Galicia Clínica is the journal of the Galician Society of Internal Medicine. Its mission is to inform the scientific community, especially in the area of healthcare, of the research work conducted by medical specialists, promoting research activities, healthcare training, mutual knowledge and collaboration amongst professionals.
Galicia Clínica by Sociedad Gallega de Medicina Interna is licensed under a Creative Commons Reconocimiento-NoComercial-SinObraDerivada 4.0 Internacional License. Created from galiciaclinica.info.
Bacteremia in centenarians: A diagnostic challenge and cause for reflection
En las últimas décadas estamos asistiendo a un envejecimiento global y progresivo de la población, fruto de una mayor expectativa de vida por la mejora en las condiciones higiénicas, el control alimentario, los programas de prevención de enfermedades y el fácil acceso a los servicios sanitarios de la población.
Copyright (c) 2025 Galicia Clínica https://creativecommons.org/licenses/by-nc-nd/4.0
Visceral obesity and cardio-renal-metabolic syndrome: The train that Internal Medicine must not miss.
Contemporary medicine is undergoing a profound transformation with the emergence of the cardio-renal-metabolic syndrome. In this new framework, visceral obesity is no longer an abstract concept but becomes the pathogenic core of a silent pandemic. Internal Medicine, by virtue of its holistic vocation, is called to stand at the forefront of this integrative approach, offering responses to one of the greatest challenges to global health in the 21st century.
cardiovascular-kidney-metabolic syndrome
Inteligencia Artificial en Salud. ¿Otra moda informática?
New pharmaceuticals for obesity treatment: when regaining control gives reason for hope
Obesity is much more than a number on the scale or a body mass index: it is the result of complex hormonal, genetic, psychological, and social interactions, and unfortunately carries a stigma as heavy as the extra pounds themselves. Until recently, therapeutic options amounted to advice to “eat better” and “move more,” often underpinned by willpower rhetoric that left most patients feeling like they hadn’t done enough. Today, molecules such as semaglutide and tirzepatide have emerged as reliable options, capable of reducing more than 15% of body weight while delivering solid metabolic and cardiovascular benefits.
Antibiotic lock therapy: a therapeutic option worth considering. Bibliographic revision.
Catheter-related infections are a significant complication that increase morbility, mortality and resource consumption. The treatment of choice is catheter removal and administration of systemic antibiotic therapy. For long-term venous catheters, antibiotic lock therapy (ALT) may be considered. In this review, we focus on long-term central venous catheter CVS and peripherally inserted CVS. Combined with systemic antibiotic therapy, it has achieved a high cure rate in the types of infections. With appropriate case selection, the catheter salvage rate is 80%, depending on the type of patogen and the symptoms of the infection.
Central venous catheter, antibiotic lock therapy, biofilm.
Pre-exposure prophylaxis (PrEp) in HIV infection - A new milestone in a long-distance race
Dentro del manejo clínico de las personas que viven con el virus de la inmunodeficiencia humana (VIH) y de la prevención de la transmisión del mismo, que aún hoy supone un importante problema de salud pública, la profilaxis pre-exposición (PrEP) constituye uno de los últimos hitos. Esta profilaxis, consistente en la administración regular de TAR a grupos de riesgo, ha demostrado con evidencia sólida adecuadas tasas de eficacia y seguridad. Su uso, que debe ser impulsado por los poderes públicos, debe no obstante ser complementado con otras medidas de prevención, máxime en un contexto de aumento de las enfermedades de transmisión sexual (ETS)
Multidisciplinary consensus on the management of dyslipidemia in patients with atherosclerotic vascular disease in Galicia
<a href="https://galiciaclinica.info/gc/Cardiovascular Disease (CVD) is the leading cause of death in Galicia. The main component of CVD is Atherosclerotic Vascular Disease (AVD), whose main clinical manifestations are ischemic heart disease, ischemic cerebrovascular disease, or peripheral artery disease. On the other hand, these diseases are associated with a great economic and social impact. The causal role of LDL-C as an etiologic agent of Atherosclerotic Vascular Disease has been demonstrated in multiple studies, as well as the beneficial effect of keeping LDL-C levels low for as long as possible to decrease cardiovascular morbidity and mortality. Despite the wide range of lipid-lowering therapies, real-life studies have shown that most patients do not achieve the LDL-c goals set by clinical practice guidelines according to their CV risk. Therefore, to improve the lipid control of