Revista clinica espanola最新文献

{"title":"Trayectoria funcional, social y calidad de vida a los 12 meses de los pacientes con una fractura de fémur: un estudio de cohorte prospectivo","authors":"G. Badosa-Collell,&nbsp;E. Ruiz-Ruiz,&nbsp;J. Amblàs-Novellas,&nbsp;J.C. Trullàs","doi":"10.1016/j.rce.2026.502608","DOIUrl":"10.1016/j.rce.2026.502608","url":null,"abstract":"<div><h3>Introduction</h3><div>Femoral fracture (FF) is a prevalent condition associated with high morbidity and mortality. The aim of this study was to describe and analyze the factors associated with the functional and social trajectory, as well as quality of life, 12 months after FF in patients over 65 years of age.</div></div><div><h3>Materials and methods</h3><div>This is a prospective observational cohort study including patients over 65 years of age admitted for FF. Quality of life (WHOQOL-Bref), functionality (Barthel Index), and social resources were assessed at baseline and at 12 months. Descriptive, univariate, and multivariate analyses were performed to identify factors associated with functional decline and institutionalization at 12 months.</div></div><div><h3>Results</h3><div>A total of 150 patients were included (mean age 88 years; 78% women). The mean [SD] Barthel Index score at baseline and 12 months was 70 [26.1] and 57.0 [32.3], respectively (<em>P</em>&lt;.001), and the WHOQOL-Bref score was de 86.0 [11.9] and 83.4 [13.8], respectively (<em>P</em>=.005). The need for institutionalization increased from 15% at baseline to 35% at 12 months. In the multivariate analysis, the FRAGIL-VIG frailty index was independently associated with greater functional decline and increased need for institutionalization at 12 months.</div></div><div><h3>Conclusions</h3><div>The IF-VIG index is a good predictor of functional decline and risk of institutionalization 12 months after a femur fracture in the geriatric population.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502608"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078382","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":"Embolia pulmonar: qué aporta la nueva guía AHA/ACC 2026","authors":"W. Briceño,&nbsp;D. Jiménez","doi":"10.1016/j.rce.2026.502610","DOIUrl":"10.1016/j.rce.2026.502610","url":null,"abstract":"<div><div>Recently, the 2026 American Heart Association (AHA)/American College of Cardiology (ACC)/American College of Chest Physicians/American College of Chest Physicians/Society for Cardiovascular Angiography and Interventions/Society of Hospital Medicine/Society of Interventional Radiology/Society of Vascular Medicine/Society for Vascular Nursing Guideline for Evaluation and Management of Acute Pulmonary Embolism in Adults (AHA/ACC Acute PE Guideline) has been published. We aimed to critically evaluate the most significant sections of the guidelines. The new risk classification provides granularity, although the new categories require validation. We concur with the guidelines’ recommendations regarding the use of low-molecular-weight heparins (parenteral treatment) and direct oral anticoagulants (oral treatment) as the preferred anticoagulants for the vast majority of patients with acute PE. Finally, the guidelines suggest reperfusion therapies for scenarios that currently lack robust scientific evidence; therefore, the results of ongoing clinical trials must be awaited to determine their precise indications.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502610"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078383","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":"Sulfonilureas y riesgo de fractura en pacientes con diabetes mellitus tipo 2: una revisión sistemática y un metaanálisis","authors":"L. Xu,&nbsp;R. Yuan,&nbsp;H. Yue,&nbsp;M. Wang,&nbsp;W. Cai","doi":"10.1016/j.rce.2026.502596","DOIUrl":"10.1016/j.rce.2026.502596","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between sulfonylureas and fracture risk in patients with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>PubMed, Web of Science, the Cochrane Library and Embase were systematically searched for observational studies evaluating sulfonylurea-associated fracture risk in patients with T2DM. Pooled relative risk (RR) and its 95% confidence interval (CI) were calculated.</div></div><div><h3>Results</h3><div>Twelve observational studies involving 5,854,139 patients were included. Sulfonylurea use was significantly associated with increased risks of overall fractures (RR<!--> <!-->=<!--> <!-->1.28; 95% CI: 1.11–1.47) and osteoporotic fractures (RR<!--> <!-->=<!--> <!-->1.38; 95% CI: 1.05–1.80). Site-specific analyses revealed a 23% increase in hip fracture risk (RR<!--> <!-->=<!--> <!-->1.23; 95% CI: 1.03–1.46) and a 47% increase in vertebral fracture risk (RR<!--> <!-->=<!--> <!-->1.47; 95% CI: 1.24–1.74). Fracture risk profiles varied across sulfonylurea subtypes.