Search

Zephyranthes citrina is an ornamental American bulbous plant used as an ornamental garden crop for the aesthetic qualities of its yellow perigonium. The objective of this work was to characterize the species by classical chromosome staining and fluorochrome banding. A sporophytic chromosome number of 2n=8x=48 chromosomes was observed, being the karyotypic formula 20 m + 26 sm + 2 st. Satellites were detected in the short arm of metacentric chromosomes 8, 9, 11 and 12, which colocalized with constitutive heterochromatin CMA+/DAPI-/0 bands. The karyotype comprised chromosome pairs with terminal constitutive heterochromatin bands that included satellites and heteromorphic clusters indicating that it is an allooctoploid. These results will be used as a tool for monitoring genetic improvement, in interspecific crosses and its progenies and in biotechnological procedures by in vitro culture. Key words: constitutive heterochromatin, chromosome banding, bulbous, plant genetic resources, karyotype

Background: The association between heart rate (HR) and pulmonary embolism (PE) outcomes has not been well studied. Furthermore, optimal cutoffs to identify low-risk and intermediate- to high-risk patients are not well known. Research Question: Does an association exist between baseline HR and PE outcome across the continuum of HR values? Study Design and Methods: The current study included 44,331 consecutive nonhypotensive patients with symptomatic PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry between 2001 and 2021. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess the association between admission HR and outcomes. Results: A positive relationship was found between admission HR and 30-day all-cause and PE-related mortality. Considering an HR of 80 to 99 beats/min as a reference, patients in the higher HR strata showed higher rates of all-cause death (adjusted OR, 1.5 for HR of 100-109 beats/min; adjusted OR, 1.7 for HR of 110-119 beats/min; adjusted OR, 1.9 for HR of 120-139 beats/min; and adjusted OR, 2.4 for HR of ≥ 140 beats/min). Patients in the lower strata of HR showed significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR, 0.6 for HR of 60-79 beats/min; and adjusted OR, 0.5 for HR of < 60 beats/min). The findings for 30-day PE-related mortality were similar. For identification of low-risk patients, a cutoff value of 80 beats/min (vs 110 beats/min) increased the sensitivity of the simplified Pulmonary Embolism Severity Index (sPESI) from 93.4% to 98.8%. For identification of intermediate- to high-risk patients, a cutoff value of 140 beats/min (vs 110 beats/min) increased the specificity of the Bova score from 93.2% to 98.0%. Interpretation: In nonhypotensive patients with acute symptomatic PE, a high HR portends an increased risk of all-cause and PE-related mortality. Modifying the HR cutoff in the sPESI and the Bova score improves prognostication of patients with PE.

After more than a year of pandemic, the international medical community has changed the perception of fear to one of respect for SARS-COV-2. This has been the consequence of the integral study of all the dimensions of the disease, from viral recombinant capacity to transmissibility, diagnosis, care and prevention. This document summarizes the main strategic lines of study and approach to the pandemic in Madrid.

Venous thromboembolism (VTE) is a frequent complication in patients with cancer and a leading cause of morbidity and death. The objective of the RIETECAT study was to compare the long-term effectiveness and safety of enoxaparin versus dalteparin or tinzaparin for the secondary prevention of VTE in adults with active cancer. We used the data from the multicenter, multinational RIETE registry to compare the rates of VTE recurrences, major bleeding, or death over 6 months in patients with active cancer and acute VTE using full doses of enoxaparin versus dalteparin or tinzaparin, and a multivariable Cox proportional hazard model was used to analyze the primary end point. From January 2009 to June 2018, 4451 patients with active cancer received full doses of the study drugs: enoxaparin, 3526 patients; and dalteparin or tinzaparin, 925 (754 + 171) patients. There was limited difference in VTE recurrences (2.0% vs 2.5%) and mortality rate (19% vs 17%) between the enoxaparin and dalteparin or tinzaparin subgroups. However, there was a slight numerical increase in major bleeding (3.1% vs 1.9%). Propensity score matching confirmed that there were no differences in the risk for VTE recurrences (adjusted hazard ratio [aHR], 0.81; 95% confidence interval [CI], 0.48-1.38), major bleeding (aHR, 1.40; 95% CI, 0.80-2.46), or death (aHR, 1.07; 95% CI, 0.88-1.30) between subgroups. In RIETECAT, in patients with cancer and VTE receiving full-dose enoxaparin or dalteparin or tinzaparin, no statistically significant differences were observed regarding effectiveness and safety outcomes over a 6-month period.

