[Analysis of infectious diseases care in Spanish hospitals from 2016-2020, including the first year of the SARS-CoV-2 pandemic]. / Análisis de la atención a patologías infecciosas en los hospitales españoles en el periodo 2016-2020, incluyendo el primer año de pandemia por SARS-CoV-2.

Aims: This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. Materials and method: This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016-2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. Results: Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. Conclusions: At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients.

Analysis of infectious diseases care in Spanish hospitals from 2016 to 2020, including the first year of the SARS-CoV-2 pandemic.

AIMS: This work aimed to review patients discharged from Spanish hospitals with a principal diagnosis of infection during a 5-year period, including the first year of the SARS-CoV-2 pandemic. MATERIALS AND METHOD: This work analyzed the Basic Minimum Data Set (CMBD) of patients discharged during the 2016⬜2020 period from hospitals in the Spanish National Health Service in order to identify cases with a principal diagnosis of an infectious disease according to the ICD-10-S code. All patients older than 14 years of age admitted to a conventional ward or intensive care unit, excluding labor and delivery, were included in the analysis and were evaluated based on the discharging department. RESULTS: Patients discharged with infectious diseases as the principal diagnosis have increased from 10% to 19% in recent years. A large part of the growth is due to the SARS-CoV-2 pandemic. Internal medicine departments cared for more than 50% of these patients, followed by pulmonology (9%) and surgery (5%). In 2020, 57% of patients with a principal diagnosis of infection were discharged by internists, who cared for 67% of patients with SARS CoV-2. CONCLUSIONS: At present, more than half of patients admitted with a principal diagnosis of infection are discharged from internal medicine departments. Given the growing complexity of infections, the authors advocate for an approach in which training allows for specialization, but within a generalist context, for the better management of these patients.

Utility of lateral flow tests in SARS-CoV-2 infection monitorization.

OBJECTIVE: 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. 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).

Clinical ultrasonography in systemic autoimmune diseases. / Ecografía clínica en las enfermedades autoinmunes sistémicas.

Clinical ultrasonography should be considered a complementary examination that can change clinical practice, as well as a tool to add to the medical history. Systemic autoimmune diseases (SAD) can involve numerous structures and organs. Ultrasonography has broad applied utility in detecting complications such as the presence of free intraabdominal, pleural and pericardial fluid in polyserositis, left ventricular systolic dysfunction in myocarditis and deep vein thrombosis in antiphospholipid syndrome. Specifically for SAD, ultrasonography helps examine the salivary glands in Sjögren's syndrome, determines the presence of the halo sign in giant cell arteritis and the presence of tendon or joint inflammation, quantifies pulmonary hypertension in scleroderma and assesses the presence of interstitial pulmonary disease in dermatomyositis. Clinical ultrasonography performed by internists is therefore an extremely useful technique in the diagnosis and follow-up of patients with SAD.

Analysis of hospitalizations by cardiovascular disease in the population with diabetes in Spain. / Análisis de las hospitalizaciones por enfermedad cardiovascular en población diabética en España.

OBJECTIVES: Diabetes mellitus is associated with a marked increase in cardiovascular disease. In this study, we analysed the prevalence of diabetes mellitus in hospitalised patients in Spain in 2015 and the burden of associated cardiovascular disease. METHODS: By analysing the 2015 minimum basic data set (MBDS) of the Spanish Ministry of Health, we included all patients discharged with a diagnosis of diabetes mellitus. We describe the epidemiological characteristics, distribution by the various hospital departments and the presence of cardiovascular disease. RESULTS: In 2015, there was 3,727,583 hospital discharges in Spain, 619,188 of which involved patients with diabetes (16.7%), 56.8% of whom were men and with a mean age of 73.2years. The prevalence of cardiovascular disease was 40.8%, distributed among congestive heart failure (20.1%), cerebrovascular disease (10.3%), coronary artery disease (9.4%) and peripheral arterial disease (9.1%). Most of the patients were admitted to internal medicine (34.2%), cardiology (9.5%) and general surgery (8.9%) departments. The mean overall stay was 8.2days, the readmission rate at 30days was 14%, and the mortality rate was 6.8%. The patients hospitalized in internal medicine had higher severity levels (3-4) than those hospitalized in other medical departments (41.9% vs. 31.6%, respectively; P<.01) and those hospitalized in surgical departments (11.2%; P<.01). CONCLUSIONS: Diabetes mellitus is a significant comorbidity for patients hospitalized in internal medicine. A significant proportion of these patients present cardiovascular disease, mostly heart failure.

