Pub Date : 2026-02-01DOI: 10.1016/j.rce.2025.502457
J.A. Cuenca-Gómez , M.S. Dawid-Milner , R. Sánchez-Martínez
Ehlers-Danlos Syndromes (EDS) are hereditary connective tissue disorders that affect multiple systems. Mast Cell Activation Syndrome (MCAS) is a clinical condition characterized by chronic and aberrant activation of mast cells. This activation leads to the release of chemical mediators that cause a wide variety of symptoms across multiple organ systems. Both conditions share phenotypic similarities, particularly in symptoms associated with dysautonomia and immune-mediated manifestations.
Various studies have linked both disorders at the pathophysiological and clinical levels. For example, pathophysiologically, the close and bidirectional interaction between fibroblasts and mast cells in the extracellular matrix has been highlighted; clinically, there is a high prevalence of MCAS-related symptoms in patients with EDS, especially the hypermobile type. In recent years, emerging evidence also points to a potential molecular association.
The objective of this review is to evaluate the scientific evidence that exists between these two syndromes, at the pathophysiological, molecular and clinical levels.
{"title":"Asociación entre síndromes de Ehlers-Danlos y síndrome de activación mastocitaria. ¿Existe evidencia científica?","authors":"J.A. Cuenca-Gómez , M.S. Dawid-Milner , R. Sánchez-Martínez","doi":"10.1016/j.rce.2025.502457","DOIUrl":"10.1016/j.rce.2025.502457","url":null,"abstract":"<div><div>Ehlers-Danlos Syndromes (EDS) are hereditary connective tissue disorders that affect multiple systems. Mast Cell Activation Syndrome (MCAS) is a clinical condition characterized by chronic and aberrant activation of mast cells. This activation leads to the release of chemical mediators that cause a wide variety of symptoms across multiple organ systems. Both conditions share phenotypic similarities, particularly in symptoms associated with dysautonomia and immune-mediated manifestations.</div><div>Various studies have linked both disorders at the pathophysiological and clinical levels. For example, pathophysiologically, the close and bidirectional interaction between fibroblasts and mast cells in the extracellular matrix has been highlighted; clinically, there is a high prevalence of MCAS-related symptoms in patients with EDS, especially the hypermobile type. In recent years, emerging evidence also points to a potential molecular association.</div><div>The objective of this review is to evaluate the scientific evidence that exists between these two syndromes, at the pathophysiological, molecular and clinical levels.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502457"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.rce.2025.502456
A. Jiménez-Puente , M.D. Martín-Escalante , M. Noureddine-López , F. Rivas-Ruiz , A. Rubio-Gallo
Introduction
Patients who remain hospitalized due to the absence of adequate social support for discharge represent a growing challenge in an aging society where traditional family care networks are increasingly weakened.
Methods
We conducted a study in an acute care hospital in southern Spain, focusing on inpatients referred to the Social Work Department in whom social problems were identified as barriers to discharge (SPD). Data were reviewed from 2006 onwards, as well as across two 24-month periods: before and after the COVID-19 pandemic.
Results
2288 discharges with SPD were analyzed. From 2006 to 2024, the number of beds occupied by patients with SPD increased by an average of 0.62 beds per day each year. The rise was particularly marked in 2022 and 2024, when 1.3% of all hospital discharges were delayed due to SPD, equivalent to 11 beds occupied daily. Internal Medicine was the specialty with the highest proportion of patients with SPD: 4%.
Conclusions
Hospital stays prolonged by social problems represent a substantial burden and show a clear upward trend. The underlying causes are multifactorial, mainly related to social circumstances and the clinical complexity of patients.