We describe the most widely used temporary hospital in Europe during the first pandemic wave, its structure, function, and achievements. Other models of care developed during the pandemic around the world were reviewed including their capacity, total bed/ICU bed ratio and time of use. We particularly analyzed the common and differential characteristics of this type of facilities. IFEMA Exhibition Center was transformed into a temporary 1,300-bed hospital, which was in continuous operation for 42 days. A total of 3,817 people were treated, generally patients with mild to moderate COVID-19, 91% of whom had pneumonia. The average length of stay was 5 to 36 days. The most frequent comorbidities were hypertension (16.5%), diabetes mellitus (9.1%), COPD (6%), asthma (4.6%), obesity (2.9%) and dementia (1.6%). A total of 113 patients (3%) were transferred to another centers for aggravation, 19 (0.5%) were admitted to ICU and 16 patients (0.4%) died. An element of great help to reducing the overload of care in large hospitals during peaks of health emergencies could be these flexible structures capable of absorbing the excess of patients. These must be safe, breaking domestic transmission and guarantee social and emotional needs of patients. The success of these structures depends on delimitation in admission criteria taking into account the proportion of patients who may require, during admission, assistance in the critical care area.

The RIETE Investigators., [Background] The optimal therapy of patients with acute subsegmental pulmonary embolism (PE) is controversial., [Methods] We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of symptomatic PE recurrences during anticoagulation in patients with subsegmental, segmental, or more central PEs. [Results] Among 15 963 patients with a first episode of symptomatic PE, 834 (5.2%) had subsegmental PE, 3797 (24%) segmental, and 11 332 (71%) more central PE. Most patients in all subgroups received initial therapy with low‐molecular‐weight heparin, and then most switched to vitamin K antagonists. Median duration of therapy was 179, 185, and 204 days, respectively. During anticoagulation, 183 patients developed PE recurrences, 131 developed deep vein thrombosis (DVT), 543 bled, and 1718 died (fatal PE, 135). The rate of PE recurrences was twofold higher in patients with subsegmental PE than in those with segmental (hazard ratio [HR], 2.13; 95% confidence interval [CI], 1.16‐3.85) or more central PE (HR, 1.89; 95% CI, 1.12‐3.13). On multivariable analysis, patients with subsegmental PE had a higher risk for PE recurrences than those with central PE (adjusted HR, 1.75; 95% CI, 1.02‐3.03). After stratifying patients with subsegmental PE according to ultrasound imaging in the lower limbs, the rate of PE recurrences was similar in patients with DVT, in patients without DVT, and in those with no ultrasound imaging. [Conclusions] Our study reveals that the risk for PE recurrences in patients with segmental PE is not lower than in those with more central PE, thus suggesting that the risk of PE recurrences is not influenced by the anatomic location of PE.

Resumen Introduccion y objetivos Los problemas clinicos de los adultos con sindrome de Down parecen diferir de los de la poblacion general. Para entender mejor estas diferencias describimos las caracteristicas demograficas y clinicas de los adultos con sindrome de Down que ingresaron en los servicios de Medicina Interna espanoles en el periodo de 2005-2014. Pacientes y metodos Estudio observacional retrospectivo sobre datos recogidos en el conjunto minimo basico de datos de los episodios de ingreso de adultos con sindrome de Down en los servicios de Medicina Interna del Sistema Nacional de Salud desde 2005 hasta 2014. Se analizaron variables epidemiologicas, clinicas y sociales. Resultados Se registraron 7.548 episodios de ingreso de 3.786 pacientes. El 56,6% eran varones con una edad media (± DE) de 47 ± 13 anos. Fallecieron 715 pacientes (18,9%). La mortalidad ajustada a la edad fue 26,6% y su estancia media fue de 9,6 ± 12 dias. En 3.684 episodios (48,8%) el ingreso fue por enfermedad respiratoria y en 760 (10%), de origen cardiologico. Las comorbilidades mas frecuentes fueron el hipotiroidismo (27,1%; 2.043 episodios), la epilepsia (24,1%; 1.819 episodios) y la demencia (15,4%; 1.162 episodios). Conclusiones Los ingresos de adultos con sindrome de Down en los servicios de Medicina Interna han aumentado en la ultima decada. Si bien los motivos de ingreso, estancia media y coste por episodio de esta poblacion son similares a los de la poblacion general atendida en Medicina Interna, la mortalidad intrahospitalaria ajustada por edad fue significativamente mayor.