OMW spillage control tool based on tracking p-Coumaric acid degradation by HPLC.

Olive mill wastewater (OMW) is a major watercourse pollutant agent with a high concentration of phenolic compounds. It is estimated that 30 million OMW m3 are released into rivers every year. Protecting the health of these courses against the uncontrolled discharges implies establishing an adequate legislation, where spillage control tools play a fundamental role. In this paper, a new tool for OMW spillage control is discussed. It is based on the use of a RP-HPLC-UV protocol to track p-Coumaric acid (pCA), a characteristic OMW phenolic compound, and its derivative compounds through their chemical oxidation and biological anaerobic degradation. Laboratory assays and real-life experiences allowed to determine degradation routes and apparition times for every pCA derivative, making it possible to detect an OMW spill and assess its age. Moreover, this RP-HPLC-UV introduces solid advantages over previous detection procedures, namely, quicker response times and smaller costs than HPLC methods and superior specificity than colorimetric methods. Finally, this tool was put to test in an actual OMW-polluted watercourse. In all scenarios, the tool demonstrated solid reliability.

Positioning document on incorporating point-of-care ultrasound in Internal Medicine departments. / Documento de posicionamiento sobre la incorporación de la ecografía clínica en los servicios de Medicina Interna.

This positioning document describes the most important aspects of clinical ultrasonography in the internal medicine setting, from its fundamental indications to the recommended training period. There is no question as to the considerable usefulness of this tool in the standard clinical practice of internists in numerous clinical scenarios and settings (emergencies, hospital ward, general and specific consultations and home care). Ultrasonography has a relevant impact on the practitioner's ability to resolve issues, increasing diagnostic reliability and safety and providing important information on the prognosis and progression. In recent years, ultrasonography has been incorporated as a tool in undergraduate teaching, with excellent results. The use of ultrasonography needs to be widespread. To accomplish this, we must encourage structured training and the acquisition of equipment. This document was developed by the Clinical Ultrasonography Workgroup and endorsed by the Spanish Society of Internal Medicine.

High doses of systemic corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease. A cohort study. / Dosis altas de corticoides sistémicos en pacientes ingresados por exacerbación de enfermedad pulmonar obstructiva crónica. Un estudio de cohortes.

OBJECTIVES: To assess the effect of high doses of corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: A prospective cohort study was conducted on patients hospitalized with COPD between January and March 2015, grouped according to the glucocorticoid dosage administered (cutoff, 40mg of prednisone/day). We compared the results of hospital stay, readmission and mortality at 3 months of discharge. RESULTS: We analysed 87 patients. The median daily dose was 60mg of prednisone (interquartile range, 46.67-82.33mg/day), and the administration route was intravenous in 96.6% of the cases. We established a relative risk (RR) for hospital stays longer than 8 days of 1.095 (95% CI 0.597-2.007; P=.765) when steroid dosages greater than 40mg/day were employed. In these patients, the hazard ratio (HR) for readmission in the 3 months after discharge was 0.903 (95% CI 0.392-2.082; P=.811), and the mortality was 1.832 (95% CI 0.229-16.645; P=.568). Neither the RR nor the HR varied in a statistically significant manner after adjusting for confounding factors. CONCLUSIONS: A daily dose greater than 40mg of prednisone in patients hospitalised for COPD exacerbation was not associated with a shorter hospital stay or a reduction in readmissions or mortality at 3 months.