{"title":"Análisis de los problemas sociales para el alta en hospitalización de agudos","authors":"A. Jiménez-Puente , M.D. Martín-Escalante , M. Noureddine-López , F. Rivas-Ruiz , A. Rubio-Gallo","doi":"10.1016/j.rce.2025.502456","DOIUrl":"10.1016/j.rce.2025.502456","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients who remain hospitalized due to the absence of adequate social support for discharge represent a growing challenge in an aging society where traditional family care networks are increasingly weakened.</div></div><div><h3>Methods</h3><div>We conducted a study in an acute care hospital in southern Spain, focusing on inpatients referred to the Social Work Department in whom social problems were identified as barriers to discharge (SPD). Data were reviewed from 2006 onwards, as well as across two 24-month periods: before and after the COVID-19 pandemic.</div></div><div><h3>Results</h3><div>2288 discharges with SPD were analyzed. From 2006 to 2024, the number of beds occupied by patients with SPD increased by an average of 0.62<!--> <!-->beds per day each year. The rise was particularly marked in 2022 and 2024, when 1.3% of all hospital discharges were delayed due to SPD, equivalent to 11<!--> <!-->beds occupied daily. Internal Medicine was the specialty with the highest proportion of patients with SPD: 4%.</div></div><div><h3>Conclusions</h3><div>Hospital stays prolonged by social problems represent a substantial burden and show a clear upward trend. The underlying causes are multifactorial, mainly related to social circumstances and the clinical complexity of patients.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502456"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.rce.2025.502455
Álvaro Velasco , Ignacio Pascual Ramos , Pablo Rodríguez Alonso , Celia Denche Sanz , Rocío Tello , Jorge Solís
Introduction
GLP-1 receptor agonists, such as semaglutide, have demonstrated cardiovascular benefits in trials such as SELECT and SOUL. This study assesses the proportion of post-myocardial infarction patients who meet eligibility criteria to benefit from semaglutide.
Methods
A retrospective, single-centre observational study was conducted including 100 consecutive patients following myocardial infarction. Clinical, demographic, and laboratory data were analysed. Eligibility was assessed using the criteria from the SELECT trial (body mass index ≥27 kg/m2, no diabetes, established atherosclerotic disease) and the SOUL trial (type 2 diabetes mellitus and atherosclerotic cardiovascular disease).
Results
SELECT criteria were met by 42 patients, SOUL criteria by 34, and both by 76. This combined group was characterised by older age, greater comorbidity burden (hypertension, dyslipidaemia, type 2 diabetes mellitus), higher body mass index, and a more atherogenic lipid profile.
Discussion
The high proportion of eligible patients suggests that these trials truly represent real-world clinical practice. The SELECT + SOUL group exhibited features consistent with metabolic syndrome, potentially explaining their elevated cardiovascular risk and the likely benefit from semaglutide.
Conclusions
Semaglutide shows high potential for prescription in specialties managing patients with cardiovascular events, identifying a target group with characteristics typical of metabolic syndrome.
{"title":"Pacientes postinfarto agudo de miocardio: potencial de semaglutida en pronóstico de reducción de eventos y mortalidad","authors":"Álvaro Velasco , Ignacio Pascual Ramos , Pablo Rodríguez Alonso , Celia Denche Sanz , Rocío Tello , Jorge Solís","doi":"10.1016/j.rce.2025.502455","DOIUrl":"10.1016/j.rce.2025.502455","url":null,"abstract":"<div><h3>Introduction</h3><div>GLP-1 receptor agonists, such as semaglutide, have demonstrated cardiovascular benefits in trials such as SELECT and SOUL. This study assesses the proportion of post-myocardial infarction patients who meet eligibility criteria to benefit from semaglutide.</div></div><div><h3>Methods</h3><div>A retrospective, single-centre observational study was conducted including 100 consecutive patients following myocardial infarction. Clinical, demographic, and laboratory data were analysed. Eligibility was assessed using the criteria from the SELECT trial (body mass index ≥27<!--> <!-->kg/m<sup>2</sup>, no diabetes, established atherosclerotic disease) and the SOUL trial (type 2 diabetes mellitus and atherosclerotic cardiovascular disease).</div></div><div><h3>Results</h3><div>SELECT criteria were met by 42 patients, SOUL criteria by 34, and both by 76. This combined group was characterised by older age, greater comorbidity burden (hypertension, dyslipidaemia, type 2 diabetes mellitus), higher body mass index, and a more atherogenic lipid profile.</div></div><div><h3>Discussion</h3><div>The high proportion of eligible patients suggests that these trials truly represent real-world clinical practice. The SELECT<!--> <!-->+<!--> <!-->SOUL group exhibited features consistent with metabolic syndrome, potentially explaining their elevated cardiovascular risk and the likely benefit from semaglutide.</div></div><div><h3>Conclusions</h3><div>Semaglutide shows high potential for prescription in specialties managing patients with cardiovascular events, identifying a target group with characteristics typical of metabolic syndrome.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502455"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.rce.2025.502458