</div></div><div><h3>Conclusion</h3><div>Sulfonylureas are associated with a significant increase in the overall risk of fractures and the risk of osteoporotic fractures in patients with T2DM, and this risk is particularly prominent in hip and vertebral fractures.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502596"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078632","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":"Factores de riesgo para el desarrollo de complicaciones intrahospitalarias en los pacientes pluripatológicos","authors":"Y. Jamal-Ismail Ortiz,&nbsp;S. García-Gutiérrez,&nbsp;A. Renom-Guiteras,&nbsp;J.E. Ternero-Vega,&nbsp;M.J. Legarreta-Olabarrieta,&nbsp;D. Mestre,&nbsp;M.D. Martín-Escalante,&nbsp;R. Quirós-López,&nbsp;en nombre del grupo de trabajo de RePluris","doi":"10.1016/j.rce.2026.502595","DOIUrl":"10.1016/j.rce.2026.502595","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Multimorbid patients (MP) represent a major challenge for healthcare systems due to their high prevalence, resource utilization, and poorer prognosis. In the hospital setting, they account for approximately one in four admissions. Although complications are common in this population, there is limited information regarding their type, frequency, impact, and associated factors. The aim of this study was to analyze in-hospital complications in multimorbid patients and their impact on health outcomes.</div></div><div><h3>Materials and methods</h3><div>Prospective observational study conducted between February 2022 and June 2023. Multimorbid patients aged ≥18 years admitted for any reason were included after providing informed consent; patients who died during hospitalization were excluded. Variables collected included sociodemographic characteristics, comorbidities, reason for admission, multimorbidity criteria, type and frequency of complications, frailty, length of stay, readmissions, and 30-day mortality.</div></div><div><h3>Results</h3><div>A total of 535 patients were included (mean age 82.2 years); 334 (62.4%) developed at least one complication, accounting for 682 events. The most frequent were neurological (25.4%), digestive (19%), hematological (16%), and cardiovascular (15.7%). Patients with complications had a longer length of stay (11.6 vs. 7.3 days; <em>P</em>&lt;.001) and higher 30-day mortality (10.5 vs. 4.5%; <em>P</em>&lt;.05). In multivariate analysis, cognitive impairment, prostate disease, VIG-Frail index &gt;0.4, anemia at admission, and hospital stay &gt;6 days were associated with increased risk (AUC: 0.713; 95% CI: 0.669-0.756).</div></div><div><h3>Conclusions</h3><div>In-hospital complications are common among multimorbid patients and are associated with worse outcomes. Early identification of high-risk patients may enable preventive strategies and improve outcomes in this vulnerable population.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502595"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078625","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":"Estado vacunal de pacientes en tratamiento por VIH en un hospital de Madrid","authors":"A. Alcaide-Jiménez,&nbsp;J.E. Losa,&nbsp;V. Hernández-Múgica,&nbsp;J.G. Sánchez,&nbsp;G. Rodríguez-Caravaca,&nbsp;P. Cárdenas-Soriano,&nbsp;A.M. Pedraza-Flechas","doi":"10.1016/j.rce.2026.502597","DOIUrl":"10.1016/j.rce.2026.502597","url":null,"abstract":"<div><h3>Introduction</h3><div>People living with HIV (PLHIV) are considered at high-risk for acquiring infections or experiencing severe disease. The Spanish Ministry of Health advises vaccination against pneumococcus, meningococcus, hepatitis A and B, tetanus, human papillomavirus (HPV), herpes zoster (HZ), varicella, and measles, mumps, and rubella (MMR) for PLHIV.</div><div>We aimed at determining the vaccination status of PLHIV on antiretroviral therapy (ART) in a hospital in Madrid in 2023.</div></div><div><h3>Methods</h3><div>Cross-sectional study in 96 PLHIV receiving ART. Vaccination status was evaluated regarding official recommendations. Coverage was calculated according to schedule.</div></div><div><h3>Results</h3><div>78.1% had received at least one dose of a vaccine as part of the recommended schedule. Completed schedule was more frequent for HZ (68.75%), followed by pneumococcus (38.54%) and meningococcus (2.01%). 12.50% had received at least on dose of the HPV vaccine and 20.83% had received a diphtheria/tetanus vaccine dose within the last 10 years. Immunity to hepatitis B and A was observed in 57.30% and 56.30%, respectively. Vaccination coverage during the 2022–2023 campaign was 50% for both, COVID-19 and influenza.</div></div><div><h3>Conclusions</h3><div>Patients’ compliance with vaccination schedules was acceptable in general, and low regarding meningococcal vaccination. Patient engagement and awareness strategies are essential to promote vaccination uptake in this population.