Metabolic hepatic steatosis (MetHS) is a clinically heterogeneous, multisystemic, dynamic, and complex disease, whose progression is one of the main causes of cirrhosis and hepatocarcinoma. This clinical practice guideline aims to respond to its main challenges, both in terms of disease burden and complexity. To this end, recommendations have been proposed to experts through the Delphi method. The consensus was optimal in recommendations regarding type 2 diabetes as a risk factor (1.5.1, 4.5.1), in which cases early detection of MetHS should be carried out (4.5.2). Its results also emphasize the importance of the use of non-invasive tests (FIB-4, NFS, HFS) for the exclusion of significant fibrosis in patients with suspected MetHS (2.3.1, 2.3.3). Diagnosis should be carried out through the sequential combination of non-invasive indices and transient elastography by FibroScan® for its risk stratification (2.3.3). A nearly unanimous consensus was reached regarding the role of early prevention in the impact on the quality of life and survival of patients (5.1.2), as well as on the effectiveness of the Mediterranean diet and physical exercise in relation to the improvement of steatosis, steatohepatitis and fibrosis in MetHS patients (5.2.2) and on the positive results offered by resmiterom and semaglutide in promoting fibrosis regression (5.4.1). Finally, a great consensus has been reached regarding the importance of multidisciplinary management in MetHS, for which it is essential to agree on multidisciplinary protocols for referral between levels in each health area (6.2.1), as well as ensuring that referrals to Hepatology/Digestive and Endocrinology or Internal Medicine services are effective and beneficial to prevent the risk of disease progression (6.2.3, 6.3.1).
Introducción La prevalencia del cáncer ha aumentado asociada a una mayor complejidad de los pacientes. En este contexto, la implantación del internista en la asistencia al paciente con tumor sólido ha crecido en los últimos años. Se pretende describir la actividad del internista en la asistencia al paciente oncológico en los hospitales españoles. Material y métodos Estudio transversal y descriptivo a partir de una cohorte formada por todos los hospitales públicos y los principales privados. La información se recogió a través de encuesta respondida por médicos internistas y oncólogos en enero y febrero de 2025. Resultados Se obtuvo respuesta de 188 de los 481 centros objetivo (39,1%), representando el 51,2% de los centros públicos y el 16,7% de los privados. En 181 centros se atendían pacientes oncológicos hospitalizados, siendo responsabilidad de oncología médica en el 56,4% de los centros y de medicina interna en el 43,6%. Entre aquellos donde ingresaban a cargo de oncología médica, se disponía de internista en planta de hospitalización (modelo de asistencia compartida) en el 37,3% de los casos. En global, en el 64,5% de los centros, los pacientes oncológicos ingresaban en plantas con presencia de internistas, ya fuera mediante atención directa por medicina interna o bien con el modelo de asistencia compartida. Conclusión Los internistas desempeñan un papel esencial en la atención del paciente oncológico en España, especialmente en las plantas de hospitalización. La elevada implantación del internista justificaría su reconocimiento como actividad estructural en la asistencia al paciente oncológico, así como su participación activa en equipos de trabajo multidisciplinares.
Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disorder characterized by mucocutaneous telangiectases and visceral vascular malformations, leading to recurrent bleeding, iron-deficiency anemia, and organ complications. Pulmonary, cerebral, and hepatic involvement are major determinants of morbidity and mortality. Management has traditionally relied on local and interventional approaches, which are largely palliative and do not address underlying disease mechanisms. New insights in HHT pathophysiology, particularly in the dysregulated BMP9-BMP10/ENG/ALK1 pathway, which is fundamental to the angiogenesis process, have enabled the development of targeted systemic therapies. Although no systemic drug is specifically approved for HHT, antifibrinolytics, anti-angiogenic agents, mTOR and AKT inhibitors, and immunomodulatory drugs have shown variable efficacy in selected patients. This review summarizes current evidence on systemic therapies and ongoing clinical trials, highlighting their potential to complement existing strategies and move toward disease-modifying approaches.
Introduction The prevalence of cancer has increased, together with greater patient complexity. In this context, the involvement of hospitalists in the care of patients with solid tumours has grown in recent years. The aim of this study is to describe the activity of hospitalists in the care of patients with cancer in Spain. Materials and methods A cross-sectional study based on a cohort comprising all public hospitals and the main private hospitals of Spain was performed. Information was collected through a survey completed by hospitalists and oncologists in January and February 2025. Results Responses were obtained from 188 of the 481 hospitals (39.1%), representing 51.2% of public centres and 16.7% of private ones. In 181 centres, patients with cancer were admitted for inpatient care: this responsibility fell to the Department of Oncology in 56.4% of centres and to Department of Internal Medicine in 43.6%. Among centres where patients were admitted under the Department of Oncology, a hospitalist was part of the inpatient ward team (“co-management” model) in 37.3% of cases. Overall, in 64.5% of centres, oncology patients were admitted to wards staffed by hospitalists, either through direct Internal Medicine care or through the “co-management” model. Conclusion Hospitalists play a key role in the care of oncology patients in Spain, particularly in inpatient wards. The widespread involvement of hospitalists supports recognizing this work as a structural component of oncology patient care, as well as their active participation in multidisciplinary teams.