A. Cotos Suárez , M. Alonso-Sardón , V. Velasco Tirado , A. López-Bernus , L. Sancha Domínguez , B. Rodríguez Alonso , J. Pendones Ulerio , J.L. Muñoz Bellido , M. Belhassen-García
Introduction
Cellulitis is a skin and soft tissue infection caused by the entry of a microorganism into the subcutaneous tissue. Nowadays it represents one of the main causes of hospital admission, mainly due to incorrect diagnosis or the need for intravenous treatment. The aim of this study is to observe the characteristics of cellulitis in patients admitted to our hospital during two years in order to determine whether admissions were really necessary.
Methods
Retrospective study of admissions for cellulitis between 2022 and 2023 at the Salamanca University Hospital, classified according to the CREST-SEWS criteria.
Results
During the study period, 332 patients with cellulitis were admitted to the Salamanca University Hospital. 56% of the patients were classified as grade II (those who do not have severe symptoms, but who are usually admitted due to their comorbidities). 70% of the patients had some comorbidity or risk factor such as skin disorders, type II diabetes mellitus or heart failure. The most common site of infection was the lower extremities. The etiologic agent of the infection could be established in 28% of the patients, and the most frequently isolated microorganism was methicillin-sensitive S.aureus. The most common treatment was β-lactams, specifically amoxicillin/clavulanic acid (39.5%) and piperacillin/tazobactam (23.8%).
Conclusions
In order to treat infectious cellulitis, it is essential to carry out a correct etiological diagnosis in order to establish the most appropriate treatment and reduce unnecessary admissions, especially in patients with class II cellulitis.
{"title":"Manejo actual de la celulitis infecciosa: desde la epidemiología hasta el abordaje hospitalario en España","authors":"A. Cotos Suárez , M. Alonso-Sardón , V. Velasco Tirado , A. López-Bernus , L. Sancha Domínguez , B. Rodríguez Alonso , J. Pendones Ulerio , J.L. Muñoz Bellido , M. Belhassen-García","doi":"10.1016/j.rce.2025.502458","DOIUrl":"10.1016/j.rce.2025.502458","url":null,"abstract":"<div><h3>Introduction</h3><div>Cellulitis is a skin and soft tissue infection caused by the entry of a microorganism into the subcutaneous tissue. Nowadays it represents one of the main causes of hospital admission, mainly due to incorrect diagnosis or the need for intravenous treatment. The aim of this study is to observe the characteristics of cellulitis in patients admitted to our hospital during two years in order to determine whether admissions were really necessary.</div></div><div><h3>Methods</h3><div>Retrospective study of admissions for cellulitis between 2022 and 2023 at the Salamanca University Hospital, classified according to the CREST-SEWS criteria.</div></div><div><h3>Results</h3><div>During the study period, 332 patients with cellulitis were admitted to the Salamanca University Hospital. 56% of the patients were classified as grade<!--> <!-->II (those who do not have severe symptoms, but who are usually admitted due to their comorbidities). 70% of the patients had some comorbidity or risk factor such as skin disorders, type<!--> <!-->II diabetes mellitus or heart failure. The most common site of infection was the lower extremities. The etiologic agent of the infection could be established in 28% of the patients, and the most frequently isolated microorganism was methicillin-sensitive <em>S.</em> <em>aureus</em>. The most common treatment was β-lactams, specifically amoxicillin/clavulanic acid (39.5%) and piperacillin/tazobactam (23.8%).</div></div><div><h3>Conclusions</h3><div>In order to treat infectious cellulitis, it is essential to carry out a correct etiological diagnosis in order to establish the most appropriate treatment and reduce unnecessary admissions, especially in patients with class<!--> <!-->II cellulitis.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502458"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.rce.2025.502452
F. Aguilar Rodríguez , C. Díaz Pedroche , A. Guzmán Carreras , B. Sánchez Sauce , J.I. Molina-Puente , A.A. Kishta , M. Méndez Bailón
Background
Follow-up within Integrated Management Units for Heart Failure (UMIPIC) in patients with multiple comorbidities discharged after heart failure (HF) improves outcomes during the acute phase. However, many Internal Medicine departments use alternative models, and it remains unclear whether these alternative approaches provide additional benefits compared to exclusive follow-up in Primary Care (PC), as well as whether hospital-based consultations maintain their impact once patient stability is achieved.