Background and objectives The clinical problems of adults with Down syndrome (DS) seem to differ from those of the general population. To better understand these differences, we list the demographic and clinical characteristics of adults with DS admitted to Spanish internal medicine departments during 2005–2014. Patients and methods We conducted an observational retrospective study using data collected from the minimum basic data set on hospitalisation episodes of adults with DS in the internal medicine departments of Spain’s National Health System from 2005 to 2014. We analysed the patients’ epidemiological, clinical and societal data. Results A total of 7548 hospitalisation episodes from 3786 patients were recorded. Some 56.6% of the patients were male with a mean age (±SD) of 47 ± 13 years, and 715 of the patients died (18.9%). The age-adjusted mortality was 26.6%, and the mean stay was 9.6 ± 12 days. The hospitalisation was for respiratory disease in 3684 episodes (48.8%) and for cardiac origin in 760 (10%). The most common comorbidities were hypothyroidism (27.1%, 2043 episodes), epilepsy (24.1%, 1819 episodes) and dementia (15.4%, 1162 episodes). Conclusions The hospitalisation of adults with DS in internal medicine departments has increased in the past decade. Although the reasons for hospitalisation, mean stay and cost per episode for this population are similar to those of the general population treated by internal medicine departments, the age-adjusted hospital mortality was significantly greater.

Objective The aim of our study was to determine whether the care of patients with moderate dependency who were hospitalised in a functional impairment prevention unit (FIPU) was superior to that of a conventional unit (CU) in terms of functional impairment and mean stay. Methods We conducted a single-centre, retrospective, controlled intervention study that compared acute treatment in an FIPU and in conventional wards. The study included 466 elderly patients with moderate dependence (Barthel index, 30–70) and older than 75 years. Of these, 280 were included in the intervention group and 186 in the control group. The primary outcomes were loss of functionality attributable to the hospitalisation (measured by the loss of ambulation and urinary continence) and differences in the length of stay. Results The patients hospitalised in the FIPU showed less functional impairment as determined by the loss of urinary continence (2.1 % of the FIPU patients vs. 9.7 % of the CU patients; p Conclusion The acute care of elderly patients with moderate dependency in an FIPU was independently associated with less functional decline and shorter stays.

Resumen Objetivo Determinar si el cuidado de los pacientes con un moderado grado de dependencia ingresados en una unidad de prevencion del deterioro funcional (UPDF) era superior al cuidado en una unidad convencional (UC) en terminos de deterioro funcional y estancia media. Metodos Estudio retrospectivo, controlado, de intervencion en un solo centro, que compara el tratamiento agudo en una UPDF y en plantas convencionales. Se incluyeron 466 pacientes ancianos con un grado moderado de dependencia (Barthel 30-70), mayores de 75 anos. De estos, 280 pacientes formaron parte del grupo de intervencion y 186 del grupo control. Los resultados primarios fueron la perdida de funcionalidad achacable al ingreso (medida por perdida de deambulacion y continencia urinaria) y las diferencias en la duracion de la estancia. Resultados Los pacientes ingresados en la UPDF presentaron un menor deterioro funcional determinado por la perdida de la continencia urinaria (2,1% de pacientes en UPDF vs. 9,7% en UC; p Conclusion La atencion aguda de pacientes ancianos con un grado moderado de dependencia en una UPDF se asocio de forma independiente con un menor deterioro funcional y una menor estancia.

The purpose of this guide is to suggest, based on the available clinical evidence, the prevention measures for venous thromboembolism during pregnancy, childbirth and postpartum in expert recommendations and international guidelines. Venous thromboembolism is a cause of maternal death, and it is therefore important to consider those situations in which the risk is greater and for which women should undergo preventive treatment. Personal and family history, the presence of acquired or hereditary thrombophilia, patient-related factors and those related to pregnancy or childbirth have a relative weight that determines the start of treatment and its duration. Low-molecular-weight heparin is the treatment of choice for these women. Prophylaxis might be necessary during the antenatal or postnatal period, and the duration and indication will vary depending on the risks and benefits.

