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Introduction: Biological therapies used for the treatment of inflammatory bowel disease (IBD) have shown to be effective and safe, although these results were obtained from studies involving mostly a young population, who are generally included in clinical trials. The aim of our study was to determine the efficacy and safety of the different biological treatments in the elderly population., Methods: Multicenter study was carried out in the GETECCU group. Patients diagnosed with IBD and aged over 65 years at the time of initiating biological therapy (infliximab, adalimumab, golimumab, ustekinumab or vedolizumab) were retrospectively included. Among the patients included, clinical response was assessed after drug induction (12 weeks of treatment) and at 52 weeks. Patients' colonoscopy data in week 52 were assessment, where available. Regarding complications, development of oncological events during follow-up and infectious processes occurring during biological treatment were collected (excluding bowel infection by cytomegalovirus)., Results: A total of 1090 patients were included. After induction, at approximately 12-14 weeks of treatment, 419 patients (39.6%) were in clinical remission, 502 patients (47.4%) had responded without remission and 137 patients (12.9%) had no response. At 52 weeks of treatment 442 patients (57.1%) had achieved clinical remission, 249 patients had responded without remission (32.2%) and 53 patients had no response to the treatment (6.8%). Before 52 weeks, 129 patients (14.8%) had discontinued treatment due to inefficacy, this being significantly higher (p<0.0001) for Golimumab - 9 patients (37.5%) - compared to the other biological treatments analyzed. With respect to tumor development, an oncological event was observed in 74 patients (6.9%): 30 patients (8%) on infliximab, 23 (7.14%) on adalimumab, 3 (11.1%) on golimumab, 10 (6.4%) on ustekinumab, and 8 (3.8%) on vedolizumab. The incidence was significantly lower (p=0.04) for the vedolizumab group compared to other treatments. As regards infections, these occurred in 160 patients during treatment (14.9%), with no differences between the different biologicals used (p=0.61): 61 patients (19.4%) on infliximab, 39 (12.5%) on adalimumab, 5 (17.8%) on golimumab, 22 (14.1%) on ustekinumab, and 34 (16.5%) on vedolizumab., Conclusions: Biological drug therapies have response rates in elderly patients similar to those described in the general population, Golimumab was the drug that was discontinued most frequently due to inefficacy. In our experience, tumor development was more frequent in patients who used anti-TNF therapies compared to other targets, although its incidence was generally low and that this is in line with younger patients based on previous literature., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

The fluid-attenuated inversion recovery (FLAIR) sequence forms part of the vast majority of current diagnostic protocols for brain MRI. This sequence enables the suppression of the signal from cerebrospinal fluid, facilitating the detection of disease involving the subarachnoid space. The causes of hyperintensity in the arachnoid space in this sequence can be divided into two main categories: hyperintensity due to disease and hyperintensity due to artifacts. Hyperintensity due to tumors, inflammation, vascular disease, or hypercellularity of the cerebrospinal fluid or hematic contents is well known. However, numerous other non-pathological conditions, mainly due to artifacts, that are also associated with this finding are a potential source of diagnostic errors., (Copyright © 2022 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

We define a journal club as a group of people who meet to critically read and discuss scientific articles. In medicine, journal clubs are a very important part of training during residency programs. In 2013, the Spanish Society of Medical Radiology's (SERAM) journal club was established with the aim of promoting the acquisition of non-interpretative skills and training in scientific journalism during residency. After nearly 10 years, more than 137 reviewers at 54 hospitals have formed part of the SERAM's journal club. In this time period, the number of reviewers, publications, and visits to our website have increased progressively. The SERAM's journal club currently employs a structured workflow that is organized into quarterly groups and supported by a peer-review system. In the future, the SERAM's journal club aims to internationalize its content beyond the Spanish-speaking community, increase its presence in social networks, and incorporate audiovisual content., (Copyright © 2023 SERAM. Published by Elsevier España, S.L.U. All rights reserved.)

