Revista clinica espanola最新文献

英文中文

Evidencia en vida real del uso de iSGLT2 en los pacientes ancianos con insuficiencia cardíaca aguda 老年急性心力衰竭患者使用iSGLT2的实际证据

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-23 DOI: 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.

钠-葡萄糖共转运蛋白2抑制剂（SGLT-2i）已被证明对慢性心力衰竭（CHF）有效。然而，关于它们在急性心力衰竭（AHF），特别是老年患者中的应用的证据是有限的。本研究旨在评估SGLT-2i在AHF住院老年患者中的安全性和耐受性。方法对192例AHF患者进行多中心回顾性研究，患者平均年龄83.3±8.3岁，其中女性57.3%。分析住院期间SGLT-2i的起始、不良事件、死亡率和再入院率。结果31.3%的患者在入院前48小时内开始使用glt -2i治疗。只有5.7%的人经历过与药物相关的不良反应。在随访期间，10.4%的患者死亡，25%需要再次住院。结论ssglt -2i治疗老年AHF患者表现出良好的耐受性和安全性，即使在患有多种合并症的患者中也是如此。这些发现表明，在AHF住院期间早期开始SGLT-2i可能是一种有效和安全的治疗策略，支持优化这一高危人群的临床管理。

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引用次数: 0

Serie de casos de síndrome de SMART en un hospital de tercer nivel en Gran Canaria 大加纳利群岛三级医院SMART病例系列

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-16 DOI: 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.

smart（卒中样偏头痛放疗后发作）综合征是脑肿瘤放疗治疗中可能出现的并发症。目前的流行情况尚不清楚，部分原因是诊断不足。材料与方法一项描述性、前瞻性研究的设计时间为18个月。收集人口学、临床、分析和神经影像学变量。结果3例患者在接受颅放射治疗后出现局灶性神经系统症状。排除其他可能的病因后，确定SMART综合征的诊断。结论本病例系列旨在提高专业人员对该病理培训的重要性的认识，特别是考虑到肿瘤治疗的进步和预期的发病率的增加。

引用次数: 0

Tratamiento diurético combinado en insuficiencia cardiaca aguda: resultados del registro RICA-2 急性心力衰竭联合利尿治疗：RICA-2记录结果

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2026-02-01 Epub Date: 2026-01-19 DOI: 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.

目的描述急性心力衰竭（AHF）住院患者的利尿策略，并根据所接受的利尿方案确定这些患者的临床概况。材料和方法一项多中心观察性研究，纳入心衰登记（RICA-2）的内科住院AHF患者。根据所接受的利尿剂治疗将患者分为三组：单独静脉注射（IV）呋塞米、静脉注射呋塞米加噻嗪类利尿剂（TD）和静脉注射呋塞米加乙酰唑胺（ACZ）。结果共分析588例患者，中位年龄84岁[77-88]，女性51.2%。78%的病例单独给予静脉滴注呋塞米，22%的病例接受联合利尿剂治疗（17%与TD联合，5%与ACZ联合）。接受联合利尿剂治疗的患者有更高的合并症负担（入院时糖尿病、肥胖、慢性肾脏疾病和肾功能损害），更差的NYHA功能等级，更高的充血临床和生化指标，并且在入院前更频繁地使用循环利尿剂。根据使用的利尿剂策略，住院时间没有显着差异。与单独静脉注射速尿（2 kg）相比，联合利尿剂治疗与住院期间体重减轻（TD组为3 kg， ACZ组为2.75 kg）相关（P = 0.005）。结论在RICA-2登记的住院AHF患者中，最常用的利尿剂是静脉滴注呋塞米。利尿剂（尤其是与TD联合）更常用于合并症和充血较多的患者。

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引用次数: 0

Retos y oportunidades para la práctica generalista en la era de la tecnología y la IA 技术和人工智能时代综合实践的挑战和机遇

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2026-01-01 Epub Date: 2025-10-31 DOI: 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.

经过几十年的专业化，全科临床实践的新机会正在开放，这要归功于三个关键工具：专注于改变临床习惯的继续教育，为每个专业人员提供服务的先进技术，以及使用人工智能来支持更个性化的临床反思。这些工具可以使医生能够提供更复杂、基于证据和个性化的护理。一些关于人工智能的错误观念——比如认为人工智能将使学习变得不必要——只是抵制变革的表现。然而，认识到它所带来的挑战也很重要，例如过度依赖其建议或在没有批判性判断的情况下接受它们的风险。在任何情况下，对咨询结果的最终责任在于医疗专业人员。技术进步应该补充而不是取代医学的人文价值。为了充分利用这些机会，必须有继续教育、机构支持和基于临床经验和符号学观察的个人判断。