Resumen La Sociedad Espanola de Medicina Interna ha desarrollado a lo largo de 2018-2019 el proyecto «El hospital del futuro». El hospital del futuro pretende trasladar al contexto del sistema sanitario espanol la reflexion que abordo el Royal College of Physicians en el Reino Unido sobre la organizacion de la asistencia en los hospitales del futuro, desde el conocimiento acumulado sobre el Sistema Nacional de Salud. En el proyecto participaron asimismo numerosas sociedades cientifico-medicas y entidades profesionales del sector salud y asociaciones de pacientes. Este articulo tiene por objeto destacar en 10 puntos las previsiones que consideramos mas relevantes derivadas de este proyecto, dedicando el ultimo a los retos que para la Medicina Interna se deducen de estas propuestas.

Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals.

Introduction. The diagnosis of SARS-CoV-2 infection is crucial for medical and public health reasons, to allow the best treatment of cases and the best control of the pandemic. Serology testing allows for the detection of asymptomatic infections and 19-COVID cases once the virus has been cleared. We analyzed the usefulness of the SARS-CoV-2 rapid test of Autobio and tried to correlate its pattern with the severity of COVID19 infection. Material and methods. We analyzed the accuracy and clinical usefulness of a point-of-care IgM and/or IgG test for SARS-CoV-2 in 35 COVID-19 patients [12 (34.3%) mild-moderate and 23 (65.7%) severe-critical] admitted to a field hospital in Madrid, as well as in 5 controls. Results. The mean time from the first day of symptoms to the antibody test was 28 days (SD: 8.7), similar according to the severity of the disease. All patients with SARS-CoV-2 PCR+ showed the corresponding IgG positivity, while these results were negative in all control individuals. A total of 26 (74%) cases also presented with positive IgM, 19 (83%) were severe-critical cases and 7 (58%) were mild-moderate cases. The IgM response lasted longer in the severe critical cases (mean: 29.7 days; SD: 8.4) compared to the moderate cases (mean: 21.2 days; SD: 2.0). Conclusions. Rapid serology tests are useful for the diagnosis of patients with COVID-19 (mainly IgG detection) and may also be correlated with the severity of the infection (based on IgM detection).

Resumen Objetivos Investigar la prevalencia del delirio reportado, los factores asociados y los costes. Diseno Analisis retrospectivo y descriptivo de una base de datos clinico-administrativa nacional que incluye todos los pacientes ingresados en Espana en los servicios de medicina interna desde enero de 2007 a diciembre de 2014. Material y metodo Se incluyen datos sociodemograficos y clinicos (sexo, edad, diagnostico y procedimientos), entre otros. Resultados La prevalencia del delirio reportado fue del 2,5% (114.343 de 4.628.397 informes de alta). El delirio fue mas frecuente en el grupo de 81 a 90 anos (48%) y en pacientes institucionalizados (4,5% vs 2,9%; p El coste atribuible al delirio en 8 anos supera los 100 millones de euros (casi 1.000 € por ingreso/paciente). Elaboramos un modelo predictivo del riesgo de desarrollar delirio sin sensibilidad suficiente pero util para identificar pacientes de bajo riesgo. Conclusiones Los pacientes que desarrollan delirio durante su ingreso en medicina interna tienen una estancia mas prolongada, mayor mortalidad y mayor riesgo de ser institucionalizados al alta. El delirio esta probablemente poco reportado en los informes de alta que elaboran los internistas.

Objectives To investigate the prevalence of reported delirium and its associated factors and costs. Design Retrospective and descriptive analysis of a national clinical-administrative database that includes all patients hospitalized in Spain in internal medicine departments from January 2007 to December 2014. Material and method The study included the patients’ sociodemographic and clinical data (sex, age, diagnosis and procedures). Results The prevalence of reported delirium was 2.5% (114,343 of 4,628,397 discharge reports). Delirium was most common in the 81–90-year age group (48%) and in institutionalized patients (4.5% vs. 2.9%; p The costs attributable to delirium in 8 years exceeded €100 million (almost €1000 per hospitalization/patient). We developed a predictive model for the risk of developing delirium, which has insufficient sensitivity but is useful for identifying low-risk patients. Conclusions Patients who develop delirium during their hospitalization in internal medicine have a longer stay, greater mortality and an increased risk of being institutionalized at discharge. Delirium is probably poorly reported in the discharge reports prepared by internists.