Methods
We analyzed 709 HF discharges from the PROFUND-IC registry. After population weighting using inverse probability weighting (IPW), we assessed HF readmissions and all-cause mortality at 12 months, comparing patients followed in UMIPIC units, Internal Medicine outpatient clinics (non-UMIPIC), and exclusively in PC. Events occurring within the first 6 months after the acute phase were analyzed separately from those in the subsequent 6 months.
Results
Patients managed under the UMIPIC models experienced a lower 12-month risk of events compared with PC (HR: 0.56; 95% CI: 0.38-0.84; P < .01) and non-UMIPIC (HR: 0.58; 95% CI: 0.36-0.93; P = .02); the latter showed no benefit over PC. Event reduction in UMIPIC was significant during the first 6 months (HR: 0.56; 95% CI: 0.38-0.83; P < .01), with no differences between models during the stable phase.
Conclusions
Hospital-based follow-up of patients with multiple comorbidities during the first six months after an HF episode reduces HF readmissions and overall mortality compared with exclusive PC follow-up — provided it is conducted under the UMIPIC model rather than through conventional Internal Medicine consultations.
背景：心力衰竭综合管理单位（UMIPIC）对心力衰竭（HF）后出院的多重合并症患者的随访改善了急性期的预后。然而，许多内科部门使用替代模式，目前尚不清楚这些替代方法是否比初级保健（PC）的独家随访提供额外的好处，以及一旦患者稳定后，基于医院的会诊是否能保持其影响。方法我们分析了deep - ic登记的709例HF放电。在使用逆概率加权（IPW）对人群进行加权后，我们评估了12个月时HF再入院率和全因死亡率，比较了在UMIPIC单位、内科门诊诊所（非UMIPIC）和专门在PC进行随访的患者。急性期后6个月内发生的事件与随后6个月内发生的事件分开分析。结果与PC （HR: 0.56; 95% CI: 0.38-0.84; P < 0.01）和非UMIPIC （HR: 0.58; 95% CI: 0.36-0.93; P = 0.02）相比，在UMIPIC模型下管理的患者经历了较低的12个月事件风险；后者与PC相比没有任何优势。在前6个月，UMIPIC的事件减少是显著的（HR: 0.56; 95% CI: 0.38-0.83; P < 0.01），在稳定阶段，不同模型之间没有差异。结论：如果在UMIPIC模式下而不是通过传统的内科会诊，在心衰发作后的前6个月内对有多种合并症的患者进行基于医院的随访，与单独的PC随访相比，可以降低心衰再入院率和总死亡率。
{"title":"Impacto del modelo UMIPIC frente a otros modelos de seguimiento tras hospitalización por insuficiencia cardiaca en pacientes pluripatológicos","authors":"F. Aguilar Rodríguez , C. Díaz Pedroche , A. Guzmán Carreras , B. Sánchez Sauce , J.I. Molina-Puente , A.A. Kishta , M. Méndez Bailón","doi":"10.1016/j.rce.2025.502452","DOIUrl":"10.1016/j.rce.2025.502452","url":null,"abstract":"<div><h3>Background</h3><div>Follow-up within Integrated Management Units for Heart Failure (UMIPIC) in patients with multiple comorbidities discharged after heart failure (HF) improves outcomes during the acute phase. However, many Internal Medicine departments use alternative models, and it remains unclear whether these alternative approaches provide additional benefits compared to exclusive follow-up in Primary Care (PC), as well as whether hospital-based consultations maintain their impact once patient stability is achieved.</div></div><div><h3>Methods</h3><div>We analyzed 709 HF discharges from the PROFUND-IC registry. After population weighting using inverse probability weighting (IPW), we assessed HF readmissions and all-cause mortality at 12<!--> <!-->months, comparing patients followed in UMIPIC units, Internal Medicine outpatient clinics (non-UMIPIC), and exclusively in PC. Events occurring within the first 6<!