patients with Atherosclerotic Vascular Disease in Galicia, a treatment algorithm agreed upon by the different medical specialties is proposed, including recommendations for the patients’ follow-up to ensure continuity of care.">Cardiovascular Disease (CVD) is the leading cause of death in Galicia. The main component of CVD is Atherosclerotic Vascular Disease (AVD), whose main clinical manifestations are ischemic heart disease, ischemic cerebrovascular disease, or peripheral artery disease. On the other hand, these diseases are associated with a great economic and social impact. The causal role of LDL-C as an etiologic agent of Atherosclerotic Vascular Disease has been demonstrated in multiple studies, as well as the beneficial effect of keeping LDL-C levels low for as long as possible to decrease cardiovascular morbidity and mortality. Despite the wide range of lipid-lowering therapies, real-life studies have shown that most patients do not achieve the LDL-c goals set by clinical practice guidelines according to their CV risk. Therefore, to improve the lipid control of patients with Atherosclerotic Vascular Disease in Galicia, a treatment algorithm agreed upon by the different medical specialties is proposed, including recommendations for the patients’ follow-up to ensure continuity of care.
Bacteremia in centenarian patients: clinical, microbiological and prognostic profile in a cohort from northwestern Spain (2005–2024).
Objectives: To describe the clinical, microbiological, and prognostic characteristics of bacteremia in centenarian patients. Material and methods: A retrospective, descriptive study of all episodes of bacteremia in patients aged 100 years or older at Lucus Augusti University Hospital, 2005-2024. A descriptive analysis of the recorded variables was performed, along with a multivariate logstic regression to identify factors associated with mortality. Results: A total of 29 patients were included, 58.6% were women. The mean age was 101.4 ± 1.7 years, and the median Charlson Comorbidity Index was 4 (IQR 3–4). The most common infection source was urinary (48.3%), and E. coli was the predominant microorganism (51.7%). Atypical presentations were predominant. Antimicrobial resistance was observed in 27,6% of isolates, and 26.6% of patients received inappropriate empirical antibiotic therapy. The mean length of stay was 7.2 ± 5.4 days. Delirium was the most frequent complication (44.8%), and in-hospital mortality was 24.1%. Multivariate analysis showed that a higher qSOFA score at admission was independently associated with mortality (OR 4.6; 95% CI: 1.1–19.2; p=0.039). A total of 45.8% of patients were readmitted, and the median survival after the acute episode was 93 days (IQR 47–464.5). Conclusions: Bacteremia in centenarian patients is characterized by atypical presentation, clinical severity, and high morbidity and mortality. The most frequent infection source was urinary, predominantly caused by E. coli. These findings highlight the importance of early identification of severe cases, optimization of empirical antimicrobial therapy, and prevention of complications.
Bloodstream Infections; Centenarians; Gram-Negative Bacterial Infections; Urinary Tract Infections; Mortality.
NAVIGATING IPILIMUMAB-INDUCED HYPOPHYSITIS IN ADVANCED HEPATOCELLULAR CARCINOMA: A CLINICAL PERSPECTIVE
Immunotherapy, represented by immune checkpoint inhibitors (ICIs), has marked a significant breakthrough in cancer treatment. Ipilimumab (IPI), an anti-CTLA-4 agent, stands out in this therapeutic landscape. However, its efficacy is not without challenges, among them, immune-related adverse events, especially hypophysitis. In this article, we present a detailed clinical case of hypophysitis induced by the combined administration of Ipilimumab (IPI) and Nivolumab (NIVO) in a 69-year-old patient diagnosed with advanced hepatocellular carcinoma (HCC). The complexity of his medical history adds layers of intricacy to the clinical narrative. After four cycles of immunotherapy, a spectrum of symptoms emerged, requiring a multidisciplinary diagnostic and therapeutic approach. The case highlights the imperative need to understand in nuanced detail ICI-induced hypophysitis. The discussion encompasses the elusive pathophysiology, diverse clinical manifestations, and the delicate balance required for effective clinical management. Significantly, the decision-making regarding treatment continuation is explored, emphasizing the critical need for specialized clinical vigilance. This case serves as a microcosm of the broader challenges entrenched in the dynamic realm of immunotherapy. As ICIs redefine treatment paradigms for HCC, awareness of rare complications such as hypophysitis becomes indispensable. The conclusion advocates for a multidisciplinary approach to navigate these intricacies, ensuring judicious decision-making and optimal patient outcomes.