Objectives To compare the structure, resources and activity of the internal medicine units (IMUs) of the Spanish National Health System (SNHS) in 2013 and 2016. To analyze the differences between IMUs in 2016 by hospital size. Material and methods We conducted a comparison of 2 descriptive cross-sectional studies of IMUs in general acute care hospitals of the Spanish National Health System, with data referring to 2013 and 2016. The variables were collected via an ad hoc questionnaire (RECALMIN survey). Results Between 2013 and 2016, the demand for care increased dramatically (with an annual average of 11% in hospital discharges and 16% in first consultations), and comorbidity slightly increased (2%). During this period, the mean productivity of IMUs increased 16.7% (0.6 ± 0.3 vs. 0.7 ± 0.3; p = .09), and the mean stay decreased 10% (9 ± 2.2 vs. 8.1 ± 2.1 days; p = .001). Progress in implementing good practices and systematic care for complex chronic patients was scarce. Both surveys found variability among IMUs and marked differences among IMUs of hospitals of different sizes. Conclusions IMUs responded to the increased burden of care they supported during 2013–2016 by improving their efficiency and productivity; however, advances in implementing good practices, including care for chronic complex patients, were scare. The significant variability in the indicators of structure, activity and management models found in 2013 remained in 2016.

Resumen Objetivos Comparar la estructura, recursos y actividad de las Unidades de Medicina Interna (UMI) del Sistema Nacional de Salud (SNS) en 2013 y 2016. Analizar las diferencias entre UMI en 2016 por tamano de hospital. Material y metodos Comparativa de 2 estudios descriptivos transversales de UMI en hospitales generales de agudos del Sistema Nacional de Salud con datos referidos a 2013 y a 2016. Las variables fueron recogidas mediante un cuestionario «ad hoc» (encuesta RECALMIN). Resultados Entre 2013 y 2016 aumento notablemente la demanda asistencial (con un promedio anual del 11% en altas de hospitalizacion y del 16% en primeras consultas) y ligeramente la comorbilidad (2%). En el mismo periodo, aumento un 16,7% la productividad media de las UMI (0,6 + 0,3 vs. 0,7 + 0,3; p = 0,09) y la estancia media disminuyo un 10% (9 + 2,2 vs. 8,1 + 2,1 dias; p = 0,001). Los progresos en la implantacion de buenas practicas y de una atencion sistematica al paciente cronico complejo fueron escasos. La variabilidad entre UMI y las notables diferencias entre UMI de hospitales de tamano distinto fueron hallazgos de ambas encuestas. Conclusiones Las UMI respondieron al aumento de la carga asistencial que soportaron en el periodo 2013-2016 mejorando su eficiencia y productividad, pero los avances en la implantacion de buenas practicas, incluyendo la atencion al paciente cronico complejo, fueron escasos. La importante variabilidad en los indicadores de estructura, actividad y modelos de gestion encontrada en 2013 se mantuvo en 2016.

Resumen Objetivos Diabetes mellitus se asocia con un marcado incremento de enfermedad cardiovascular. En el presente estudio analizamos la prevalencia de diabetes mellitus en pacientes hospitalizados en Espana en 2015 y la carga de enfermedad cardiovascular asociada. Metodos Mediante el analisis del conjunto minimo basico de datos (CMBD) del Ministerio de Sanidad del ano 2015, se incluyen todos los pacientes dados de alta con diagnostico de diabetes mellitus. Se describen las caracteristicas epidemiologicas, la distribucion por los diferentes servicios hospitalarios y la presencia de enfermedad cardiovascular. Resultados En el ano 2015 hubo 3.727.583 altas en Espana; de ellas, 619.188 correspondian a diabeticos (16,7%); el 56,8% eran varones y la edad media era de 73,2 anos. La prevalencia de enfermedad cardiovascular fue del 40,8%, distribuida en insuficiencia cardiaca congestiva (20,1%), enfermedad cerebrovascular (10,3%), enfermedad coronaria (9,4%) y enfermedad arterial periferica (9,1%). La mayor parte de pacientes ingresaron en los servicios de medicina interna (34,2%), cardiologia (9,5%) y cirugia general (8,9%). La estancia media global fue de 8,2 dias y los reingresos a 30 dias alcanzaron el 14%. La mortalidad fue del 6,8%. Los pacientes ingresados en medicina interna tienen un grado de severidad mas alto (3-4), 41,9% vs 31,6%, que los ingresados en otros servicios medicos (p Conclusiones La diabetes mellitus es una comorbilidad importante de los pacientes ingresados en medicina interna. Una proporcion significativa de estos pacientes presenta enfermedad cardiovascular, y la mas frecuente es la insuficiencia cardiaca.