--> <!-->months after the acute phase were analyzed separately from those in the subsequent 6<!--> <!-->months.</div></div><div><h3>Results</h3><div>Patients managed under the UMIPIC models experienced a lower 12-month risk of events compared with PC (HR: 0.56; 95%<!--> <!-->CI: 0.38-0.84; <em>P</em> <!--><<!--> <!-->.01) and non-UMIPIC (HR: 0.58; 95%<!--> <!-->CI: 0.36-0.93; <em>P</em> <!-->=<!--> <!-->.02); the latter showed no benefit over PC. Event reduction in UMIPIC was significant during the first 6<!--> <!-->months (HR: 0.56; 95%<!--> <!-->CI: 0.38-0.83; <em>P</em> <!--><<!--> <!-->.01), with no differences between models during the stable phase.</div></div><div><h3>Conclusions</h3><div>Hospital-based follow-up of patients with multiple comorbidities during the first six months after an HF episode reduces HF readmissions and overall mortality compared with exclusive PC follow-up — provided it is conducted under the UMIPIC model rather than through conventional Internal Medicine consultations.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502452"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.rce.2025.502451
A. Fraile Sanz , D. Abad Pérez , M. Álvarez Bello , M. Laserna Martínez , I. Luis Saludes , J.A. Perea Egido , R. Mata Caballero , I.J. Thuissard-Vasallo , J. Casado
Introduction and objectives
Heart failure (HF) is a highly prevalent condition, particularly among the elderly, and is associated with high rates of readmission and mortality. To improve prognosis, risk assessment tools such as ELAN-HF and BCN-Bio-HF have been developed to estimate mortality after a hospitalization for HF. However, in clinical practice, risk evaluation is often based on the physician's subjective perception. This study aims to compare that perception with the mortality predictions generated by these tools.
Methods
A retrospective, observational study was conducted in a secondary-level hospital between 2019 and 2021, including patients recently discharged after hospitalization for HF. At the first follow-up visit, physicians subjectively classified the patients’ risk into three levels without access to the results of the risk scores. Afterwards, the ELAN-HF and BCN-Bio-HF scores were calculated and compared with clinical outcomes at 12 months. The predictive capacity of each method was evaluated.
Results
A total of 125 patients were included (median age: 76 years [71,5-83], 56% male). The overall mortality rate was 34.4%. The ELAN-HF and BCN-Bio-HF scores better identified high-risk patients than the clinical assessment, which underestimated mortality in the low-risk group. ROC curve analysis showed good predictive ability for mortality, particularly for the BCN-Bio-HF score (AUC: 74.6%).
Conclusions
The results support that risk scores are more accurate than physicians’ subjective evaluation in predicting mortality in patients with HF. Their integration into clinical practice is recommended, given their prognostic value and usefulness in patient follow-up.