Copyright (c) 2024 GaliciaClinica - Official Journal of the Galician Society of Internal Medicine (SOGAMI) https://creativecommons.org/licenses/by-nc-nd/4.0
Insulinoma: An Undervalued Diagnosis of Hypoglycemia in Elderly Patients
Insulinoma is a rare pancreatic endocrine tumor, characterized by the inappropriate secretion of insulin, leading to episodes of hypoglycemia. During these hypoglycemic events, patients may experience autonomic and neuroglycopenic manifestations. However, it is important to note that insulinoma can also have long-term effects on cognitive function, even after hypoglycemia resolution. We present the case of an 89-year-old female with a gradual cognitive decline two years prior and recurrent episodes of stuporous level of consciousness in the preceding months. Insulinoma was confirmed through the measurement of plasma glucose, insulin, and C-peptide levels. Following the biochemical confirmation, a computed tomography (CT) scan successfully located the tumor. Surgical resection was considered high-risk. Nevertheless, after dietary modifications and the administration of diazoxide, the patient's hypoglycemic episodes were controlled. This case report highlights the importance of considering insulinoma as a potential cause of unexplained episodes of hypoglycemia, particularly in older patients with cognitive impairment.
Hepatocellular carcinoma after Fontan procedure: case report
BACKGROUND: Single ventricle includes various cardiac abnormalities in which either one ventricle is underdeveloped or a ventricular septal wall did not form, leading to the mixing of arterial and venous blood in the heart. The Fontan procedure separates the systemic and pulmonary circulations because a surgical cavopulmonary connection is made. After this procedure, there is an increased systemic venous pressure, leading to low hepatic perfusion pressure and oxygenation, fibrosis, cirrhosis and ultimately hepatocellular carcinoma. PATIENT AND METHODS: This case report details a 40-year-old man who received the Fontan procedure, developing symptoms similar to cardiac failure 30 years later. After further evaluation, findings were consistent with hepatocellular carcinoma with lung metastasis, leading to death in less than one month. RESULTS AND CONCLUSION: Fontan patients must be screened for associated liver disease with cirrhosis and hepatocellular carcinoma to prevent disease progression and its detection in advanced stages. Despite the regular follow-up in a Cardiology consultation, we point out the importance of a multidisciplinary approach to screening for complications of the Fontan procedure.
SARCOIDOSIS-LIKE SYNDROME IN A 44-YEAR-OLD WOMAN WITH ADVANCED STAGE MELANOMA TREATED WITH ADJUVANT BRAF PLUS MEK INHIBITORS. A CASE REPORT.
Pérdida involuntaria de peso: que me vea un internista
No se envía Abstract ya que los editoriales no lo necesitan.
Copyright (c) 2025 GaliciaClinica - Official Journal of the Galician Society of Internal Medicine (SOGAMI) https://creativecommons.org/licenses/by-nc-nd/4.0
Antisynthetase syndrome: when clinical variety challenges diagnosis
Prescription of physical exercise for internists
The health benefits of physical exercise are widely known. Regular physical exercise reduces mortality from all causes, the incidence of cancer, improves cognitive reserve and reduces dependency. The World Health Organization recommends for all adults at least 150 to 300 minutes of moderate physical activity per week or 75 to 150 minutes of vigorous physical activity and resistance exercise of high or moderate intensity that includes all major muscle groups 2 or more days a week. To help our patients reach this recommendation, an important tool is the prescription of physical exercise. This should include type, frequency, intensity and duration of the activity. As internists we must know the importance of physical activity and exercise in our patients, and its impact on health. Particularly important is in those sedentary patients, in whom a small increase in their physical activity has a maximum impact on their health.