Background and Objectives: This study aims to evaluate the impact of implementing multidisciplinary clinical guidelines in the process of caring for patients with hip fractures., Materials and Methods: This work is a pre- and post-intervention prospective study in the Orthogeriatrics Unit of a second-level hospital after implementing multidisciplinary clinical guidelines for hip fracture care. We analyzed patients' baseline characteristics and the variations observed in care provided and in outcome variables in the two periods studied (June 2015-May 2016 and June 2016-May 2017)., Results: The baseline characteristics of the population were similar in the pre-intervention period (n = 455) compared to the post-intervention period (n = 456). Patients' mean age was 84.8 ± 6.8 years and 70.8% were women. The implementation of the multidisciplinary clinical guidelines led to a reduction in the mean length of hospital stay (16.9 days vs. 15.6 days, p= .014); improved osteoporosis treatment prescribing (51.6% vs. 88%, p< .001); and reduced episodes of delirium (44% vs. 31.2%, p < .001), bronchospasm (18.3% vs. 12%, p = .019), heart failure (20% vs. 11.5%, p < .001), and COPD exacerbation (7.9% vs. 3.8%, P = .017). We observed an increase in pressure ulcers at discharge (2.9 vs. 9%, P < .001). There were no differences in the percentage of operations in less than 48 h (56% vs. 61.2% p = .64), hospital readmissions (6.9% vs. 5.9%, p = .51), or mortality (5.0% vs. 7.2%, p = .17)., Conclusions: The implementation of multidisciplinary clinical guidelines improved aspects of the care process for patients with hip fracture., (Copyright © 2021 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.)

Objective: To undertake the cultural adaptation and the psychometric assessment of the Summary of Diabetes Self-Care Activities measure (SDSCA) in Spanish population with type 2 diabetes mellitus., Design: Clinimetric validation study., Setting: Primary health care centers of District Malaga and Valle del Guadalhorce., Participants: Three hundred thirty-one persons with type 2 diabetes mellitus., Main Measurements: The SDSCA validated in mexican population was subjected to semantic and content equivalence using a Delphi method, its legibility was determined by INFLESZ scale. Subsequently psychometric validation was conducted through exploratory and confirmatory factor analysis (herein after EFA and CFA), internal consistency, test-retest reliability and discriminant validity., Results: Two rounds were needed to achieve the consensus in between the panel members. Then, the index provided a good readability. The EFA suggested a model with 3 factors (diet, exercise and self-analysis) with 7 items which explained 79.16% variance. The results of CFA showed a good fit of SDSCA-Sp. The Internal consistency was moderate to low (α-Cronbach =0.62) and test-retest reliability was evaluated in 198 patients (t=0.462-0.796, p<0.001) with a total correlation of 0.764 (p< 0.0001)., Conclusions: The SDSCA-Sp is used, in a valid way to assess self-care in type 2 DM version in clinical practice and research with similar clinimetric properties to previous studies., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

Infections are frequent and can be severe in recipients of solid organ transplantation. Prevention and treatment are priority objectives of multidisciplinary transplant teams. Interactions between antimicrobials (indicated for prevention and therapy) and immunosuppressants (for preventing rejection) make treatment more complex than in the general population. Co-administration of immunosuppressants and antibiotics can cause harmful interactions, modifying the pharmacokinetic and pharmacodynamic characteristics of both groups of drugs. The loss of the transplanted organ due to reduced levels of immunosuppressants is a unique consequence of the often lethal interactions in this group of patients. By contrast, elevated levels of these drugs cause toxicity, and reduced concentrations of antimicrobial treatment fail to contain the infection. Azoles, rifabutin, protease inhibitors, non-nucleoside reverse transcriptase inhibitors and antimicrobial macrolides all interact with immunosuppressants. In this article, we review interactions between antibiotics and immunosuppressants in order to adopt the most appropriate clinical approach (dosage adjustments, close monitoring of plasma levels and organ function) and determine whether they can be used together with any measure of safety., (Copyright © 2012 Elsevier España S.L. All rights reserved.)

Background: To evaluate the diagnostic usefulness of AUDIT (Alcohol Use Disorders Identification Test) for detecting hazardous alcohol consumption in primary care settings, to assess the potential differences according to age or sex and to compare its diagnostic value with that of other conventionally used measures (CAGE questionnaire and biological markers)., Patients and Method: This is a descriptive cross-sectional study for evaluation of diagnostic tests with 500 participating patients randomly selected among those attending a family health care center. Data about alcohol intake were collected using a semistructured interview, considering as hazardous alcohol consumption a weekly intake of 35 SDUs (standard drink unit) or above for men and 21 for women. AUDIT and CAGE questionnaires were administered and blood levels of GGT, MCV, AST, ALT, alkaline phosphatase, platelets, tryglicerides and uric acid were determined. For each one of those sensitivity, specificity, global value, predictive values, positive and negative probability ratio were calculated as well as ROC analysis for the questionnaires., Results: Sensitivity of AUDIT in detecting current hazardous drinkers was 89%, specificity was 93% and area under ROC was 0.98 (95% CI, 0.96-0.99). Its sensitivity was found to be lower in the female group (60 vs. 78%) as well as for age group under 60 years (86 vs. 100%). CAGE questionnaire showed a sensitivity of 48% and a specificity of 97%. Biological markers offered sensitivities lower than 40% and specificities over 90%., Conclusions: AUDIT is a useful tool for detecting hazardous alcohol consumption in ambulatory care. Its sensitivity being lower for women and its diagnostic usefulness significantly exceeding that of other screening measures commonly used.