{"title":"Valor pronóstico de la impresión clínica frente a las escalas ELAN-HF y BCN-Bio-HF tras un ingreso por insuficiencia cardíaca aguda","authors":"A. Fraile Sanz , D. Abad Pérez , M. Álvarez Bello , M. Laserna Martínez , I. Luis Saludes , J.A. Perea Egido , R. Mata Caballero , I.J. Thuissard-Vasallo , J. Casado","doi":"10.1016/j.rce.2025.502451","DOIUrl":"10.1016/j.rce.2025.502451","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Heart failure (HF) is a highly prevalent condition, particularly among the elderly, and is associated with high rates of readmission and mortality. To improve prognosis, risk assessment tools such as ELAN-HF and BCN-Bio-HF have been developed to estimate mortality after a hospitalization for HF. However, in clinical practice, risk evaluation is often based on the physician's subjective perception. This study aims to compare that perception with the mortality predictions generated by these tools.</div></div><div><h3>Methods</h3><div>A retrospective, observational study was conducted in a secondary-level hospital between 2019 and 2021, including patients recently discharged after hospitalization for HF. At the first follow-up visit, physicians subjectively classified the patients’ risk into three levels without access to the results of the risk scores. Afterwards, the ELAN-HF and BCN-Bio-HF scores were calculated and compared with clinical outcomes at 12<!--> <!-->months. The predictive capacity of each method was evaluated.</div></div><div><h3>Results</h3><div>A total of 125 patients were included (median age: 76<!--> <!-->years [71,5-83], 56% male). The overall mortality rate was 34.4%. The ELAN-HF and BCN-Bio-HF scores better identified high-risk patients than the clinical assessment, which underestimated mortality in the low-risk group. ROC curve analysis showed good predictive ability for mortality, particularly for the BCN-Bio-HF score (AUC: 74.6%).</div></div><div><h3>Conclusions</h3><div>The results support that risk scores are more accurate than physicians’ subjective evaluation in predicting mortality in patients with HF. Their integration into clinical practice is recommended, given their prognostic value and usefulness in patient follow-up.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502451"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.rce.2025.502453
M. Raya-Cruz , A. Bustos-Merlo , M.J. Soriano-Pérez , D. Rico-López , R. Córdoba-Peinado , Alfredo José Pardo-Cabello , F. Gómez-Delgado , en representación del grupo estudio EMRIC
Introduction
Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) have proven effective in chronic heart failure (CHF). However, evidence regarding their use in acute heart failure (AHF), particularly among elderly patients, is limited. This study aimed to assess the safety and tolerability of SGLT-2i in elderly patients hospitalized for AHF.
Methods
We conducted a multicenter retrospective study including 192 patients admitted with AHF, with a mean age of 83.3 ± 8.3 years, of whom 57.3% were female. The initiation of SGLT-2i during hospitalization, adverse events, mortality, and readmission rates were analyzed.
Results
SGLT-2i therapy was initiated within the first 48 hours of admission in 31.3% of patients. Only 5.7% experienced drug-related adverse effects. During follow-up, 10.4% of patients died and 25% required hospital readmission.
Conclusions
SGLT-2i treatment in elderly patients with AHF demonstrated good tolerance and safety, even in those with multiple comorbidities. These findings suggest that early initiation of SGLT-2i during hospitalization for AHF may represent an effective and safe therapeutic strategy, supporting the optimization of clinical management in this high-risk population.