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502597"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078633","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":"La formación en medicina interna en la era de la inteligencia artificial","authors":"J. García-Alegría,&nbsp;D. Ruiz-Hidalgo,&nbsp;M. Rodríguez-Carballeira","doi":"10.1016/j.rce.2026.502609","DOIUrl":"10.1016/j.rce.2026.502609","url":null,"abstract":"<div><div>Artificial intelligence (AI) is transforming knowledge management in medicine, with a radical impact on training and the acquisition of professional skills. This review aims to guide and optimise the use of AI in the training of internal medicine residents, with an emphasis on the reliability of information, clinical safety, ethical considerations, the clinical process, prompt engineering, the role of simulation, training risks, shared decision-making with patients, the role of tutors, and opportunities for the speciality, all with the central premise that AI complements but does not replace clinical training.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502609"},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078384","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":"Notificación de sospechas de reacciones adversas a medicamentos por enfermeras a un programa de farmacovigilancia hospitalaria. Estudio descriptivo retrospectivo","authors":"P. Ordóñez-Rufat,&nbsp;D. Rodríguez-Cumplido,&nbsp;R. Llop-Rius,&nbsp;A. Tarres-Martínez,&nbsp;P. Hereu-Boher","doi":"10.1016/j.rce.2026.502577","DOIUrl":"10.1016/j.rce.2026.502577","url":null,"abstract":"<div><h3>Introduction</h3><div>Adverse drug reactions (ADR) are a common cause of illness. The Spontaneous reporting of adverse drug reactions is essential to characterize drug toxicity. Nurses, due to their proximity to patients, can contribute to detect them. The purpose is to describe the number of notifications of adverse drug reactions from nurses after a set of actions aimed at promoting reporting.</div></div><div><h3>Material and method</h3><div>Single-center observational, retrospective, and descriptive study on the characteristics and number of spontaneous ADR reports made by nurses following the implementation of informational/training actions in different healthcare areas of a tertiary hospital.</div></div><div><h3>Results</h3><div>Of the total 806 of suspected adverse drug reactions, nurses reported 124 (38.51%). There was a predominance of women 77 (62,1%), with a mean age of 54 years; 22.6% were over 65 years of age and 61.3% were polymedicated (five or more drugs prescribed). The most frequently reported reactions were skin disorders, and 71% of them resolved within 24<!--> <!-->hours. Intravenous contrast agents for diagnostic testing were the most reported drugs. In 116 (93.5%) of cases, the reactions were considered definitively or probably related to the drug.</div></div><div><h3>Conclusions</h3><div>It is essential to promote the role of nurses in increasing adverse drug reactions reporting in order to sustainably strengthen pharmacovigilance systems.</div><div>Continuous training that is adapted and maintained over time, as well as intuitive and accessible notification circuits, can contribute to improving participation.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 7","pages":"Article 502577"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148651702","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":"La enfermedad tromboembólica venosa relacionada con los anticonceptivos hormonales. Grupo de Enfermedad Tromboembólica de la Sociedad Española de Medicina Interna y Sociedad Catalana de Anticoncepción","authors":"A. Franco Moreno,&nbsp;J. Perelló Capó,&nbsp;O. Madridano Cobo,&nbsp;N. Muñoz Rivas,&nbsp;M. Martín Asenjo,&nbsp;Á. Blanco Molina","doi":"10.1016/j.rce.2026.502579","DOIUrl":"10.1016/j.rce.2026.502579","url":null,"abstract":"<div><div>Combined hormonal contraceptives (CHCs) constitute one of the most widely used contraceptive methods in women of reproductive age and play a relevant role not only in contraception but also in the treatment of various gynecological conditions. However, their use is associated with an increased risk of venous thromboembolic disease (VTE; deep vein thrombosis and pulmonary embolism) due to the induction of a hypercoagulable state. This effect is primarily related to the estrogenic component and is modulated by the type of associated progestogen. The formulations containing low-dose estrogen and levonorgestrel, as well as progestin-only contraceptives (except medroxyprogesterone), have the most favorable prothrombotic profile and should be prioritized when hormonal contraception is indicated, particularly in women with additional risk factors. In women with VTE risk factors, the use of progestogen-only is recommended, as these are not associated with an increased thrombotic risk. The use of CHC after an episode of VTE requires individualized assessment; in selected cases, it may be temporarily continued during anticoagulant therapy. Before discontinuation of anticoagulation, CHCs should be replaced by a progestogen-only. CHCs are contraindicated in women with a history of VTE who are not receiving anticoagulant treatment. Appropriate selection of the contraceptive method and patient education regarding the symptoms of VTE are essential to minimize thrombotic risk, optimize safety, and promote early detection of thrombosis. This document provides an updated review of the thrombotic risk associated with different CHCs and offers practical recommendations for their management in women at high risk or with a history of VTE, emphasizing the need for individualized evaluation and a multidisciplinary approach.