Background: Exercise tests has been used in the diagnosis of metabolic myopathies. If there is an abnormal response pattern in mild mitochondrial myopathy (MM) and her role in the initial suspect diagnostic is unknown., Subjects and Methods: Prospective study of 26 patients with mitochondrial myopathy (15 men, 11 women) and a control group of 14 sedentary volunteers (9 men, 5 woman) with similar antropometric characteristics. We have made pulmonary function tests and treadmill exercise with serial venous sampling of blood lactate, piruvate, ketone bodies, free fatty acids and creatinkinase., Results: Patients with MM showed exercise limitation with lower maximal power (MM = 143 [47] vatts, C = 187 [40] vatts, p = 0.006), maximal oxygen uptake (MM = 27 [8] ml/min/kg, C = 40 [7] ml/min/kg, p = 0.001) and maximal oxygen pulse (MM = 11 [3] ml/beat, C = 14 [3] ml/beat, p = 0.006). For the same oxygen uptake the heart rate was higher and the anaerobic threshold was earlier in MM patients (MM = 48% [14], C = 62% [12], p = 0.01). We found a considerable slower maximal oxygen uptake in patients with lipid increase in muscle biopsy (n = 15). Acetoacetate curves, beta-hydroxybutyrate, free fatty acids and creatinkinase were similar in both groups. The exercise test was pathologic in 17/26 of the patients. The sensitivity of the exercise test for maximal oxygen uptake was 0.65., Conclusions: The cardiopulmonary exercise test is a useful test in the suspect initial diagnostic of patients with mild mitochondrial myopathy because the majority of patients show a pathologic test.

Objective: To determine functional social support in patients included in programme of care for chronic patients confined to their homes, and to compare rural area with urban area., Design: Descriptive and crossover study., Setting: Urban and rural health centres., Patients: 103 patients were interviewed in their homes (41 of them were in a rural area and 62 in a urban area). All patients were included in programme of care for chronic patients confined to their homes. Patients with neurological o psychiatric disorders who were not able to answer coherently were excluded., Measurements and Main Results: We used the DUKE-UNC questionnaire which measured the functional social support in two sub-scales: confidential support and affective support. We didn't find any relation between the functional social support and age, sex, civil condition or health problems. Patients of the rural area perceive less confidential support than patients of the urban area. We didn't find any difference in the perception of the affective support between both areas., Conclusions: In the rural area, the patients included in the programme of care for chronic patients confined to their homes perceive less possibility to communicate problems, important events or conflictive situations that require comprehension and help.

One of the few cases of thyrotoxic periodic paralysis in our country is reported. A twenty-one year old male patient with Graves disease for more than three years had a poor compliance with the therapeutical regimen, with mainly nightly episodes of self-limited limb weakness associated with hypokalemia. The patient has no familiar antecedents of periodic paralysis and the clinical manifestations resolved with treatment of hyperthyroidism.

Objective: To determine the characteristics, family surrounding and place of death of terminal oncologic patients from 1991., Design: Descriptive and retrospective study. We used Fisher's test. SITE. San Gregorio, Telde (Las Palmas province)., Patients: We worked with 27 patients in terminal disease (17 were men and 10 were women)., Measurements and Main Results: Average age was 66.7 +/- 17 years. The most frequent type was digestive (10), breast (5) and lung (3). Average time of survival was 17.5 +/- 26.5 months. Principal symptoms were: pain (23), anorexia (17), constipation (13) and depression (11). 23 received analgesia (11 with morphine), 17 laxatives and 13 benzodiazepines. The numbers of visit they received was 13.6 +/- 9.3 patients knew their diagnostic. 22 of the families were considered collaborators. 70% of patients in control by Primary Care Center died at home; whereas no one did so in control by hospital (p = 0.029)., Conclusions: Half of the patients in terminal phase in our zone die in their home. Patients under control by Primary Care Center are significantly more likely to die in their own homes. We give special attention to the high percentage of patients who use opiates. Finally we consider that workers in Primary Care Centers are a vital element in handle these patients and their families.