{"title":"Evidencia en vida real del uso de iSGLT2 en los pacientes ancianos con insuficiencia cardíaca aguda","authors":"M. Raya-Cruz , A. Bustos-Merlo , M.J. Soriano-Pérez , D. Rico-López , R. Córdoba-Peinado , Alfredo José Pardo-Cabello , F. Gómez-Delgado , en representación del grupo estudio EMRIC","doi":"10.1016/j.rce.2025.502453","DOIUrl":"10.1016/j.rce.2025.502453","url":null,"abstract":"<div><h3>Introduction</h3><div>Sodium-glucose cotransporter 2 inhibitors (SGLT-2i) have proven effective in chronic heart failure (CHF). However, evidence regarding their use in acute heart failure (AHF), particularly among elderly patients, is limited. This study aimed to assess the safety and tolerability of SGLT-2i in elderly patients hospitalized for AHF.</div></div><div><h3>Methods</h3><div>We conducted a multicenter retrospective study including 192 patients admitted with AHF, with a mean age of 83.3<!--> <!-->±<!--> <!--> <!-->8.3 years, of whom 57.3% were female. The initiation of SGLT-2i during hospitalization, adverse events, mortality, and readmission rates were analyzed.</div></div><div><h3>Results</h3><div>SGLT-2i therapy was initiated within the first 48<!--> <!-->hours of admission in 31.3% of patients. Only 5.7% experienced drug-related adverse effects. During follow-up, 10.4% of patients died and 25% required hospital readmission.</div></div><div><h3>Conclusions</h3><div>SGLT-2i treatment in elderly patients with AHF demonstrated good tolerance and safety, even in those with multiple comorbidities. These findings suggest that early initiation of SGLT-2i during hospitalization for AHF may represent an effective and safe therapeutic strategy, supporting the optimization of clinical management in this high-risk population.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502453"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.rce.2025.502454
A. Relloso de la Fuente , J.F. García Granado , O.G. Quesada Morales , M. del C. Pérez Vieitez , M.J. Alemany Rodríguez , A.N. González Hernández
Introduction
SMART (stroke-like migraine attacks after radiation therapy) syndrome is a possible complication of radiotherapy used in the treatment of brain tumours. The current prevalence is not well known, partly because it is underdiagnosed.
Material and Methods
A descriptive, prospective study was designed over a period of 18 months. Demographic, clinical, analytical and neuroimaging variables were collected.
Results
Three patients were included who, after receiving holocranial radiotherapy, developed focal neurological symptoms after a variable latency period. After ruling out other possible aetiologies, the diagnosis of SMART syndrome was established.
Conclusion
This case series aims to raise awareness among professionals of the importance of training in this pathology, especially in view of the advances in oncological treatments and the expected increase in its incidence.
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Pub Date : 2026-02-01DOI: 10.1016/j.rce.2025.502450
J. Casado , D. Abad , G. Ropero-Luis , M. Francisco Dávila , A. Muela , A. Bustos-Merlo , J.C. Arévalo-Lorido , M. Sánchez-Marteles , J. Pérez-Silvestre , J.C. Trullas , en representación de los investigadores del registro RICA-2
Objective
To describe the diuretic strategy used in patients hospitalized for acute heart failure (AHF), as well as to identify the clinical profiles of these patients according to the diuretic regimen received.
Materials and methods
A multicenter observational study of patients hospitalized for AHF in Internal Medicine departments and included in the Heart Failure Registry (RICA-2). Patients were categorized into three groups based on the diuretic treatment received: intravenous (IV) furosemide alone, IV furosemide plus thiazide diuretics (TD), and IV furosemide plus acetazolamide (ACZ).
Results
A total of 588 patients were analyzed (median age 84 [77-88] years; 51.2% female). IV furosemide alone was administered in 78% of cases, while 22% received combination diuretic therapy (17% with TD and 5% with ACZ). Patients treated with combination diuretics had a higher burden of comorbidities (diabetes, obesity, chronic kidney disease, and renal function impairment at admission), worse NYHA functional class, higher clinical and biochemical markers of congestion, and were more frequently on loop diuretics prior to admission. No significant differences were found in the length of hospital stay according to the diuretic strategy used. Combination diuretic therapy was associated with greater weight loss during hospitalization (3 kg in the TD group and 2.75 kg in the ACZ group) compared to IV furosemide alone (2 kg) (P = .005).
Conclusions
The most frequently used diuretic strategy in patients hospitalized for AHF in the Internal Medicine departments included in the RICA-2 registry is IV furosemide alone. The combination of diuretics (especially with TD) is more commonly used in patients with more comorbidities and congestion.
