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Evaluar si los síntomas/signos de congestión en pacientes con insuficiencia cardíaca aguda (ICA) atendidos en los servicios de urgencias hospitalarios (SUH) permiten predecir la evolución a corto plazo.

El último consenso sobre insuficiencia cardíaca aguda de la Sociedad Española de Cardiología, la Sociedad Española de Medicina Interna y la Sociedad Española de Medicina de Urgencias y Emergencias se elaboró en 2015, por lo que era necesaria una actualización para revisar las diversas novedades relacionadas con la temática de insuficiencia cardíaca aguda que han ido apareciendo los últimos años. Entre ellas están la publicación de las nuevas guías europeas sobre insuficiencia cardíaca en el 2016, nuevos estudios sobre el manejo farmacológico de los pacientes durante la hospitalización y novedades sobre diversos aspectos relacionados con la insuficiencia cardíaca aguda, tales como el abordaje precoz, terapia intermitente, insuficiencia cardíaca avanzada y congestión refractaria. Por ello, este consenso se elaboró con la intención de actualizar todos los aspectos relacionados con la insuficiencia cardíaca aguda y proporcionar un documento que detallase de manera completa el diagnóstico, tratamiento y manejo de esta enfermedad.

Describir las características demográficas y de comorbilidad de los pacientes con COVID-19 fallecidos en hospitales españoles durante el brote pandémico de 2020 y compararlas según si ingresaron o no en una Unidad de Cuidados Intensivos (UCI) antes del fallecimiento.

Describir frecuencia, características clínicas y evolución de los pacientes con insuficiencia cardiaca aguda (ICA) ingresados directamente desde urgencias en hospitalización a domicilio (HaD) así como compararlos con los ingresados en medicina interna (MI) o unidad de corta estancia (UCE).

Describir las características clínicas y el pronóstico–mortalidad intrahospitalaria, a 30 días y a 12 meses y reconsulta en urgencias a 30 días por insuficiencia cardiaca aguda– de pacientes atendidos en servicios de urgencias hospitalarios por insuficiencia cardiaca aguda de nueva aparición o de novo (ICAN) y compararlas con los que consultan por insuficiencia cardiaca crónica descompensada (ICAD).

Analizar si los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) presentan diferencias clínicas y de manejo terapéutico en urgencias cuando desarrollan un episodio de insuficiencia cardiaca aguda (ICA) y analizar la mortalidad durante dicha descompensación.

Conocer la implantación y características de la ventilación no invasiva (VNI) en los servicios de urgencias hospitalarios (SUH) públicos de Cataluña. Analizar si hay diferencias en función de la tipología, del grado de actividad y de la existencia de una unidad de cuidados intensivos (UCI) en el hospital.

Analizar los cambios en la epidemiología, en la atención clínica ambulatoria y en urgencias, y la evolución de los pacientes atendidos por insuficiencia cardiaca aguda (ICA) en los servicios de urgencias hospitalarios (SUH) españoles entre 2007 y 2014.

Analizar los factores relacionados con el tratamiento crónico inadecuado con digoxina, y si esta inadecuación impacta en la evolución a corto plazo.

Disponer de escalas pronósticas en la insuficiencia cardiaca crónica agudizada para detectar la mortalidad precoz es fundamental. El objetivo de este estudio es crear una escala pronóstica (escala EAHFE-3D) que estratifique el riesgo de muerte a muy corto plazo.

Conocer la percepción de los pacientes con insuficiencia cardiaca (IC) sobre su enfermedad, tratamiento y soporte, así como los especialistas que intervienen tras una descompensación, y si existe relación entre el tipo de especialista involucrado en el seguimiento y el pronóstico a medio plazo.

Estudiar la evolución temporal de los índices bibliométricos de internistas con una trayectoria investigadora consolidada, con el fin de predecir el comportamiento futuro de un investigador y evaluar si la producción centrada en un área concreta de la medicina interna permite obtener mayor visibilidad que en medicina interna general.

OBJECTIVE: To compare two teaching methodologies for PROCES (a basic cardiopulmonary resuscitation (b-CPR) programme for secondary school students): one exclusively performed by school teachers (study group) and another by a mixed team of school teachers and healthcare providers (control group). METHODS: According to their preferences, teachers chose either method and students were consequently assigned to the control or study group. All participants took a 10 multiple-choice question exam regarding b-CPR skills twice: immediately after PROCES and one year later. Eight or more correct answers was considered satisfactory learning. Results between groups were compared. Associations between satisfactory learning and some student characteristics were analysed. RESULTS: Immediately after PROCES, 442 students (219 in the study group and 223 in the control group) took the exam. The percentage of satisfactory learning was not different: 67.1% in the study group and 64.6% in the control group. Immediate satisfactory learning was related to the absence of pending subjects in the control (odds ratio (OR) 2.31, 95% CI 1.16 to 4.64) and study (OR 5.87, 95% CI 1.22 to 28.20) groups. One year later, a greater percentage of retention of b-CRP skills was detected in the study group (57.1% vs 40.6%; p = 0.01). The absence of any pending subject (OR 6.86, 95% CI 1.83 to 25.66) was independently associated with better retention in the study group, but not the control group. CONCLUSIONS: Secondary school teachers, previously trained in b-CPR, can teach these skills effectively to 14–16-year-old students using PROCES. The retention of b-CPR skills is greater with this methodology compared with a more standardised programme.

