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Background: Spain has been one of the countries most affected by the COVID-19 pandemic. Objective: To create a registry of patients with COVID-19 hospitalized in Spain, in order to improve our knowledge of the clinical, diagnostic, therapeutic, and prognostic aspects of this disease. Methods: A multicentre retrospective cohort study, including consecutive patients hospitalized with confirmed COVID-19 throughout Spain. Epidemiological and clinical data, additional tests at admission and at seven days, treatments administered, and progress at 30 days of hospitalization were collected from electronic medical records. Results: Up to June 30th 2020, 15,111 patients from 150 hospitals were included. Their median age was 69.4 years (range: 18-102 years) and 57.2% were male. Prevalences of hypertension, dyslipidemia, and diabetes mellitus were 50.9%, 39.7%, and 19.4%, respectively. The most frequent symptoms were fever (84.2%) and cough (73.5%). High values of ferritin (73.5%), lactate dehydrogenase (73.9%), and D-dimer (63.8%), as well as lymphopenia (52.8%), were frequent. The most used antiviral drugs were hydroxychloroquine (85.6%) and lopinavir/ritonavir (61.4%); 33.1% developed respiratory distress. Overall mortality rate was 21.0%, with a marked increase with age (50-59 years: 4.7%, 60-69 years: 10.5%, 70-79 years: 26.9%, ≥ 80 years: 46.0%). Conclusions: The SEMI-COVID-19 Network provides data on the clinical characteristics of patients with COVID-19 hospitalized in Spain. Patients with COVID-19 hospitalized in Spain are mostly severe cases, as one in three patients developed respiratory distress and one in five patients died. These findings confirm a close relationship between advanced age and mortality., Antecedentes: España ha sido uno de los países más afectados por la pandemia de COVID-19.Objetivo: Crear un registro de pacientes hospitalizados en España por COVID-19 para mejorar nuestro conocimiento sobre los aspectos clínicos, diagnósticos, terapéuticos y pronósticos de esta enfermedad. Métodos: Estudio de cohorte retrospectiva, multicéntrico, que incluye pacientes consecutivos hospitalizados con COVID-19 confirmada en toda España. Se obtuvieron los datos epidemiológicos y clínicos, las pruebas complementarias al ingreso y a los 7 días de la admisión, los tratamientos administrados y la evolución a los 30 días de hospitalización de las historias clínicas electrónicas. Resultados: Hasta el 30 de junio de 2020 se incluyeron 15.111 pacientes de 150 hospitales. Su mediana de edad fue 69,4 años (rango: 18-102 años) y el 57,2% eran hombres. Las prevalencias de hipertensión, dislipemia y diabetes mellitus fueron 50,9%, 39,7% y 19,4%, respectivamente.Los síntomas más frecuentes fueron fiebre (84,2%) y tos (73,5%). Fueron frecuentes los valores elevados de ferritina (73,5%), lactato deshidrogenasa (73,9%) y dímero D (63,8%), así como lalinfopenia (52,8%). Los fármacos antivirales más utilizados fueron la hidroxicloroquina (85,6%)y el lopinavir/ritonavir (61,4%). El 33,1% desarrolló distrés respiratorio. La tasa de mortalidad global fue del 21,0%, con un marcado incremento con la edad (50-59 años: 4,7%; 60-69 años:10,5%; 70-79 años: 26,9%; ≥ 80 años: 46%).Conclusiones: El Registro SEMI-COVID-19 proporciona información sobre las características clínicas de los pacientes con COVID-19 hospitalizados en España. Los pacientes con COVID-19 hospitalizados en España son en su mayoría casos graves, ya que uno de cada 3 pacientes desarrolló distrés respiratorio y uno de cada 5 pacientes falleció. Nuestros datos confirman una estrecha relación entre la edad avanzada y la mortalidad, La Sociedad Española de Medicina Interna (SEMI) es la patrocinadora de este estudio.

