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Objective To assess whether a sustained optimal haemoglobin value in the 3 months after admission for heart failure (HF) decompensation reduces morbidity and mortality during the 12 months after admission for acute HF. Patients and method Retrospective study of the 1408 patients older than 65 years included in the RICA registry divided into 3 groups: no anaemia (group A), recovered anaemia (group B), and persistent anaemia (group C), according to haemoglobin levels on admission, and 3 months after discharge. Kaplan-Meier curves were constructed, comparing the groups using the log-rank test and a Cox regression model was performed to analyse survival. Results 578 (41.1%), 299 (21.2%) and 531 (37.7%) were included in groups A, B and C, respectively. We recorded a total of 768 deaths and readmissions. There were 23 (4%), 12 (4%) and 49 (9.2%), (p=.001) individuals who died due to HF and 154 (27%), 73 (24%) and 193 (36%) (P Conclusions Persistent anaemia in the months after admission for HF increases morbidity and mortality in the subsequent year.

To evaluate the aspects of the basal bone health status in prostate cancer patients. Furthermore, to evaluate in a real-world setting the effect of different schemes (intermittent or continuous) of androgen deprivation therapy (ADT) and the effect of denosumab in bone mass density (BMD).Observational, retrospective study of a cohort of prostate cancer patients in treatment with luteinizing hormone-releasing hormone (LH-RH) agonists, evaluated in the rheumatology department of a tertiary center. Demographics, FRAX score, LH-RH treatment scheme, osteoporosis treatment, laboratory data and BMD were collected. Mixed effect regression models to analyze the interaction between LH-RH treatment scheme, denosumab and BMD evolution were used.Eighty-three patients (mean age 71±8years) were included. At the basal evaluation, 16% of patients presented densitometric osteoporosis and 27% of patients presented high fracture risk. Eighty percent of patients had inadequate vitaminD levels. VitaminD30ng/mL was correlated with higher T-scores. There was no association between LH-RH treatment scheme and BMD evolution, however there was a positive association with denosumab.A high proportion of patients presented elevated fracture risk or inadequate vitaminD levels, not previously recognized. Bone health assessment and fracture risk evaluation are convenient in these patients. In a real-world setting, the effect of denosumab in BMD is detected, however the effect of intermittent LH-RH schema treatment is less evident.

Background and objectives Sporadic inclusion body myositis (sIBM) diagnosis is frequently delayed or confused with another class of disorders, and misdiagnosis is common. Sometimes, we have problems diagnosing an sIBM in the early stages or predicting when a PM is going to become an sIBM. In this sense, we believe that p62 immunostaining could help clinicians. Case report We report the case of a 61-year-old patient with sIBM who six years earlier had been diagnosed with polymyositis (PM). After muscle biopsies analyses, we showed the natural history of sIBM by p62 expression. Results When we looked for p62 aggregates retrospectively we could see small dotted p62 aggregates in the muscle fibres of the first muscle biopsy. Six years later, the patient presented with the typical clinical picture of sIBM, also the muscle biopsy was characteristic, with large p62 aggregates. Conclusions Probably p62 immunostaining could help to distinguish PM patients that are going to become sIBM, but to date there has been no systematic study to clarify p62 utility in myositis.

Resumen Introduccion y objetivo La sensibilidad de los programas de cribado de cancer colorrectal determina su efectividad y esta directamente relacionada con el cancer de intervalo ( C I). Este estudio describe la frecuencia y las caracteristicas de los CI del Programa de la ciudad de Barcelona y analiza su relacion con el valor cuantitativo del test de cribado previo (FIT). Material y metodos Se incluyen los CI tras FIT negativo de las primeras dos rondas del Programa (2010-2013); periodo de observacion hasta julio de 2017. La fuente de informacion de los CI es su notificacion por profesionales y pacientes y el cruce de bases de datos hospitalarias y CMBD. Resultados La sensibilidad del Programa es del 82%. Los CI se diagnostican mas en colon proximal y recto y en estadios avanzados que los canceres de cribado, y presentan valores FIT mas elevados que el conjunto de personas con FIT negativo. Conclusiones La sensibilidad obtenida es aceptable y comparable a la de otros programas. El valor cuantitativo del FIT en personas con test negativo deberia incluirse en las estrategias de personalizacion del cribado para reducir el riesgo de CI.