CORRELATION OF MEASUREMENTS OF PREPERITONEAL TISSUE AND VISCERAL TISSUE WITH GLYCOSYLATED HEMOGLOBIN AND CHOLESTEROL VALUES
Background and Objectives: Obesity is a prevalent and increasingly common issue, strongly linked to conditions such as type 2 diabetes mellitus (T2DM) and dyslipidemia (DL). The role of fat, specifically visceral adipose tissue (VAT), and its subtype, preperitoneal adipose tissue (PAT), appears to be pivotal in visceral obesity and the development of related complications. The main objectives were to correlate the proportion of VAT measured by bioelectrical impedance analysis (BIA) and the thickness of PAT measured by ultrasound with analytical levels of HbA1c and total cholesterol (TC), as well as to assess their application in the diagnosis of T2DM and DL. Materials and Methods: An observational, descriptive, and retrospective study was conducted with 72 patients attending the preoperative rehabilitation consultation at the Infanta Cristina University Hospital. These patients were assessed for VAT and PAT, and the results were correlated with their analytical levels of HbA1c and TC. Results: The accumulation of both VAT and PAT showed a significant correlation with elevated HbA1c levels (p<0.001 and p=0.001, respectively), indicating the presence of T2DM. Additionally, isolated excess VAT was found to be associated with DL (p=0.041), likely due to its correlation with elevated TC levels. Conclusions: The presence of a pathogenic link between visceral obesity, defined by the accumulation of VAT and PAT, with T2DM and DL, and its determination via BIA and ultrasound for body composition, may suggest a precise diagnosis of both conditions.
Unusual presentation of Pott’s disease: a case report
Bacteraemia and Hepatic Abscess Caused by Desulfovibrio Desulfuricans
This case report presents a rare liver abscess caused by Desulfovibrio desulfuricans bacteremia in an elderly Indian patient. Desulfovibrio spp. are gram-negative, sulfate-reducing anaerobic bacteria that are typically found in the environment and can also be normal inhabitants of the oral cavity and intestinal tract. While liver abscesses are commonly caused by gram-negative bacilli, Desulfovibrio spp. are rarely reported as causative agents. The patient, an 83-year-old Indian female, was living in Portugal for a long time. She had multiple comorbidities and presented with general malaise, asthenia associated with decreased appetite, and diarrhea. CT scan confirmed the presence of liver abscesses and blood cultures identified Desulfovibrio desulfuricans as the causative agent. Treatment involved percutaneous drainage of the abscesses and a 6-week course of antibiotics with metronidazole initially and then with amoxicillin/clavulanic acid. The patient showed clinical improvement, and subsequent negative haemocultures and imaging control indicated the effectiveness of the treatment. However, the patient's condition deteriorated due to respiratory failure caused by COVID-19, highlighting the impact of underlying comorbidities. The rarity of Desulfovibrio desulfuricans infections in Portugal further emphasizes the significance of this case. It raises questions about the potential influence of ethnicity and geography on susceptibility to such infections, warranting further research.
Copyright (c) 2023 GaliciaClinica - Official Journal of the Galician Society of Internal Medicine (SOGAMI) https://creativecommons.org/licenses/by-nc-nd/4.0
Bullous Leukemia cutis: a rare form of skin infiltration by leukemic cells.
Lemièrre Syndrome and Leptospirosis – Two Simultaneous Entities
Hypophosphatemia after intravenous iron administration
Disseminated nocardiosis - A case report
Nocardiosis, caused by various species of Nocardia, poses diagnostic and therapeutic challenges due to its diverse clinical presentations that often mimic other infections and malignancies. We present the case of a 72-year-old woman with a history of autoimmune hepatitis and diabetes mellitus (DM) who initially presented with fever, headaches, and confusion. Extensive investigations revealed an ischemic lesion in the central nervous system (CNS) attributed to vasculitis. Two months later, she returned with literal paraphasia, ocular symptoms (red eye and retro-orbital pain), and fever. Despite negative blood cultures, Nocardia cyriacigeorgica was isolated from vitreous humor and lung tissue, confirming the diagnosis of disseminated nocardiosis. A rigorous treatment regimen, including trimethoprim/sulfamethoxazole (TMP/SMX), Meropenem, and Linezolid, led to significant improvement. This case underscores the diagnostic complexity of Nocardiosis, emphasizing the need for early and precise diagnosis, multidisciplinary care, and prolonged treatment in severe cases. Further research is required to optimize therapeutic protocols, particularly in CNS-involved Nocardiosis.