Statins are generally well tolerated, but muscular adverse effects appear to be the most common obstacle limiting their use. Our objective was to describe the severity of muscle injury (myalgia, myositis and rhabdomyolysis) and associated conditions related to statin therapy that may be clinically significant.A cross-sectional one-visit, non-interventional, national multicenter study including patients of both sexes over 18 years of age referred for past or present muscle symptoms associated with statin therapy was conducted. Clinical, biochemical and drug therapy characteristics were obtained at the initial evaluation.3,845 patients were recruited from a one-day record from 2,001 physicians. Myalgia was present in 78.2% of patients, myositis in 19.3% and rhabdomyolysis in 2.5%. The prevalence of different comorbidities such as diabetes, hypertension, atrial fibrillation, and coronary heart disease increased as the severity of myopathy rose. High-intensity statin therapy was used in 33.4% of patients. Concomitant drugs metabolized by the CYP450 3A4 pathway were taken by 9.3% of patients, and statins with this metabolic route by 75%. Independent variables associated with myositis or rhabdomyolysis compared with myalgia alone in the multivariate model were excessive alcohol consumption and pravastatin therapy.Myalgia was the most common muscle adverse effect associated with statin therapy. Excessive alcohol consumption and pravastatin were independently associated with myositis or rhabdomyolysis.

Background and objective Atherogenic dyslipidaemia is underdiagnosed, undertreated, and under-controlled. The aim of the present study was to assess the positioning of clinical guidelines as regards atherogenic dyslipidaemia. Material and method The major clinical guidelines of scientific societies or official agencies issued between January 1, 2012 and March 31, 2015 were collected from the MEDLINE database. High-density lipoprotein (HDL) cholesterol, triglycerides, atherogenic dyslipidaemia, non-HDL cholesterol, and apolipoprotein (apo) B were gathered from the 10 selected guidelines, and it was assessed whether these parameters were considered a cardiovascular risk factor, a therapeutic target, or proposed a pharmacological strategy. Results American guidelines, except the National Lipid Association (NLA), do not consider HDL cholesterol and triglycerides in cardiovascular prevention. The NLA emphasises the relevance of atherogenic dyslipidaemia. The Canadian guidelines introduced non-HDL cholesterol and ApoB as alternative targets, and proposes non-statin treatment in the presence of low HDL cholesterol and hypertriglyceridaemia. The International Atherosclerosis Society (IAS) and National Institute for Health and Care Excellence (NICE) guidelines promote the importance of non-HDL cholesterol. European, Brazilian and Japanese guidelines highlight HDL cholesterol and triglycerides, but with the limitation that the main evidence comes from sub-analysis of clinical studies. Conclusions The clinical guidelines analysed do not consider, or unconvincingly address, the importance of atherogenic dyslipidaemia.

Introducción. Presentamos los resultados de la evaluación de las Jornadas Complutenses de Investigación para alumnos de pregrado en Ciencias de la Salud, una actividad académica con dos años de experiencia y una participación de 1.434 alumnos, creada en nuestra universidad para impulsar en los alumnos de pregrado habilidades comunicativas y de metodología en investigación. Sujetos y métodos. Mediante una encuesta anónima se evaluó en los alumnos el grado de satisfacción e interés (aprender metodología científica, aprender a hablar en público, etc.) y también en los moderadores de mesas (originalidad, planteamiento metodológico, presentación iconográfica, exposición oral, viabilidad y relevancia de las comunicaciones presentadas). Resultados. En las I Jornadas se inscribieron 500 alumnos, todos de la Universidad Complutense de Madrid (UCM), y se presentaron un total de 169 comunicaciones (129 orales, 40 pósters). En las II Jornadas lo hicieron 934 alumnos, 838 de la UCM y 96 de otras nueve universidades, y se presentaron un total de 286 comunicaciones (180 orales, 106 pósteres). Conclusiones. Es una actividad en la que el alumno pasa a ser un gestor activo y difusor de aprendizaje, y potencia de una manera dinámica habilidades en comunicación científica. También tiene beneficios para el profesorado y la institución universitaria, que la convierten en una ‘terapia pedagógica holística'. Introduction. We present here the results of the appraisal of the Complutense Conference on Research for undergraduate students in Health Sciences, an academic activity which has been running for two years, with the participation of 1,434 students. It was set up in this University to encourage communication skills and research methodology among undergraduate students. Subjects and methods. By means of an anonymous survey, the levels of satisfaction and interest of the students were evaluated (learning scientific methodology, learning to speak in public, etc.); similarly, that of the panel moderators (originality, methodological approach, iconographic presentation, oral presentation, viability and relevance of presentations given). Results. The First Conference had 500 registered students, all from the Complutense University of Madrid (UCM), with a total of 169 presentations (129 oral, 40 poster). In the Second Conference there were 934 students, 838 from the UCM and 96 from nine other universities, with a total of 286 presentations (180 oral, poster 106). Conclusions. This is an activity in which the student becomes an active manager and imparter of learning, and dynamically reinforces his or her skills in science communication. It also has benefits for teachers and the University itself, making it a ‘holistic pedagogical therapy'.