Resumen Introduccion El sindrome MELAS –miopatia, encefalopatia, acidosis lactica y episodios similares a ictus– es una citopatia mitocondrial relacionada con varias mutaciones del ADN mitocondrial, siendo la substitucion A3243G en el gen tARN Leu la mas frecuentemente asociada. Pacientes y metodos Aparte de su sintomatologia habitual, los pacientes presentan historia de sordera neurosensorial y diabetes tipo 2 (DM2). Ademas, estudios recientes muestran que algunos pacientes tienen tambien afeccion renal, normalmente en forma de glomeruloesclerosis focal y segmentaria (GFS). Resultados En este articulo se discute la afeccion renal de 2 pacientes no emparentados portadores de la mutacion A3243G. Los 2 presentan sordera neurosensorial y DM2. Se realizo estudio anatomopatologico en ambos. Uno de ellos desarrollo proteinuria en rango nefrotico e insuficiencia renal terminal, con cambios de GFS en la biopsia, mientras que el otro presentaba proteinuria leve e insuficiencia renal, sin cambios histologicos resenables en la microscopia optica. Conclusion La presencia de GFS u otra afeccion glomerular o tubular renal, acompanada de sordera neurosensorial y DM2, podria ser indicativa de la existencia de la mutacion A3243G y estos hallazgos deberian propiciar un estudio genetico y una evaluacion de posible afeccion extrarrenal.

Diabetes, chronic obstructive pulmonary disease (COPD) and anemia are comorbidities with a high prevalence and impact in heart failure (HF). The presence of these comorbidities considerably worsens the prognosis of HF. Diabetic patients have a higher likelihood of developing symptoms of HF and both the treatment of diabetes and that of acute HF are altered by the coexistence of both entities. The glycemic targets in patients with acute HF are not well-defined, but could show a U-shaped relationship. Stress hyperglycemia in non-diabetic patients with HF could also have a deleterious effect on the medium-term prognosis. The inter-relationship between COPD and HF hampers diagnosis due to the overlap between the symptoms and signs of both entities and complementary investigations. The treatment of acute HF is also altered by the presence of COPD. Anemia is highly prevalent and is often the direct cause of decompensated HF, the most common cause being iron deficiency anemia. Iron replacement therapy, specifically intravenous forms, has helped to improve the prognosis of acute HF.

Introduction MELAS syndrome – myopathy, encephalopathy, lactic acidosis and stroke-like episodes – is a maternally-inherited mitochondrial cytopathy related to several mitochondrial DNA mutations, with the A3243G mutation in tRNALeu gene being the most frequent of them. Patients and methods Apart from its typical symptomatology, patients usually exhibit a maternally-inherited history of neurosensory deafness and insulin-dependent type 2 diabetes mellitus (T2DM). Recent studies have shown that few patients carrying a A3243G mutation also suffer from renal dysfunction, usually in form of focal segmental glomerulosclerosis (FSGS). Results In this study we examine kidney involvement in 2 unrelated patients with a A3243G mutation by genetic testing. Both have a maternally-inherited neurosensory deafness and insulin-dependent T2DM. A renal biopsy was performed in both patients. One patient developed nephrotic proteinuria and renal insufficiency, with FSGS findings being observed in the kidney biopsy, whereas the other suffered from mild proteinuria and renal insufficiency, with non-specific glomerular changes. Conclusion The presence of FSGS or other kidney involvement accompanied by hereditary neurosensory deafness and T2DM could be suggestive of a A3243G tRNALeu mutation and should prompt a genetic testing and an evaluation of potential extrarenal involvement.

The transition process from paediatric to adult care is a subject of great interest in recent years, especially in chronic diseases with childhood onset, such as inborn errors of metabolism (IEM). Advances in diagnosis and treatment of these diseases have improved their prognosis, with a high number of patients with IEM who currently reach adult age and need to be attended to by non-paediatric professionals. The objective of this work is to establish action guidelines so that the specialists involved can guarantee a successful transition of these patients' healthcare.After carrying out a bibliographic review of the subject, the authors, beginning with their own experience, produced an initial document which was subjected to successive debates until the final document was obtained. The consensus recommendation was decided by the majority in case of criterion discrepancy.A series of recommendations are presented for the best clinical management of the transitions of care of patients with IEM from the paediatric to adult care setting in order to achieve the best results in this process given the special characteristics of this patient subgroup and the main difficulties entailed in the transition process.The role of the internal medicine doctor in this transition process and correct interrelation with the paediatric and social setting is stressed. Furthermore, actions and attitudes are suggested to improve the quality of said transition.

Resumen Fundamento y objetivo Evaluar el caracter pronostico de la anemia y su etiologia en la insuficiencia cardiaca (IC). Pacientes y metodo Cohorte multicentrica prospectiva de pacientes con IC al ano de ingreso hospitalario. Resultados Un total de 57 (27%) de los 211 pacientes fallecieron y 115 (67,8%) reingresaron. La mortalidad fue superior en el grupo con anemia (31,8%), sin significacion estadistica (p = 0,09) excepto para mortalidad por IC refractaria (p = 0,013). Fueron predictores de mortalidad por IC el indice de Barthel ( hazard ratio [HR] 0,97; intervalo de confianza del 95% [IC 95%] 0,96-0,98) y la creatinina plasmatica al alta (HR 2,28; IC 95% 1,51-3,45), mientras que para reingreso lo fueron el indice de Charlson ( odds ratio [OR] 1,16; IC 95% 0,98-1,38), el tratamiento con antagonistas del calcio (OR 0,29; IC 95% 0,1-0,84) y no ser tratado con digoxina (OR 2,33; IC 95% 1,09-4,97), esta ultima con mayor influencia en el reingreso por IC (OR 3,07; IC 95% 1,39-6,79), junto con no ser el inicio de IC (OR 2,8; IC 95% 1,45-5,39). Conclusiones La anemia supone un mayor riesgo de mortalidad por IC refractaria, pero no de reingreso, en el primer ano tras una descompensacion aguda.