Brain Abscess Due to Systemic Embolization
A brain abscess is a focal infection of the brain. It can be caused by hematogenous or direct spread, presenting with non-specific symptoms that can delay diagnosis. They are most often bacterial, but they can also be fungal, parasitic or granulomatous. Neurological manifestations such as stroke, meningitis, or brain abscess can develop from endocarditis, so this entity should always be considered and investigated. The authors present a case of a patient with a heart valve prosthesis for aortic stenosis and a brain abscess due to systemic embolization from subacute endocarditis.
Isolated involuntary weight loss: Clinical characteristics and predictors of malignancy.
Introduction: Involuntary weight loss (IPP) is a common problem in outpatient clinics. The objective of our study is to analyze the factors related to the presence of cancer as a cause of PPI in this type of patients. Methods: Retrospective, descriptive, observational, multicenter study. We analyzed epidemiological and clinical variables of all patients referred to the Internal Medicine clinic for IWL from October 2017 to December 2022. Results: We included 366 patients, 49% being male and a mean age of 62.6 (17.4) years. Cancer was responsible for the IWL in 33 patients (9%), non-malignant organic pathology in 120 patients (32.8%), psychiatric diseases in 90 patients (24.6%), and no cause was found in 123 patients (33.6%). Overall mortality at 12 months was 5.5%, being significantly higher in the group of patients whose etiology was a cancerous process compared to the other pathologies (39.4% vs. 8,2%, p<0.001). The logistic regression analysis determined that the predictors of cancer as a cause of IWL were male sex [OR 0.34, (95% CI 0.144-0.802), p<0.014], the presence of anorexia [OR 3.565, (95% CI 1.539-8.260), p<0.003], leukocyte concentration [OR 1.156, (95% CI 1.105-1.133), p<0.042] and hemoglobin concentration in blood [OR 0.593, (95% CI 0.479-0.734), p <0.001]. Conclusions: 9% of the patients with IWL had a cancer as the underlying cause, finding predictors of this. Mortality at one year was significantly higher in this subgroup of patients.
Involuntary weight loss, Unintentional weight loss, Cancer, Malignancy.
Lesiones de Janeway en paciente con sarcomade Kaposi clásico
Describimos el caso de un paciente con sarcoma de Kaposi clásico que contrae una endocarditis infecciosa sobre válvula nativa por Staphylocuccus epidermidis meticilín resistente y desarrolla lesiones de Janeway. Estas últimas juegan un papel clave ya que son difíciles de discernir debido a las lesiones cutáneas del Kaposi.
Darier's disease with esophageal involvement, a case report.
Darier's disease (DD) is an autosomal dominant dermatosis caused by mutation of ATP2A2 gene at 12q23-24, characterized histologically by acantholysis and dyskeratosis1. It's a rare disease, distinguish by the presence of red-brown keratotic papules of follicular, palm-plantar, nail and less often in oral mucosa2. We report a case of a 70-year-old woman with medical history of neuropsychiatric disorders, chronic kidney disease (CKD), anemia of CKD, diabetes mellitus 2, hypertensive heart disease. At admission she presented widespread hyperkeratotic skin lesions and erythronychia. A skin biopsy confirmed the diagnosis of DD. An upper gastrointestinal endoscopy revealed extensive esophagitis histologically in favor of association with DD. Some extracutaneous manifestations have been described, the majority were neuropsychiatric disorders, with only a few cases described of esophageal mucous membranes affection. It appears to be due to the pleiotropic effect that has mutations in ATP2A2 in other cells3,4.
Darier's disease, acantholysis, dyskeratosis, esophageal involvement.
Copyright (c) 2026 Galicia Clínica https://creativecommons.org/licenses/by-nc-nd/4.0
From pulmonary tuberculosis to meningitis: a revealing clinical case
The case presents a 58-year-old man, originally from Pakistan, who presented to the emergency department with significant neurological symptoms. Through various imaging techniques and analysis of the cerebrospinal fluid (CSF), the diagnosis of tuberculous meningitis accompanied by tuberculomas was established, a rare but severe manifestation of tuberculosis.