Las nuevas necesidades en la formación de los futuros médicos, particularmente aquéllas relacionadas con la definición, adquisición y evaluación de competencias, necesitan una potente estructura hospitalaria que soporte la docencia práctica en habilidades clínicas. El trascendente papel reservado a los hospitales universitarios significa que la institución sanitaria debe adaptarse para facilitar la implantación de una enseñanza de calidad, en aspectos estructurales y en el proceso de definición de objetivos y de evaluación de resultados a través de pruebas objetivas. Ello implica cambios en la estructura, en la organización y en la gestión. The training of future doctors entails a series of new needs, especially in relation to the definition, acquisition and evaluation of abilities, and this requires the backing of a powerful hospital structure that is capable of offering the practical teaching and learning of clinical skills. The fundamental role played by university hospitals means that the health care institution must adapt itself to facilitate the implementation of high quality teaching, both as regards structural aspects and in the process of defining aims and evaluating results by means of objective testing. This involves changes in the structure, the organisation and management.

La anemia constituye un hallazgo frecuente en los pacientes con colitis ulcerosa, y su etiología suele ser multifactorial. Puede deberse a un sangrado crónico, a déficits nutricionales, a la toma de determinada medicación como la salazopirina, o bien tratarse de una anemia relacionada con una enfermedad de cáracter crónico como viene a serlo la colitis ulcerosa. Sin embargo, esta enfermedad se asocia frecuentemente a diversos trastornos inmunológicos, entre ellos, la anemia hemolítica autoinmune. Esta complicación, aunque rara, puede hallarse en el 0,2 al 0,7% de los pacientes afectos de colitis ulcerosa, y hasta en un 1,82% de los pacientes con esta enfermedad pueden presentar un test de Coombs directo positivo sin evidencia de hemolisis. Presentamos un nuevo caso de un paciente con colitis ulcerosa y anemia hemolítica autoinmune. Anaemia is a common problem in pacients with ulcerative colitis, and its etiology is usually multifactorial. It can be produced by chronic blood loss, nutritional deficiencies, drugs such as salazopyrine, or it can be related to those chronic disease. However, ulcerative colitis is knowed to be associated with several immune disorders, as autoimmune haemolytic anaemia. Nevertheless, this rare complication can be found in 0.2 to 0.7% of patients affected by ulcerative colitis, and although 1.82% of patients with ulcerative colitis have a positive direct Coombs test without evidence of hemolysis. We report one new case of ulcerative colitis associated with autoimmune anaemia haemolytic, and a review the literature.

The alterations in serum concentration of thyroxine (T4), tri-iodine-thyronine (T3), reverse tri-iodinetiroinine (rT3), thyrotropine (TSH and free thyroxine index (IT4L), are studied in 37 patients diagnosed of sepsis who were divided into two groups according to their evolution: Group A: 22 patients who evolved favourably, and Group B: 15 patients who died, as well as in 14 healthy controls; this was carried out in order to establish, on one hand, its prognostic value, and, on the other, which of these parameters is most useful in the evaluation of thyroid function in these patients. A decrease in serum T3 levels was observed in patients from both groups (p less than 0.001) which was accompanied by an increase in rT3 levels (p less than 0.001) and a decrease in It4L (p less than 0.001); No significant modifications were observed in T4 and TSH. On follow up of 12 patients from group A and 14 from group B, an increase in mean T3 concentration was observed (p less than 0.02) only in the first patient from both groups. The greatest discriminative efficacy of thyroid hormones study with an unfavorable sepsis evolution corresponded to a T3 value below 35 ng/dl.

