Revista clinica espanola最新文献

{"title":"Respuesta a: ¿Inicio de inhibidores del cotransportador de sodio-glucosa tipo 2 (iSGLT2) en pacientes con insuficiencia cardíaca aguda en urgencias?","authors":"P. Llorens","doi":"10.1016/j.rce.2026.502484","DOIUrl":"10.1016/j.rce.2026.502484","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502484"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429084","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}

{"title":"Determinantes sociales de la salud: una prioridad para la medicina interna. Documento de posicionamiento de la Sociedad Española de Medicina Interna (SEMI) y la Sociedad Portuguesa de Medicina Interna (SPMI)","authors":"M.M. Chimeno ,&nbsp;L. Duarte Costa ,&nbsp;V. Barreto ,&nbsp;J.L. Bianchi ,&nbsp;L. Campos ,&nbsp;J. Araújo Correia ,&nbsp;J. Moreno Díaz ,&nbsp;J.M. Porcel ,&nbsp;J. Porto ,&nbsp;L. Santos ,&nbsp;P. Pérez-Martínez","doi":"10.1016/j.rce.2026.502468","DOIUrl":"10.1016/j.rce.2026.502468","url":null,"abstract":"<div><h3>Introduction</h3><div>Internal medicine, owing to its comprehensive and cross-sectional approach, is uniquely positioned to lead the integration of social determinants of health (SDOH) into clinical practice.</div></div><div><h3>Methods</h3><div>Based on the Delphi methodology promoted by the Spanish Society of Internal Medicine (SEMI) and the Portuguese Society of Internal Medicine (SPMI), this study explored perceptions, barriers, and strategies for integrating SDOH into hospital care. Experts from both countries participated in a two-round consultation process, followed by a consensus meeting, which resulted in a prioritized roadmap of action.</div></div><div><h3>Results</h3><div>Our findings show strong agreement on the relevance of SDOH for health outcomes, the need for mandatory and transversal training at all educational levels, and the importance of validated tools for systematic screening. Key barriers include lack of time, insufficient specific training, limited human resources, and the absence of structured SDOH data in electronic health records. Additionally, the results emphasize the importance of interdisciplinary teams, coordination with social services, and adapting care pathways to patients’ social contexts. Emerging determinants include population aging, mental health, climate change, and digital transformation, including artificial intelligence.</div></div><div><h3>Conclusions</h3><div>This decalogue provides a practical and prioritized roadmap to transform Internal Medicine care towards a more equitable, comprehensive, and SDOH-sensitive model, with training, service organization, technological resources, and collaboration as fundamental pillars.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502468"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429079","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}

{"title":"Evolución de las alteraciones radiológicas en los pacientes no vacunados con neumonía por COVID-19 y predicción del desarrollo de fibrosis pulmonar a los 6 meses según un modelo predictivo","authors":"S. Cuenca Peris ,&nbsp;M. Marín Royo ,&nbsp;S.F. Marco Domenech","doi":"10.1016/j.rce.2026.502488","DOIUrl":"10.1016/j.rce.2026.502488","url":null,"abstract":"<div><h3>Introduction</h3><div>Alteration in pulmonary function tests and radiological abnormalities are present in a significant percentage of COVID-19 survivors. Our aim is to evaluate radiological findings and functional respiratory parameters involved in lung fibrosis at six months after SARS-CoV-2 pneumonia and use initial score of the predictive model to predict fibrotic-like changes at 6 months.</div></div><div><h3>Material and methods</h3><div>Prospective observational study including unvaccinated patients with COVID-19 pneumonia. Pulmonary function tests and chest CT were performed six months after acute pneumonia.</div></div><div><h3>Results</h3><div>One hundred nine patients were included. Bilateral ground-glass opacities (94%) were the most frequent radiological finding, followed by bilateral consolidations (36%) and crazy paving patterns (28%). Ct tracking shows a significant decrease in bilateral ground glass, consolidations and bilateral crazy paving at 6 months. In contrast, architectural distortion tends to increase over time. The presence of bronchial dilatation, subpleural curved line and parenchymal bands on initial CT were associated with radiological signs of lung fibrosis at 6 months. An initial score of the predictive model &gt;<!--> <!-->0.6 predicts fibrotic-like changes at 6 months (AUC: 77.8%; Specificity: 85.4%; Sensitivity: 58.1%). The proportion of patients with DLCO<!--> <!-->&lt;<!--> <!-->80% was 55%.</div></div><div><h3>Conclusions</h3><div>In 50 patients, 6 months CT detected signs of fibrotic-like changes. The presence of bronchial dilatation, subpleural curved line and parenchymal bands could be used as early predictors of fibrotic-like changes in patients with COVID-19 pneumonia. Initial score of the predictive model<!--> <!-->&gt; 0,6 allows the selection of patients at risk of developing pulmonary fibrotic-like changes. DLCO was the one most frequently impaired at 6 months.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502488"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429080","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}