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引用次数: 0

Un ojo más cerrado… y un diagnóstico inesperado 闭上眼睛——一个意想不到的诊断

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2026-01-01 Epub Date: 2025-12-05 DOI: 10.1016/j.rce.2025.502417

M. Moro Muñiz, A. Janicka-Caulineau, D. Salom Alonso

引用次数: 0

Comorbilidades autoinmunes en pacientes con esclerosis múltiple. Un estudio basado en la población utilizando inteligencia artificial 多发性硬化症患者的自身免疫并发症。使用人工智能的以人口为基础的研究

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2026-01-01 Epub Date: 2025-12-15 DOI: 10.1016/j.rce.2025.502414

N. García-Alvarado , M.I. Morales-Casado , P. Beneyto-Martín

Introduction

The prevalence of autoimmune comorbidities in patients with multiple sclerosis (MS) has been the subject of numerous epidemiological studies. Due to the presence of biases and the heterogeneity of the publications, this association has not been firmly demonstrated. The aim of our study is to establish the prevalence of autoimmune diseases in MS patients from our region (Castilla-La Mancha, Spain) and to compare it with the prevalence of autoimmune diseases in a non-MS population, in order to strengthen the evidence for an association between MS and other autoimmune conditions.

Patients and methods

We conducted a retrospective, non-interventional, multicenter study analyzing the electronic medical records of 3,309,298 patients in the Castilla-La Mancha area (Spain) using an artificial intelligence system.

Results

The 22.5% of MS patients had at least one other autoimmune disease. Hypothyroidism, followed by type 1 diabetes mellitus and psoriasis, were the three most frequent autoimmune diseases in the MS cohort.

Conclusions

In the present study, we observed an association between most of the autoimmune diseases studied and MS when comparing their prevalence in the MS population versus the non-MS population. Confirmation of these findings could lead to changes in preventive strategies, diagnostic protocols, and therapeutic approaches for MS patients. Large-scale data analysis using artificial intelligence may help resolve epidemiological questions that remain unanswered to date.

多发性硬化症（MS）患者自身免疫性合并症的患病率一直是众多流行病学研究的主题。由于存在偏倚和出版物的异质性，这种关联尚未得到证实。我们研究的目的是建立自身免疫性疾病在我们地区（西班牙Castilla-La Mancha） MS患者中的患病率，并将其与非MS人群中自身免疫性疾病的患病率进行比较，以加强MS与其他自身免疫性疾病之间关联的证据。患者和方法我们进行了一项回顾性、非干预性、多中心研究，使用人工智能系统分析了西班牙Castilla-La Mancha地区3,309,298名患者的电子病历。结果22.5%的MS患者至少有一种其他自身免疫性疾病。甲状腺功能减退，其次是1型糖尿病和牛皮癣，是MS队列中最常见的三种自身免疫性疾病。结论在本研究中，我们通过比较自身免疫性疾病在多发性硬化症人群和非多发性硬化症人群中的患病率，观察到大多数自身免疫性疾病与多发性硬化症之间的关联。这些发现的证实可能导致MS患者预防策略、诊断方案和治疗方法的改变。使用人工智能的大规模数据分析可能有助于解决迄今为止尚未解决的流行病学问题。

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引用次数: 0

Inteligencia artificial generativa: los modelos fundacionales. Procesamiento del lenguaje natural y modelos de lenguaje grandes 生成式人工智能：基础模型。自然语言处理和大型语言模型

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2026-01-01 Epub Date: 2025-12-16 DOI: 10.1016/j.rce.2025.502413

J. Mora-Delgado , L. Ramos-Ruperto , M.J. Pardilla , M.Á. Sicilia , A. Rodríguez-González , J.M. Sempere , R. Puchades

This work aims to provide internists with a practical, focused overview of how generative artificial intelligence (AI) based on large language models can be effectively integrated into daily clinical practice. It describes the primary adaptation mechanisms like fine-tuning and retrieval-augmented generation (RAG) for tasks such as report generation, synthesis of clinical findings, and support in differential diagnoses, highlighting real-world examples in Internal Medicine. Technical and organizational requirements for adoption are analyzed, including computing infrastructure, integration with electronic health records, and security/privacy protocols under GDPR and the EU AI Act. Opportunities for enhancing clinical decision-making, optimizing workflows, and reducing administrative burden are emphasized, alongside current limitations like bias, hallucinations, and the need for human oversight. Finally, recommendations are offered for prospective validation in real-world settings and for ensuring explainable transparency, with the goal of empowering internists to incorporate these innovative tools responsibly and efficiently.