Resumen Fundamento y objetivo Estudiar los trastornos del sueno en pacientes drogodependientes ingresados, en funcion del tipo de consumo y la existencia de desintoxicaciones previas. Pacientes y metodo Se evaluaron 150 adictos ingresados en una unidad de desintoxicacion hospitalaria mediante la entrevista SCID-I. Completaron un cuestionario autoaplicado de 11 items (tipo Likert de 1-minimo a 7-maximo) que evaluo las alteraciones del sueno y su relacion con el consumo. Resultados El 75,3% eran varones. La sustancia principal de ingreso fue en un 39% el alcohol, en el 34,67% cocaina, en el 30% politoxicomanos, en el 22,67% opiaceos, en el 18% benzodiacepinas y en el 14% cannabis. El 68,1% presentaron alteraciones del sueno y el 80,1% relacionaron sus problemas del sueno con la dependencia. Todos los pacientes con ingresos previos (47,3%) mostraban preocupacion por presentar alteraciones del sueno durante el ingreso y referian mayor insomnio (43,7 frente a 22,8%, p Conclusiones Las alteraciones del sueno en drogodependientes son muy frecuentes. Los pacientes con ingresos previos y los politoxicomanos son los que presentan mas alteraciones del sueno.

Resumen Fundamento y objetivo La relevancia clinica de la insuficiencia cardiaca (IC) y de la enfermedad pulmonar obstructiva cronica (EPOC) en un mismo enfermo no esta bien establecida. El objetivo de este trabajo fue estudiar la prevalencia de EPOC en pacientes ingresados por IC, definir su perfil clinico y la relacion con el tratamiento con bloqueadores beta. Pacientes y metodo Analisis de una cohorte prospectiva de pacientes ingresados en 15 servicios de Medicina Interna desde octubre de 2005 hasta marzo de 2006. El diagnostico de EPOC se establecio por criterios clinicos o espirometria. Se recogieron datos sobre el tratamiento neurohormonal antes, durante y tras el ingreso hospitalario. Se utilizo la prueba de ji al cuadrado y la t de Student. Con las variables significativas se construyo un modelo de regresion logistica. En todos los casos se considero una significacion bilateral para p Resultados Se incluyo a 391 pacientes, con una prevalencia de EPOC del 25,1%. En dos tercios de los pacientes se establecio el diagnostico solo por criterios clinicos. El 23,5% de los enfermos tenia un estadio moderado o grave de EPOC. En el analisis bivariante se relaciono la presencia de EPOC con el sexo masculino (p Conclusiones La prevalencia de EPOC es elevada en IC, y el perfil es el de un hombre de edad avanzada, con elevada comorbilidad y sobrepeso. El tratamiento con betabloqueadores se condiciona por el deterioro de la funcion ventricular, sin relacion con la EPOC.

Resumen Fundamento y objetivo La inflamacion y el estres oxidativo intervienen en el desarrollo de la patogenia de los sindromes coronarios agudos (SCA). El objetivo de este estudio ha sido analizar las concentraciones sericas de la proteina C reactiva de alta sensibilidad (PCR-as) y del malondialdehido (MDA) en pacientes con SCA consumidores de cocaina. Pacientes y metodo Se ha realizado un analisis retrospectivo de 43 pacientes con SCA y test de cocaina positiva en orina, a quienes se comparo con una muestra de 49 pacientes con este diagnostico y sin consumo de cocaina. Se valoraron las caracteristicas clinicas, analiticas, electrocardiograficas y hemodinamicas. Resultados Ambos grupos fueron similares en las caracteristicas clinicas, analiticas, electrocardiograficas y hemodinamicas, excepto que los pacientes con SCA y cocaina positiva eran mas jovenes y predominaba la elevacion transitoria del segmento ST. Los valores de PCR-as fueron menores para el grupo de SCA y cocaina positiva (media de 4,82 [DE: 0,67] frente a 5,34 [DE: 0,81] mg/l; p Conclusiones El estres oxidativo desempena un papel preponderante sobre la inflamacion en los diversos mecanismos que involucran a la cocaina en la patogenia de los SCA, independientemente de la edad y los factores de riesgo cardiovasculares.