{"title":"El nivel educativo como modulador de la relación entre índice de masa corporal, presión arterial y síntomas depresivos en población peruana: un análisis de mediación moderada","authors":"A. Guevara-Tirado","doi":"10.1016/j.rce.2026.502473","DOIUrl":"10.1016/j.rce.2026.502473","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze whether systolic blood pressure influences the relationship between body mass index and depressive symptoms, and whether educational level moderates these associations in Peruvian adults.</div></div><div><h3>Methods</h3><div>Cross-sectional study using data from the Peruvian Demographic and Health Survey (ENDES). Individuals aged ≥15 years were included. Depression was assessed with the PHQ-9 (continuous score); BMI and SBP were treated as continuous variables. A moderated mediation model (PROCESS model 59) was applied, adjusting for alcohol consumption, age, mother tongue, ethnic identity, and marital status.</div></div><div><h3>Results</h3><div>In the moderated analysis, BMI showed a positive association with SBP (B<!--> <!-->=<!--> <!-->0.61; 95% <span>C</span>I: 0.57–0.66), with a stronger effect in individuals with higher education (B<!--> <!-->=<!--> <!-->0.81) compared to those with basic education (B<!--> <!-->=<!--> <!-->0.61). Alcohol consumption (B<!--> <!-->=<!--> <!-->1.20), speaking an indigenous mother tongue (B<!--> <!-->=<!--> <!-->1.26), and age (B<!--> <!-->=<!--> <!-->0.42 per year) were associated with higher SBP, while living with a partner was protective (B<!--> <!-->=<!--> <!--> <!-->−<!--> <!-->2.05). In the model for depressive symptoms, BMI (B<!--> <!-->=<!--> <!-->0.04) and SBP (B<!--> <!-->=<!--> <!-->0.02) increased PHQ-9 scores; the effect of SBP was greater among higher-educated individuals (B<!--> <!-->=<!--> <!-->0.036) than those with basic education (B<!--> <!-->=<!--> <!-->0.022). The moderated mediation showed that the indirect component via SBP was higher in individuals with higher education (B<!--> <!-->=<!--> <!-->0.081) than in those with basic education (B<!--> <!-->=<!--> <!-->0.035), with a moderated mediation index of 0.040 (95% CI: 0.028–0.052).</div></div><div><h3>Conclusions</h3><div>Educational level modulates the relationship between BMI, blood pressure, and depression, highlighting health inequalities that can inform public health strategies and prevention policies.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502473"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147428021","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}

{"title":"Un caso raro de linfangioma quístico del cuello en un paciente adulto","authors":"M. Colangeli ,&nbsp;M. Palmas ,&nbsp;P. Spinnato","doi":"10.1016/j.rce.2026.502490","DOIUrl":"10.1016/j.rce.2026.502490","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502490"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429082","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}

