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To describe the care provided at the end of life for patients who die in internal medicine departments.An observational, cross-sectional, retrospective multicentre, clinical audit study was conducted where each hospital included the first 10 patients who died in the internal medicine department starting on December 1, 2015. We collected demographic and clinical data and information regarding the circumstances and care at the time of death.The study included 1,447 patients with a median age of 84 years. Of these, 1,065 (74.3%) were polypathological, 751 (51.9%) were terminal and 248 (17.1%) had cancer. For the terminal patients, do-not-resuscitate orders were established for 539 (73.3%), and palliative sedation was performed for 422 (57.4%). There was no record as to whether psychological, religious or grief care was provided in 32%, 64.8% and 44.1% of the terminal patients, respectively. The patients with cancer were more often competent to make decisions (54.4% vs. 15.5%; P.001), knew their prognosis (42.6% vs. 8.6%; P.001), received psychological care (24.9% vs. 8.6%; P.001), died in an individual room (64.6% vs. 44.4%; P.001) and were accompanied (81.9% vs. 71.9%; P=.003). Their relatives also more frequently received grief care (15.6% vs. 8.2%; P=.002).There is insufficient recording in the medical history as to the end-of-life care. There are differences in the care provided to patients with cancer and to those without cancer.

Cystatin C (CysC) is a protease encoded by housekeeping genes. Although its prognostic value in heart failure (HF) is well known, it is debatable whether this value is due to the greater accuracy of CysC in calculating the glomerular filtration rate or to its involvement in pathological ventricular remodelling. The aim of this study was to determine whether CysC expression changes in the myocardium of foetuses of different ages and in the myocardium of adults with various cardiovascular diseases, as well as to analyse the correlation between its serum concentrations and cardiac structure and morphology in a patient group with HF.We analysed the correlations (Pearson's r and Spearman's test) between the serum CysC levels and echocardiographic parameters of 351 patients with HF. We also performed immunohistochemical staining for CysC, metalloproteinase-9 (MMP-9) and desmin in 9 cardiac tissue samples from autopsies of 4 foetuses of different gestational ages and 5 healthy adults or adults with cardiovascular disease.For the patients with HF, there was no correlation between the CysC concentrations and the cardiac parameters measured by 2D echocardiography. The immunohistochemistry showed a weak background staining for CysC in all samples, regardless of age and the presence or absence of cardiovascular diseases.Our results suggest that CysC does not have a significant role in the pathological remodelling of the left ventricle in HF.

Medical interconsultation for hospitalised patients is a regular activity among internal medicine specialists. However, despite its growing impact and importance, a model that defines its characteristics, objectives and information has not been established. This study, conducted by the Shared Care and Interconsultations Group of the Spanish Society of Internal Medicine, proposes a number of general recommendations concerning the method for requesting and responding to hospital medical interconsultations, as well as a format for these interconsultations.

Evaluate comorbidity in patients hospitalized due to COPD in the Internal Medicine services.An observational, prospective and multicenter study. The Charlson index and a specific questionnaire were used.A total of 398 patients, 353 men (89%), with mean age of 73.7 years (8.9) and mean FEV(1) of 43.2% (12.5), were included. The most frequent comorbidities were: arterial hypertension (55%), arrhythmias (27%) and diabetes mellitus (26%). A total of 27% suffered heart failure, 17% coronary disease and 9% previous myocardial infarction. The number of associated chronic diseases was 3.6 (1,8). Score on Charlson index was 2.72 (2).The patients hospitalized due to decompensated COPD had an elevated comorbidity.

Two cases of multiple compartment syndrome in two male patients with history of drug and alcohol abuse are here reported. The clinical picture, course, therapy and sequelae are described and a special emphasis is placed on triggering causes. Given the increasing number of patients presenting to the Emergency Departments with history of overdose and in comatose status, an early clinical suspicion of these pictures is worth noting to avoid severe sequelae which, if not treated early, are irreversible and lead to permanent disability.

Lyme's disease (LD) is a multisystemic infection due to Borrelia Burgdorferi transmitted through the byte of a vector arthropod of the Ixodes genre. Until now we do not know exactly which is the geographical distribution in our setting, no case have been published in the Aragon Community. We present four patients diagnosed of Lyme's disease following clinical and serological criteria (IFI) according to the recommendations of the Spanish Group for the study of Lyme's disease. A patient with Chronic Migratory Erythema (ECM); two others in stage II--one with predominant dermal lesions and other with predominant neurological symptoms--and finally, a patient in stage III with polyarticular symptoms and with antecedent of having showed a lymphocytic meningoencephalitis.

Idiopathic retroperitoneal fibrosis (IRF) is a disease difficult to diagnose. It is considered by different authors of autoimmune origin given its similarity to other connective tissue diseases. We present the case of a female patient diagnosed by a postmortem study, of IRF with multiorgan involvement (lymph nodes, serose tissue, liver, spleen, adrenal glands, thyroid and kidneys) and atypical presentation, not finding other similar cases in the national literature.