RESULTS: The response rate was low (32%), but similar to other related works. The greatest satisfaction was obtained by pain relief (87.5%) and nurse availability (91.4%). However, doctor availability was one of the worst rated aspects despite being considered very important (17.2% dissatisfied group). The lowest percent of satisfaction was obtained in relation to the information provided by the medical staff. CONCLUSIONS: Although several care aspects were rated satisfactorily, the communication with the patient and their families is an unresolved matter. Promotion of communication will improve satisfaction and, therefore, the quality of care

Relationship among angiotensin-converting enzyme polymorphism, cardiovascular risk, and osteoporotic fractures.

OBJECTIVE: Angiotensin-converting enzyme (ACE) has been related to cardiovascular physiology and bone remodeling. Our aim was to assess the relationship among ACE polymorphisms, cardiovascular risk, and osteoporotic fractures. MATERIAL AND METHODS: We prospectively enrolled 71 patients with hypertension from 2001 to 2014. Sociodemographic and medical data were collected. Comorbidity was evaluated with Charlson index. Densitometric studies on lumbar spine were performed. ACE polymorphism was analyzed by polymerase chain reaction. Data were analyzed using SPSS 15.0 (p value <0.05). RESULTS: Homozygous deletion (DD) genotype was described in 32.4% of patients, homozygous insertion (II) in 19.7%, and heterozygous insertion/deletion (ID) in 47.9%. On stratifying data by ACE polymorphism, we observed that DD carriers demonstrated neither greater cardiovascular risk factors (30.4% vs. 33.3%, p=0.4) and higher comorbidity (34.8% vs. 22.9%, p=0.3) nor higher osteoporotic fracture incidence (17.4% vs. 16.8%, p=0.9). In women, no significant differences were observed between DD homozygous individuals and ID+II subjects. CONCLUSION: It is unclear whether DD genotype is an independent risk factor for cardiovascular disease. In contrast to our expectations, we found no relationship among the DD genotype, cardiovascular risk, and osteoporotic fracture incidence.

T-cell primary leptomeningeal lymphoma in cerebellopontine angle.

Primary meningeal lymphomas are very rare and those derived from T cells are even more infrequent (less than 5% of primary central nervous system lymphomas). Cerebellopontine angle involvement in the primary T-cell lymphoma is exceptional. Clinical presentation depends on the type of lesions, and histological diagnosis is needed. We present a rare case of a 50-year-old woman who presented with clinical cerebellar syndrome with posterior opsoclonus-myoclonus syndrome. Necropsy evaluation revealed primary diffuse leptomeningeal non-Hodgkin's T-cell lymphoma.

Sarcoidosis and sacroiliitis, a case report.

Sarcoidosis is a multisystem disorder of unknown etiology characterized by the presence of non-caseating granulomas in the organs affected. Sarcoid arthropathy is a rare manifestation, and sacroiliitis is an unusual first manifestation of the disorder.

[Factors associated with antiretroviral treatment and their influence on health related quality of life in HIV infected patients]. / Factores relacionados con el tratamiento antirretroviral y su influencia en la calidad de vida relacionada con la salud en personas infectadas por VIH.

OBJECTIVES: Access to antiretroviral treatment (ART) has become essential to delay HIV clinical progression and increase survival, so improving Health Related Quality of Life (HRQL). The aim of this investigation was to describe factors associated with ART and their impact on HRQL in HIV infected patients. METHODS: A cross-sectional study on 150 HIV-outpatients in a tertiary hospital was designed, and ART-related data collected. Adherence was assessed by the SMAQ questionnaire. HRQL data were collected by disease-specific questionnaire MOS-HIV (Medical Outcomes Study HIV Health Survey). RESULTS: A total of 84% of patients were on ART. Half of the treatment regimens were Protease inhibitor (PI) based, LPV/r being the most commonly used drug. The large majority of treatments used (89.7%) were second line or successive, and NNRTI-based combinations were the most used in first line. Lipodystrophy was the most frequently referred side-effect (61.1%). Almost all (94.5%) of our patients declared they were adapting well to treatment in their daily-life-activities, with 64.3% adhering to treatment according to the SMAQ (Simplified Medication Adherence Questionnaire) questionnaire. In the HRQL, patients with PI-based treatment got lower scores in 4 of 11 domains with the MOS-HIV questionnaire; while patients that adapted well to their ART had better scores in 4 of 11 domains and overall HRQL assessment in MOS-HIV. CONCLUSIONS: Most of our patients were on ART during our investigation. We have documented a negative association between PI-based treatment and HRQL domains, and a positive association between subjective ART adaptation and HRQL. The assessment of HRQL in this population has increasing interest as it is influenced by ART related factors as treatment improves life conditions of HIV infected people.