RECALMIN II. Eight years of hospitalisation in Internal Medicine Units (2007-2014). What has changed? / RECALMIN II. Ocho años de hospitalización en las Unidades de Medicina Interna (2007-2014). ¿Qué ha cambiado?

OBJECTIVES: To analyse the evolution of care provided by the internal medicine units (IMU) of the Spanish National Health System from 2007 to 2014. MATERIAL AND METHODS: We analysed all discharges from the IMU of the Spanish National Health System in 2007 and 2014, using the Minimum Basic Data Set. We compared the risk factors by episode, mortality and readmissions between the two periods. We prepared specific fits for the risk for mortality and readmissions in heart failure, pneumonia and chronic obstructive pulmonary disease, as well as the Charlson index for all activity. RESULTS: Discharges from the IMU between the two periods increased 14%. The average patient age increased by 2.8 years (71.2±17.1 vs. 74±16.2; p<.001), with a marked increase in comorbidity (Charlson index, 4±3.7 vs. 4.7±3.9; p<.001; 24% increase in risk factors per episode). The adjusted mortality rates decreased slight but significantly, with a slight increase in readmissions. CONCLUSIONS: During the analysed period, there was an increase of almost 3 years in the mean age of patients treated in the IMU of the Spanish National Health System, with a marked increase in comorbidity. These results should lead to a more appropriate assignment of nurse workloads and an increased implementation of good practices in clinical management.

Tuberculosis and immigration in an area of southwest Madrid.

OBJECTIVE: To describe differences between Spanish and immigrant tuberculosis (TB) cases. DESIGN: Retrospective descriptive study of Spanish and immigrant TB patients diagnosed in a Madrid hospital from 2004 to 2013. RESULTS: A total of 322 patients were analysed, 183 Spanish-born and 139 immigrants (sub-Saharan Africa 32.4%, Morocco 28.8%, Latin America 20.1% and Eastern Europe 17.3%). Immigrants were younger and had a higher rate of human immunodeficiency virus (HIV) infection (P < 0.05). Spanish TB patients were often smokers and immunosuppressed (not HIV) (P < 0.001). No differences in symptoms and site of disease were detected. A higher proportion with isoniazid (INH) resistance was observed among immigrants (14.6% vs. 3.8%, P < 0.05), regardless of country of origin. Being an immigrant was an independent risk factor for INH resistance (OR 4.8, 95%CI 1.3-17.9). CONCLUSION: There is currently no consensus on whether or not it would be appropriate to treat Spanish and immigrant patients with different regimens. Being an immigrant is a clear risk factor for INH resistance. According to our results, it is necessary to evaluate the impact of changing treatment protocols in Madrid, Spain. It is also important to introduce specific strategies for the management of TB among immigrants.

[Description of hospital discharges in patients with systemic lupus erythematosus]. / Descripción de las altas hospitalarias en pacientes con lupus eritematoso sistémico.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease that mainly affects young women and whose mortality is increasing for this age group. OBJECTIVES: We used the national registry of Hospital discharges in Spain based on the study of the Minimum Basic Data Set (MBDS) to analyze hospital discharges of patients whose diagnosis included that of LES. MATERIAL AND METHODS: A cross-sectional, descriptive study was performed of all episodes coded as having LES using ICD-9-MC coding system of the patients hospitalized within the period 2005-2008. RESULTS: A total of 5,464 episodes were identified, 1,855 (33%) as main diagnosis and 3,609 (66%) as secondary diagnosis. Patients having LES the main diagnosis were younger (41.56 ± 17.55 vs 56.07 ± 19.01 years; P < .001), had fewer elective admittances (62.5 vs 84.8%; P<.001), lower comorbidity as measured by the Charlson's index (Charlson>2; 18 vs 35%; P<.001) and lower mortality (1.1 vs 5.4%; P < .001). CONCLUSIONS: Patients admitted to internal medicine departments in Spain with a diagnosis of LES accounts for 0.3% of the total. Two different groups of patients are identified. The first group was younger, had lower comorbidity and were in the early phases of diagnosis and/or treatment. The second group was more numerous, older, with a higher comorbidity, with admittances frequently related to infections or cardiovascular complications and higher mortality rate.