{"title":"Situación actual y papel de los internistas en los comités de ética asistencial en España. Estudio PANACEAS","authors":"P. Durán del Campo ,&nbsp;G. Solano Iturri ,&nbsp;B. Alonso Ortiz ,&nbsp;J. Bertran Muñoz ,&nbsp;A.M. Bravo Blanco ,&nbsp;L. Briongos Figuero ,&nbsp;C. Carrera García ,&nbsp;A.D. Chacón Moreno ,&nbsp;A. Blanco Portillo ,&nbsp;J.M. Galván-Román ,&nbsp;como miembros del Grupo de Trabajo de Bioética y Profesionalismo de la Sociedad Española de Medicina Interna","doi":"10.1016/j.rce.2026.502483","DOIUrl":"10.1016/j.rce.2026.502483","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyze the current situation of Healthcare Ethics Committees (HECs) in Spain, their composition and functions, as well as the implementation of Clinical Ethics Consultancy (CEC). Finally, to assess the involvement of internists in HECs.</div></div><div><h3>Materials and methods</h3><div>A cross-sectional descriptive study conducted through a self-administered online survey distributed between February and May 2025 to all identified HECs in the country.</div></div><div><h3>Results</h3><div>A total of 112 HECs (47.66%) out of the 235 accredited nationwide participated. The average number of members per committee was 16 (range: 6-29). The most represented professional profiles were nursing and medicine. In 99.1% of the committees, at least one member had postgraduate training in Bioethics. The most frequent range of meetings per year was between 7 and 12 (46.8%). Most HECs (91.1%) were involved in educational activities, and 58% had produced ethical documents. The majority reviewed between 1 and 5 cases annually (69.6%). The CEC role was established in 40.2% of HECs and in the process of implementation in 18.8%. Internists were present in 54% of HECs. In 65% of cases, the internist is part of the CEC.</div></div><div><h3>Conclusions</h3><div>HECs in Spain demonstrate significant involvement in educational activities and the development of ethical documents; however, they receive a relatively low number of annual consultations. CEC is gradually being integrated into the structure of HECs, which may enhance the management of ethical inquiries. Internists are members of more than half of the HECs and play a very active role in their operations.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502483"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147428019","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}

{"title":"Tratamiento basal con betabloqueantes e inhibidores del sistema renina angiotensina y su asociación con eventos adversos en insuficiencia cardíaca aguda","authors":"A. Haro ,&nbsp;J. Jacob ,&nbsp;X. Rossello ,&nbsp;A. Alquézar-Arbe ,&nbsp;P. Llorens ,&nbsp;Ò. Miró ,&nbsp;en representación del grupo Icasemes","doi":"10.1016/j.rce.2026.502487","DOIUrl":"10.1016/j.rce.2026.502487","url":null,"abstract":"<div><h3>Introduction</h3><div>Baseline treatment with beta-blockers (BB) and/or renin-angiotensin system inhibitors (RASi) has been extensively studied in the context of heart failure, given its fundamental role in modulating the neurohormonal axis and improving survival.</div></div><div><h3>Objective</h3><div>To investigate whether there is an association between receiving baseline treatment with BB or RASi, either alone or in combination, and the short-term prognosis of an episode of acute heart failure (AHF).</div></div><div><h3>Method</h3><div>Patients from the EAHFE registry (Epidemiology of Acute Heart Failure in Spanish Emergency Departments) were analyzed. This is a multicenter, prospective, multipurpose registry that collects all AHF episodes presenting to participating hospital emergency departments over a period of 1 to 2 months between 2007 and 2018. The primary outcome variable investigated was in-hospital all-cause mortality during the emergency departments stay or hospitalization. Adjusted analyses were conducted using multiple logistic regression and multiple imputation to control for potential confounding factors.</div></div><div><h3>Results</h3><div>The study included a total of 17,916 episodes of AHF. A total of 26.2% of patients did not receive treatment with either BB or RASi, constituting the reference group. Overall, 17.8% of patients received BB only, 30.4% were treated exclusively with RASi, and 25.7% received a combination of both drugs. The mean age of the patients was 80.4 years (standard deviation 10.2 years), and 55.7% were women. In-hospital mortality was 7.3%. After multivariable adjustment, a significant association with lower mortality was found for treatment with BB alone (odds ratio [OR]<!--> <!-->=<!--> <!-->0.826, 95% confidence interval [CI]: 0.685-0.996), OR<!--> <!-->=<!--> <!-->0.709 (95%CI: 0.600-0.837) RASi alone and for combined treatment with RASi and BB (OR<!--> <!-->=<!--> <!-->0.699, 95%CI: 0.580-0.843). In the adjusted model with multiple imputation, the results remained significant.</div></div><div><h3>Conclusions</h3><div>In patients with an episode of AHF, baseline treatment with BB, RASi, or both is associated with lower all-cause mortality. This association is strongest in the group of patients receiving both treatments combined, and the results remain significant after multivariate adjustment.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502487"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429078","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}