{"title":"Tratamiento diurético combinado en insuficiencia cardiaca aguda: resultados del registro RICA-2","authors":"J. Casado , D. Abad , G. Ropero-Luis , M. Francisco Dávila , A. Muela , A. Bustos-Merlo , J.C. Arévalo-Lorido , M. Sánchez-Marteles , J. Pérez-Silvestre , J.C. Trullas , en representación de los investigadores del registro RICA-2","doi":"10.1016/j.rce.2025.502450","DOIUrl":"10.1016/j.rce.2025.502450","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the diuretic strategy used in patients hospitalized for acute heart failure (AHF), as well as to identify the clinical profiles of these patients according to the diuretic regimen received.</div></div><div><h3>Materials and methods</h3><div>A multicenter observational study of patients hospitalized for AHF in Internal Medicine departments and included in the Heart Failure Registry (RICA-2). Patients were categorized into three groups based on the diuretic treatment received: intravenous (IV) furosemide alone, IV furosemide plus thiazide diuretics (TD), and IV furosemide plus acetazolamide (ACZ).</div></div><div><h3>Results</h3><div>A total of 588 patients were analyzed (median age 84 [77-88] years; 51.2% female). IV furosemide alone was administered in 78% of cases, while 22% received combination diuretic therapy (17% with TD and 5% with ACZ). Patients treated with combination diuretics had a higher burden of comorbidities (diabetes, obesity, chronic kidney disease, and renal function impairment at admission), worse NYHA functional class, higher clinical and biochemical markers of congestion, and were more frequently on loop diuretics prior to admission. No significant differences were found in the length of hospital stay according to the diuretic strategy used. Combination diuretic therapy was associated with greater weight loss during hospitalization (3<!--> <!-->kg in the TD group and 2.75<!--> <!-->kg in the ACZ group) compared to IV furosemide alone (2<!--> <!-->kg) (<em>P</em> <!-->=<!--> <!-->.005).</div></div><div><h3>Conclusions</h3><div>The most frequently used diuretic strategy in patients hospitalized for AHF in the Internal Medicine departments included in the RICA-2 registry is IV furosemide alone. The combination of diuretics (especially with TD) is more commonly used in patients with more comorbidities and congestion.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502450"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.rce.2025.502367
F. Borrell Carrió , J. Vidal-Alaball
After decades of specialization, new opportunities are opening up for general clinical practice thanks to three key tools: continuing education focused on transforming clinical habits, access to advanced technology at the service of each professional, and the use of artificial intelligence to support more personalized clinical reflection. These tools could empower physicians to offer more complex, evidence-based, and personalized care.
Some erroneous beliefs about artificial intelligence —such as the idea that it will make studying unnecessary— are simply manifestations of resistance to change. However, it is also important to recognize the challenges it poses, such as the risk of over-reliance on its proposals or accepting them without critical judgment. In any case, the ultimate responsibility for the outcome of a consultation rests with the medical professional.
Technological advances should complement, not replace, the humanistic values of medicine. To make the most of these opportunities, it is essential to have continuing education, institutional support, and personal judgment based on clinical experience and semiological observation.
{"title":"Retos y oportunidades para la práctica generalista en la era de la tecnología y la IA","authors":"F. Borrell Carrió , J. Vidal-Alaball","doi":"10.1016/j.rce.2025.502367","DOIUrl":"10.1016/j.rce.2025.502367","url":null,"abstract":"<div><div>After decades of specialization, new opportunities are opening up for general clinical practice thanks to three key tools: continuing education focused on transforming clinical habits, access to advanced technology at the service of each professional, and the use of artificial intelligence to support more personalized clinical reflection. These tools could empower physicians to offer more complex, evidence-based, and personalized care.</div><div>Some erroneous beliefs about artificial intelligence —such as the idea that it will make studying unnecessary— are simply manifestations of resistance to change. However, it is also important to recognize the challenges it poses, such as the risk of over-reliance on its proposals or accepting them without critical judgment. In any case, the ultimate responsibility for the outcome of a consultation rests with the medical professional.</div><div>Technological advances should complement, not replace, the humanistic values of medicine. To make the most of these opportunities, it is essential to have continuing education, institutional support, and personal judgment based on clinical experience and semiological observation.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 1","pages":"Article 502367"},"PeriodicalIF":1.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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