In order to evaluate whether plasma beta-thromboglobulin (as a marker of the degree of platelet function) in patients presenting clinically evident atherosclerosis is related to the presence or absence of different risk factors (smoking habit, arterial hypertension, hypercholesterolemia, diabetes, hypertriglyceridemia, obesity, hyperuricemia, alcoholism), 40 patients have been studied in whom mean beta-thromboglobulin levels was 54 +/- 25.56 ng/ml, which is very superior to levels considered normal. However, the presence of one or more risk factors did not lead to significant variations in b-thromboglobulin concentrations, and no differences were found either when each risk factor was considered separately. The positive correlation (r = 0.98; p less than 0.01) between beta-thromboglobulin and apo B levels is highlighted. The results suggest that platelet hyperfunction seems to be due to a greater extent to the atherosclerotic process rather than to the existence of a particular risk factor.

Effects of calorie/protein malnourishment have been studied on plasma concentrations of cholesterol, triglycerides, HDL-C, LDL-C and apolipoproteins A and B, in institutionalized elderly people, 53 males and 62 females, of whom 19 females and 12 males were malnourished. In malnourished patients, total cholesterol and LDL-C were significantly lower both in males and in females, but HDL-C was lower only in females. No significant differences in plasma triglycerides were found between the control and the malnourished groups. Apolipoprotein A showed no significant changes on malnourished males, but did show a significant lowering in malnourished females. On the opposite, apolipoprotein B was lower in males than in females. The lowering in cholesterol in malnourished patients leads us to think that this could be a early predictor of nutritional risk in the elderly.

The elevated incidence of malnutrition in the elderly and its close relation with the prevalence and evolution of determined diseases raises the need for early identification. Despite the existence of numerous indicators, specificity, sensitivity or occasionally both are lacking.One hundred fifteen institutionalized elderly of which 19 females and 12 males had signs of malnutrition were studied. A dietetic survey was carried out on all of those studied by means of a 24 hour recollection-interview, during which triceps fold (TF) and muscular area of the arm (MAA) were measured and serum concentrations of prealbumin (PA) protein bound to retinol (PBR), albumin (ALB), trasferrin (TNF) and complement factor 3 (C3) were determined.Not only caloric but also proteic intake were significantly lower in the undernourished (p less than 0.001) as with ALB (p less than 0.001), TNF (p less than 0.001) and C3 (p less than 0.02 in males and p less than 0.05 in females). However, the sensitivity demonstrated by the dietetic survey (77% in males and 73% in females) was higher to that presented by ALB (44% in males and 53% in females), TNF (33% in males and 53% in females) and C3 (0 in both sexes).The results obtained demonstrate that the dietetic survey is a valid method for detecting not only the risk but also the subclinical presence of malnutrition, in contrast to ALB, TNF and C3 which, to that end, were of less use.

El carcinoma epidermoide de piel es la segunda neoplasia maligna cutánea en frecuencia tras el carcinoma basocelular, con una incidencia a lo largo de la vida de un 7-11%. El tratamiento quirúrgico consigue la curación completa en la mayoría de los casos, pero hasta 5% de estos tumores desarrollan metástasis locorregionales o a distancia, siendo la supervivencia media en estos casos inferior a 2 años. Más de un 75% de los carcinomas epidermoides cutáneos (CEC) se localizan en la región facial, cuero cabelludo, labio y pabellones auriculares. En estas localizaciones, el crecimiento relativamente rápido de estos tumores y la demora en las listas de espera quirúrgicas, suponen un problema importante en el manejo de los pacientes ya que, además de garantizar el control oncológico, debemos lograr un óptimo resultado funcional y cosmético...