Factores relacionados con el tratamiento antirretroviral y su influencia en la calidad de vida relacionada con la salud en personas infectadas por VIH / Factors associated with antiretroviral treatment and their influence on health related quality of life in HIV infected patients

Objetivo El acceso al tratamiento antirretroviral (TARV) retrasa la progresión clínica del VIH y aumenta la supervivencia, mejorando la calidad de vida relacionada con la salud (CVRS). El objetivo de nuestra investigación fue describir los factores asociados al TARV y su influencia en la CVRS en personas infectadas por VIH. Material y método Se diseñó un estudio transversal en 150 pacientes con VIH de un hospital de tercer nivel, recogiéndose datos relativos al TARV. La adherencia se valoró con el cuestionario SMAQ (Simplified Medication Adherence Questionnaire). Los datos de CVRS se obtuvieron con el cuestionario MOS-HIV (Medical Outcomes Study HIV Health Survey).Resultados El 84% de nuestros pacientes estaban en TARV. La mitad de las pautas se basaban en inhibidores de la proteasa (IP), siendo LPV/r el fármaco de este grupo más empleado. En el 89,7% el régimen era el segundo o sucesivo, y la combinación basada en no análogos la más empleada en el tratamiento de primera línea. La lipodistrofia fue el efecto secundario más referido (61,1%). El 94,5% adaptaba bien el TARV a su vida diaria, siendo adherentes el 64,3%, según el cuestionario SMAQ. En cuanto a la CVRS, los pacientes con IP obtuvieron peores puntuaciones en 4 de las 11 dimensiones del cuestionario MOS-HIV. Los pacientes que dijeron adaptar bien el TARV presentaron mejores puntuaciones en 4 de las 11 dimensiones y en la valoración global del MOS-HIV. Conclusiones La prevalencia de pacientes en TARV en nuestra serie fue alta, habiéndose documentado relación negativa entre la toma de IP y CVRS, y positiva entre adaptación subjetiva del TARV y CVRS. La valoración de la CVRS en estos pacientes es importante, ya que se ve influida por factores relativos al TARV, dado que este mejora las condiciones vitales de las personas infectadas por VIH (AU)

Objectives Access to antiretroviral treatment (ART) has become essential to delay HIV clinical progression and increase survival, so improving Health Related Quality of Life (HRQL). The aim of this investigation was to describe factors associated with ART and their impact on HRQL in HIV infected patients. Methods A cross-sectional study on 150 HIV-outpatients in a tertiary hospital was designed, and ART-related data collected. Adherence was assessed by the SMAQ questionnaire. HRQL data were collected by disease-specific questionnaire MOS-HIV (Medical Outcomes Study HIV Health Survey).Results A total of 84% of patients were on ART. Half of the treatment regimens were Protease inhibitor (PI) based, LPV/r being the most commonly used drug. The large majority of treatments used (89.7%) were second line or successive, and NNRTI-based combinations were the most used in first line. Lipodystrophy was the most frequently referred side-effect (61.1%). Almost all (94.5%) of our patients declared they were adapting well to treatment in their daily-life-activities, with 64.3% adhering to treatment according to the SMAQ (Simplified Medication Adherence Questionnaire) questionnaire. In the HRQL, patients with PI-based treatment got lower scores in 4 of 11 domains with the MOS-HIV questionnaire; while patients that adapted well to their ART had better scores in 4 of 11 domains and overall HRQL assessment in MOS-HIV. Conclusions Most of our patients were on ART during our investigation. We have documented a negative association between PI-based treatment and HRQL domains, and a positive association between subjective ART adaptation and HRQL. The assessment of HRQL in this population has increasing interest as it is influenced by ART related factors as treatment improves life conditions of HIV infected people (AU)