这项工作旨在为内科医生提供一个实用的、有重点的概述，即如何将基于大型语言模型的生成式人工智能（AI）有效地集成到日常临床实践中。它描述了主要的适应机制，如微调和检索增强生成（RAG），用于报告生成、临床发现综合和鉴别诊断支持等任务，突出了内科医学中的实际例子。分析了采用的技术和组织要求，包括计算基础设施、与电子健康记录的集成以及GDPR和欧盟人工智能法案下的安全/隐私协议。强调了加强临床决策、优化工作流程和减轻行政负担的机会，以及当前的局限性，如偏见、幻觉和对人类监督的需求。最后，为在现实环境中进行前瞻性验证和确保可解释的透明度提供了建议，其目标是使内科医生能够负责任和有效地采用这些创新工具。

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引用次数: 0

Machine learning y deep learning en medicina interna: desmitificando conceptos 内科中的机器学习和深度学习：揭秘概念

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2026-01-01 Epub Date: 2025-12-13 DOI: 10.1016/j.rce.2025.502412

L. Ramos-Ruperto , J. Mora-Delgado , A. Rodríguez-González , M.A. Sicilia , M.J. Pardilla , J.M. Sempere , R. Puchades

Machine learning (ML) is a branch of artificial intelligence that is transforming clinical practice by providing tools capable of analyzing large volumes of data, identifying complex patterns, and generating predictions useful for medical decision-making. This article offers a practical and accessible introduction to key ML concepts for internists, addressing its application in tasks such as diagnosis, prognosis, and clinical management. The main types of learning (supervised, unsupervised, and reinforcement learning), the importance of data quality, and the systematic process for developing ML projects in medicine are described. Advanced approaches, such as neural networks and model explainability, are also explored. By integrating these tools, clinicians can improve diagnostic accuracy, personalize treatments, and optimize resources, always with a critical approach that respects medical ethics.

机器学习（ML）是人工智能的一个分支，通过提供能够分析大量数据、识别复杂模式和生成对医疗决策有用的预测的工具，正在改变临床实践。本文为内科医生提供了一个实用的、可访问的ML关键概念的介绍，解决了它在诊断、预后和临床管理等任务中的应用。介绍了学习的主要类型（监督学习、无监督学习和强化学习）、数据质量的重要性以及在医学中开发ML项目的系统过程。先进的方法，如神经网络和模型的可解释性，也进行了探讨。通过整合这些工具，临床医生可以提高诊断准确性、个性化治疗并优化资源，同时始终采用尊重医学伦理的关键方法。

引用次数: 0

De la alfabetización digital a la medicina aumentada: comprender para confiar 从数字素养到增强医学：从理解到信任

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2026-01-01 Epub Date: 2025-12-16 DOI: 10.1016/j.rce.2025.502415

R. Quirós-López , J. Trujillo-Santos

引用次数: 0

Evolución del profesorado acreditado por la ANECA para el Grado de Medicina (2019-2024). Expectativas ante el nuevo modelo de acreditación 由ANECA认证的医学学位教师的演变（2019-2024）。对新认证模式的期望

IF 1.7 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Revista clinica espanola

Pub Date : 2026-01-01 Epub Date: 2025-12-09 DOI: 10.1016/j.rce.2025.502416

J.P. Lara Muñoz , J.A. Vargas Núñez , J.J. García Seoane , A.F. Compañ Rosique

The training required for a Medical Degree requires a sufficient faculty structure to guarantee the acquisition of general practitioner skills. The National Conference of Deans of Spanish Medical Schools (CNDFME) has highlighted the significant faculty shortage, maintaining collaboration with university and healthcare institutions, promoting an increase in accredited faculty, modifications to the accreditation model, and the implementation of new teaching positions.

The evolution of accredited faculty for the Health Sciences Branch (2019-2024) is described: the number of accredited permanent teachers has increased significantly. The modifications to the accreditation processes incorporated in the Organic Law of the University System (LOSU) and the new accreditation model (RD 678/2023) are considered positive in encouraging the best professionals to join the faculty of the Schools of Medicine.

医学学位所需的培训要求有足够的师资结构，以保证获得全科医生的技能。西班牙医学院院长全国会议（CNDFME）强调了教员严重短缺的问题，与大学和保健机构保持合作，促进增加经认证的教员，修改认证模式，并设立新的教学职位。描述了健康科学分部认可教师（2019-2024）的演变：认可的长期教师数量显着增加。大学系统组织法（LOSU）对认证程序的修改和新的认证模式（RD 678/2023）被认为是积极的，鼓励最优秀的专业人员加入医学院的教师队伍。

引用次数: 0

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