[Adverse drug events in patients hospitalized in internal medicine]. / Acontecimientos adversos causados por medicamentos en pacientes ingresados en medicina interna.

OBJECTIVE: Adverse drug events (ADE) are a public health problem, the dimension of which is difficult to quantify because it is under-reported. We have aimed to identify and describe the ADEs recorded in the minimum basic data set (MBDS) of the Internal Medicine Services during the years 2005-7. PATIENTS AND METHODS: A cross-sectional study. Those episodes coded as such, according to the ICD-9-CM, in the discharge reports of all the patients hospitalized during 2005-07 in the entire Spanish territory, were selected. The sociodemographic variables, diagnostic categories and types of drugs, among others, were described and analyzed. RESULTS: Of the 1,567,659 discharges coded in the Minimum Basic Data Set" (MBDS), 96,607 ADEs were recorded in 86,880 episodes (5.55%). Of these 82.86% were not preventable and 17.14% were preventable. A total of 4.5% of the episodes recorded an adverse drug reaction (ADR). The ADE's were more frequent in women and the appearance of an ADR during admission was accompanied by an increase in the hospital stay. CONCLUSIONS: The MBDS is a useful tool for the identification, quantification and analysis of the ADRs, however, it is limited by the low recording of the discharge reports.

[Two-year analysis of Internal Medicine activity in the National Health Care System hospitals]. / Análisis de dos años de actividad de Medicina Interna en los hospitales del sistema nacional de salud.

INTRODUCTION: We present a summary of the results of the hospital activities of the Internal Medicine (IM) Departments of the National Health Care System during the years 2005-2006. MATERIAL AND METHODS: The patients hospitalized in the IM departments of Spain during 2005 and 2006 were analyzed according to the data obtained from the minimum basic data set (MBDS), in which the administrative data were collected (age, gender, personal data) and clinical data (one principal diagnosis and up to 1 secondary diagnosis and 19 clinical procedures) for all the patients hospitalized in the public and private hospitals of Spain. RESULTS: During this period, there were 7,130.85 discharges in our country, 1,099.65 of these being from IM. A total of 53.6% of the patients were male, with mean age of 70.6 years, mean stay of 10 days (standard deviation [SD] 11.7) and 9.9% deaths. A total of 9.7% of the patients were admitted through the Emergency Department. Mean weight was 1.74 (SD 1.41) according to the American classification system and 1.1 (SD 0.73) according to the National Health System data. Respiratory failure diagnostic related group (DRG-541, 88 and 101) accounted for 14% of the discharges and heart failure (DRG 17, 544 and 87) accounted for 1.4% of all the episodes. CONCLUSIONS: In Spain, the internal medicine doctors attended one out of every 6 hospitalized patients. Admissions for more than half of the patients admitted due to cardiorespiratory disorder were unscheduled and one out of every 10 died during their stay. These data illustrate the importance of this specialty in the context of health care of our country. (c) 2009 Elsevier España, S.L. All rights reserved.

Biomass stabilization in the anaerobic digestion of wastewater sludges.

Sludge stabilization processes include both volatile solid destruction and biomass stabilization. Traditionally, both processes have been considered together, in such a way that, when volatile solid destruction is achieved, the biomass is considered stabilized. In this study, volatile solids reduction and biomass stabilization in the anaerobic digestion of primary, secondary and mixed sludges from municipal wastewater treatment plants were researched in batch cultures by measurements of suspended solids and suspended lipid-phosphate. The estimated kinetic constants were higher in all sludge types tested for the biomass stabilization process, indicating that volatile solids destruction and biomass stabilization are not parallel processes, since the latter one is reached before the former.