Analizar si la hospitalización en unidades de corta estancia (UCE) de pacientes diagnosticados en urgencias de insuficiencia cardíaca aguda (ICA) resulta efectiva en términos de estancia hospitalaria y si se asocia con diferencias en la evolución a corto plazo.

Objective.To ascertain whether mitochondrial function is impaired in polymyalgia rheumatica (PMR) and giant cell arteritis (GCA).Patients and methods.Thirteen patients suffering from isolated PMR, 19 from GCA (eight with and 11 without PMR) and 25 healthy people submitted to orthopaedic surgery were included. Skeletal muscle was obtained from the quadriceps by open biopsy. Mitochondrial histological abnormalities were assessed on Gomori's trichrome staining and on cytochrome c oxidase and succinic dehydrogenase reactions. Biochemical studies consisted of polarographic measurement of oxidative activity using complex I, II, III and IV substrates, and spectrophotometric determination of individual enzymatic activity of such complexes.Results.We did not find differences among groups either with respect to the percentage of histological or histochemical abnormalities [P=not significant (NS) for all stainings and reactions], oxidative capacity (P=NS for all substrates) or individual enzymatic activities (P=NS for all complexes).Conclusion.Skeletal muscle mitochondria remain histologically and functionally unaffected in PMR and in GCA.Keywords:Polymyalgia rheumatica, Giant cell arteritis, Mitochondria, Ragged-red fibres, Electron transport chain.

Abstract: Background: General anaesthetics inhibit mitochondrial function in animal models. However, very few studies have been performed in humans, and the results have not been conclusive. Methods: We prospectively studied the oxygen consumption and the individual enzyme activity of each complex of the mitochondrial respiratory chain of skeletal muscle mitochondria in 54 healthy individuals who underwent general anaesthesia for orthopaedic surgery. The control group (n = 54) was made up of individuals submitted to the same orthopaedic procedure under regional anaesthesia (n = 31), and patients who underwent muscle biopsies for diagnostic purposes by local anaesthesia (n = 23). Results: We found a significant decrease in the oxidation of glutamate (−36%), succinate (−25%) and ascorbate (−29%) in the general anaesthetic group compared with the controls (P < 0.001 for all substrates). The level of such inhibition was similar for volatile anaesthetics with strong (halothane) or weak (isoflurane) negative inotropic effect. By contrast, the enzymatic activity of all individual complexes and the coupling of oxidative phosphorylation did not differ between the two groups. Conclusion: We conclude that during general anaesthetic procedures there is an extensive inhibition of substrate oxidation in human muscle mitochondria, and that it is not caused by a direct effect on complexes of the mitochondrial respiratory chain or through uncoupling oxidative phosphorylation.

Objective: Mitochondrial dysfunction in idiopathic inflammatory myopathies (IIM) remains a controversial issue. The aim of the present study was to investigate the correlation between histological abnormalities and the biochemical function of the skeletal muscle mitochondria from patients with dermatomyositis (DM).Method: We evaluated 10 patients with a new diagnosis of DM and 15 healthy individuals, matched by age and gender. Muscle biopsy was routinely processed for histochemical studies and biochemical analysis of pure mitochondria. The percentages of ragged-red fibres (RRF), cytochrome c oxidase (COX)-negative fibres and succinic dehydrogenase (SDH) hyper-reactive fibres were calculated, oxygen utilization using different substrates was assessed polarographically, and enzymatic activity of individual complexes of the electron transport chain (ETC) and ATPase was measured spectrophotometrically.Results: We found an increased percentage of COX-negative and SDH hyper-reactive fibres in DM patients (0.82 and 1.82%, respectively) compared to controls (0.26 and 0.22%; P <0.05 and P=0.001, respectively); however, oxidation rates of different substrates and enzymatic activities of ETC and ATPase did not differ significantly between both groups.Conclusion: The overall function of ETC from skeletal muscle mitochondria is not affected in DM.Key words: Idiopathic inflammatory myopathies, Dermatomyositis, Mitochondria, Electron transport chain, ATPase, Cytochrome c oxidase, Succinic dehydrogenase, Ragged-red fibres.

The objective of this study was to assess the influence of overcrowding on health care quality provided by emergency departments ED. The study was carried out in an urban, university tertiary care hospital. All patients seen at the internal medicine unit IMU of the ED who returned during the following 72 hours, and those who died in the ED rooms were included in the study. During a consecutive period of 2 years 104 weeks, we prospectively quantified the number of weekly visits, revisits and deaths. We calculated revisit and mortality rates in respect of percentage of all visited patients for each week. Correlation between the number of weekly visits, and revisit and mortality rates was assessed using a simple linear regression model. We consigned 81 301 visits, 1137 revisits and 648 deaths mean ± SD number of weekly visits, revisits and deaths were 782 68, 10.93 3.97 and 6.23 3.04 respectively weekly revisit rate was 1.40 0.48 and weekly mortality rate was 0.79 0.36. We observed a significant, positive correlation between mortality rates and weekly number of visits p0.01. Although a similar trend was also found for revisit rates, such an increase did not reach statistical significance p 0.06. It is concluded that since revisit and mortality rates constitute good health care quality markers, present data demonstrate that ED overcrowding implies a decrease in the health care quality provided by it.