Aims Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation. Methods and results We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (

Registro Informatizado de Enfermedad Tromboembólica Investigators., [Objective] Overlap exists between the risk factors for coronary artery disease and venous thromboembolism (VTE). However, a paucity of data is available on the incidence of major acute cardiovascular events (MACE) and major adverse limb events (MALE) among patients presenting with VTE. Moreover, it is unknown whether the rate of cardiovascular outcomes differs among patients with unprovoked vs provoked VTE., [Methods] We analyzed the data from 2009 to 2017 in the Registro Informatizado de Enfermedad Tromboembólica registry, an ongoing, multicenter, international registry of consecutive patients with a diagnosis of objectively confirmed VTE. The query was restricted it to patients with data entry for the arterial outcomes. The baseline prevalence of coronary artery disease risk factors was compared between patients with provoked (ie, immobility, cancer, surgery, travel >6 hours, hormonal causes) and unprovoked VTE. After the initial VTE event, we followed up patients for the composite primary outcome of incident MACE (ie, stroke, myocardial infarction, unstable angina) and/or MALE (ie, major limb events). We used the χ2 test for baseline associations and a Cox proportional hazard for multivariate analysis. We used IBM SPSS, version 24 (IBM Corp, Armonk, NY) for statistical analysis. A P value of, [Results] We analyzed the data from 41,259 patients with VTE, of whom 22,633 (55.6%) had experienced a provoked VTE. During follow-up, the patients with provoked VTE were more likely to develop MACE or MALE than were patients with unprovoked VTE (hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.1-1.5). The association of arterial events with recent immobility (HR, 1.4; 95% CI, 1.5-12.1) and cancer (HR, 1.7; 95% CI, 1.4-1.9) was strong. After adjusting for multiple conventional cardiovascular risk factors, provoked VTE, compared with unprovoked VTE, was significantly associated with an increased hazard for MACE (HR, 1.4; 95% CI, 1.1-1.7). Cancer remained a significant adjusted predictor for both MACE (HR, 1.7; 95% CI, 1.4-2.1) and MALE (HR, 2.1; 95% CI 1.01-4.6) in those with provoked VTE., [Conclusions] Among patients with VTE, provoked cases, specifically those with cancer-associated VTE, have an increased risk of major arterial events.

Over the course of 2018 and 2019, the Spanish Society of Internal Medicine carried out a project called "The Future Hospital." Based on cumulative knowledge on the Spanish National Health System, this project seeks to transfer the observations on the organization of healthcare in future hospitals made by the Royal College of Physicians in the United Kingdom to the context of the Spanish healthcare system. The project's participants included numerous scientific and medical societies, professional associations in the health sector, and patient associations. This aim of this article is to highlight, in 10 points, predictions that arose from this project that we consider to be the most relevant, reserving the last point for the challenges for the field of internal medicine that can be surmised from these proposals.

The purpose of this guide is to suggest, based on the available clinical evidence, the prevention measures for venous thromboembolism during pregnancy, childbirth and postpartum in expert recommendations and international guidelines. Venous thromboembolism is a cause of maternal death, and it is therefore important to consider those situations in which the risk is greater and for which women should undergo preventive treatment. Personal and family history, the presence of acquired or hereditary thrombophilia, patient-related factors and those related to pregnancy or childbirth have a relative weight that determines the start of treatment and its duration. Low-molecular-weight heparin is the treatment of choice for these women. Prophylaxis might be necessary during the antenatal or postnatal period, and the duration and indication will vary depending on the risks and benefits.

Las características del lisianthus la hacen una flor de corte de gran interés, por lo que es necesario generar conocimiento acerca de su producción empleando técnicas como la micropropagación favoreciendo una multiplicación rápida y masiva, con plantas libres de patógenos. La organogénesis, resultado de utilizar reguladores de crecimiento de diferente modo de acción (auxina, citocinina y giberelina), incluyó la formación tanto de brotes como de raíces que se generaron en algunos casos de manera directa y en otros a partir de callo, utilizando segmentos foliares como explante. La adición de bajas concentraciones de citocinina y giberelina (1.0 mg/L benciladenina (BA) + 0.5 mg/L ácido giberélico (GA3)) al medio de cultivo, fueron necesarias para generar el mayor número de brotes (14.16 brotes por explante).