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 7","pages":"Article 502579"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148651703","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":"Variabilidad de la presión arterial, un tópico aun infravalorado","authors":"P. Stiefel,&nbsp;J. Muñoz-García,&nbsp;R. Pino-Mejías","doi":"10.1016/j.rce.2026.502580","DOIUrl":"10.1016/j.rce.2026.502580","url":null,"abstract":"<div><div>The importance of blood pressure variability has grown exponentially over the past two to three years. In this review, we aim to discuss the reasons underlying this increasing interest. First, we describe the different methods used to assess blood pressure variability, including very short-term (beat-to-beat), short-term (24-hour ambulatory blood pressure monitoring), mid-term (home self-measurements), and long-term (visit-to-visit measurements), as well as the mathematical indices used to quantify it.</div><div>We then address the clinical relevance of blood pressure variability. First, increased variability is more prevalent in several health conditions not necessarily related to vascular disease, such as mental illness, severity of COVID-19 infection, bone fractures, and various forms of cognitive impairment. Second, blood pressure variability appears to be involved in the progression from prehypertensive states to established hypertension and, once hypertension is present, in the development of target organ damage. It has also been associated with an increased risk of gestational hypertension, preeclampsia, and adverse neonatal outcomes. Furthermore, blood pressure variability, even independently of mean arterial blood pressure, influences the development, prognosis, and complications of coronary and cerebrovascular disease. Finally, we discuss evidence suggesting that blood pressure variability is associated with both vascular and all-cause mortality.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 7","pages":"Article 502580"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148651704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacto de la inclusión en un programa de cuidados paliativos de pacientes con demencia avanzada","authors":"C. Vicente Martín,&nbsp;V. de la Cuesta Esteban,&nbsp;N. Trapero Iglesias,&nbsp;A.C. Gil Abizanda,&nbsp;A. Sáenz de Urturi Rodríguez,&nbsp;J.M. Galván Román,&nbsp;R. Barba Martín,&nbsp;J.A. Rueda Camino","doi":"10.1016/j.rce.2026.502576","DOIUrl":"10.1016/j.rce.2026.502576","url":null,"abstract":"<div><h3>Background</h3><div>Despite evidence, it remains unclear whether the inclusion of patients with advanced dementia (AD) in palliative care (PC) is beneficial. The aim of this study is to examine the impact of enrolment in a PC programme on the subsequent clinical management of these patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study including patients with AD admitted between June 2022 and June 2025. Patients were classified into two groups: included in palliative care (PCU group) or not included (non-PCU group). We compared the mean number of hospital care transitions, the proportion of invasive and/or life-sustaining treatments, and the total length of hospital stay. Outcomes were adjusted using negative binomial regression.</div></div><div><h3>Results</h3><div>298 patients were included, 149 assigned to each group, with 67% being female and a mean age of 88 years (SD 6.6). The mean number of hospital care transitions was 2.7 in the non-PCU group vs. 1.7 in the PCU group (p &lt;<!--> <!-->0.001). After adjustment for confounding, the effect remained significant: IRR 0.52 (95% CI: 0.49-0.54). Inclusion in the PCU group was associated with a significant reduction in interventional procedures (-6%; 95% CI: -9.9% to -2.2%) and in the use of broad-spectrum antibiotics (mean difference: -0.7; p&lt;<!--> <!-->0.001). The total hospital length of stay was 30 days (95% CI: 22.7-37.3) in the PCU group vs 111 days (95% CI: 25.6-196.4) in the non-PCU group (p&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>Inclusion in a PC program for patients with AD is associated with lower rates of hospital care transitions and reduced use of invasive procedures.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 7","pages":"Article 502576"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148651700","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}