{"title":"¿Inicio de inhibidores del cotransportador de sodio-glucosa tipo 2 (iSGLT2) en pacientes con insuficiencia cardiaca aguda en urgencias?","authors":"P. Herrero-Puente ,&nbsp;Á. González Franco","doi":"10.1016/j.rce.2026.502470","DOIUrl":"10.1016/j.rce.2026.502470","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502470"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429085","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}

{"title":"Metodología GRADE en los consensos y guías de práctica clínica para el manejo de la oclusión venosa retiniana","authors":"C. Burgueño-Montañes ,&nbsp;R. Bouchikh-El Jarroudi ,&nbsp;M. Zavaleta-Mercado ,&nbsp;J. Galvez-Olortegui","doi":"10.1016/j.rce.2026.502469","DOIUrl":"10.1016/j.rce.2026.502469","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502469"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429083","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}

{"title":"Consultas en urgencias de los pacientes mayores que viven con VIH: una aproximación a partir del registro EDEN","authors":"Ò. Miró ,&nbsp;L. Sentís ,&nbsp;M. Carbó ,&nbsp;E. Miró ,&nbsp;D. Mérida ,&nbsp;J. González del Castillo ,&nbsp;(en representación del grupo SIESTA)","doi":"10.1016/j.rce.2026.502474","DOIUrl":"10.1016/j.rce.2026.502474","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the incidence, sociodemographic characteristics, baseline status and evolution of elderly people living with Human immunodeficiency virus (HIV) infection (PLHIV) attended in Spanish hospital emergency departments (ED).</div></div><div><h3>Methods</h3><div>Patients included in the EDEN (Emergency Department and Elder Needs) registry, which includes all patients aged 65 or older attended in 52 Spanish EDs during 7 consecutive days in 2019, were analyzed. Two groups were constructed according to whether or not they had known HIV infection (PLHIV and non-LHIV). We collected 6 sociodemographic factors and 8 referring to the patient's baseline situation. We recorded whether the episode of ED care required hospitalization, intensive care unit (ICU) admission, prolonged ED and inpatient stay, and in-hospital mortality, as well as reconsultation to the ED, rehospitalization, and death from any cause during the 3 years after discharge. The sociodemographic and baseline characteristics and the evolution of patients in the PLHIV and non-PLHIV groups were compared.</div></div><div><h3>Results</h3><div>Of 25,557 patients in the EDEN registry, 78 were PLHIV (0.30%, 95% CI 0.24% to 0.38%). The annual ED frequentation rate of PLHIV and non-PVHIV was 811 and 573 per 1000 population, respectively. The sociodemographic and baseline conditions were similar between PLHIV and non-PLHIV, with only age differing (younger PLHIV). Older PLHIV had severe comorbidity (27%), some type of functional limitation (27%) and cognitive impairment (11%). The most frequent ED diagnoses in PLHIV were pneumonia or lower respiratory tract infection (11%), heart failure or cardiogenic <em>shock</em> (8%) and joint and axial pain (6%), and in the non-HIV group there were no new diagnoses of HIV infection. 24.4% of PLHIV were hospitalized, 27.3% had a prolonged stay in the ED, 50% had prolonged hospitalization, 7.7% had in-hospital mortality, and reconsultation to the ED, hospitalization, and death during the 3 years post-discharge were 67%, 45.6%, and 21.7%, respectively. No outcome differed between PLHIV and non-PLHIV.</div></div><div><h3>Conclusion</h3><div>Older PLHIV have sociodemographic and baseline characteristics like the general population, but their rate of ED visits is higher. The severity of the episodes leading to this ED consultation is similar between PLHIV and non-PLHIV and long-term follow-up also shows no differences.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502474"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147428022","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}