Revista clinica espanola最新文献

{"title":"En respuesta al artículo de Ivars N, et al. «Características clínicas, manejo en urgencias y mortalidad de los episodios de insuficiencia cardiaca aguda en pacientes con enfermedad pulmonar obstructiva crónica»","authors":"A. Gil-Rodrigo , M.-J. Luque-Hernández , L. Cuesta-García , C. Martínez-Buendía","doi":"10.1016/j.rce.2025.502298","DOIUrl":"10.1016/j.rce.2025.502298","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502298"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288728","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":"Sobre la dificultad del diagnóstico clínico de insuficiencia cardíaca aguda en urgencias","authors":"Ò. Miró , N. Ivars , P. Llorens","doi":"10.1016/j.rce.2025.502301","DOIUrl":"10.1016/j.rce.2025.502301","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502301"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288729","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":"Uso de SCORE2 en la evaluación y control del riesgo cardiovascular en una cohorte de individuos aparentemente sanos","authors":"J. Campos ,&nbsp;A. Figueiredo ,&nbsp;J. Silva ,&nbsp;L. Azevedo ,&nbsp;I. Ribeiro ,&nbsp;M. Miranda ,&nbsp;H. Gomes","doi":"10.1016/j.rce.2025.502302","DOIUrl":"10.1016/j.rce.2025.502302","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Cardiovascular risk estimation is an essential step in reducing the onset of adverse cardiovascular events. It helps to identify healthy patients who will benefit most from treatment for atherosclerotic risk factors. The authors pretend to assess the Cardiovascular risk in an apparently healthy Portuguese population and evaluate the degree of control of LDL-cholesterol.</div></div><div><h3>Materials and methods</h3><div>This cross-sectional study assessed the cardiovascular risk level in a Portuguese population aged 40 to 69 years, using the Systematic Coronary Risk Evaluation 2 algorithm. This research received no specific funding.</div></div><div><h3>Results</h3><div>12076 apparently healthy patients were included, median age of 53.8<!--> <!-->±<!--> <!-->8.03 (min. 40; max. 69), 58.7% women and 41.3% men. Based on the Systematic Coronary Risk Evaluation 2 calculation, 59.5% of patients belonged to the low moderate risk, 35.1% to the high risk group, and 5.4% to the very high risk group.</div><div>Based on cardiovascular risk stratification, 64.6%, 94.1%, and 98.5% of the patients with low-moderate, high, and very high cardiovascular risk were above the LDL-cholesterol target, respectively. Of those with high and very high cardiovascular risk, 94.7% were above LDL-cholesterol goal in spite that 35.9% were under statin treatment.</div></div><div><h3>Conclusion</h3><div>In this real-life setting study, over a third of the population had high and very high cardiovascular risk, of which 94.7% were above the LDL-cholesterol goal. The study highlights that a large part of apparently healthy patients could benefit from a therapeutic intervention to reduce the risk of the onset of adverse cardiovascular events.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502302"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288732","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":"¿Es segura y eficaz la hospitalización a domicilio de los pacientes agudos que ingresan por infección?","authors":"L. Moreno Núñez ,&nbsp;C. Garmendia Fernández ,&nbsp;M. Ruiz Muñoz ,&nbsp;J. Collado Álvarez ,&nbsp;C. Jimeno Griño ,&nbsp;Á. Prieto Callejero ,&nbsp;E. Pérez Fernández ,&nbsp;I. González Anglada","doi":"10.1016/j.rce.2025.502308","DOIUrl":"10.1016/j.rce.2025.502308","url":null,"abstract":"<div><h3>Introduction</h3><div>Home hospitalization (HH) is a safe, effective and more efficient modality of care than conventional hospitalization (CH). There is little scientific evidence comparing these two models of hospitalization in patients admitted from the Emergency Department (ED) for infection.</div></div><div><h3>Material and methods</h3><div>Retrospective cohort study between October 1 and December 15, 2023 of patients admitted from the ED for infection. Two cohorts were analyzed, the first one, patients admitted to CH in Internal Medicine, Geriatrics or Infectious Diseases units and the second one, patients admitted to HH. Patients with hemodynamic instability, those who died in the first 48 hours of admission, <em>S. aureus</em> bacteremia, catheter-associated bacteremia, osteoarticular infection, meningitis, diverticulitis, fever without focus, and infections with undrained focus were excluded.</div></div><div><h3>Results</h3><div>257 patients were analyzed, 151 in CH and 106 in HH. The median duration of antibiotherapy was 9 days in HC vs 7 in HH (p<!--> <!-->&lt;<!--> <!-->0.001), the mean length of stay was longer in CH vs HH (6 vs 4; p<!--> <!-->=<!--> <!-->0.007). More laboratory tests were performed in CH vs HH (3 vs 1, p<!--> <!-->&lt;<!--> <!-->0.001), radiographs (11% vs 0%), ultrasound (12% vs 2%) and computed axial tomography (13% vs 3%, p<!--> <!-->&lt;<!--> <!-->0.001). Patients admitted to CH had more confusional syndrome than those admitted to HH (15% vs 2%; p<!--> <!-->&lt;<!--> <!-->0.001). There were no differences in mortality or readmissions. In the multivariate linear regression analysis, patients admitted to HH shortened their hospital stay by 1 day (95% CI: -2.2– -0.185) compared to those admitted to CH.</div></div><div><h3>Conclusion</h3><div>Patients admitted for infection in HH from the ED have a shorter hospital stay than patients admitted to CH.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502308"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288734","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 sinérgicos de impacto en los años de vida ajustados por calidad en la población geriátrica frágil","authors":"L.S. Briongos Figuero ,&nbsp;J.P. Miramontes González ,&nbsp;M. Gabella Martín ,&nbsp;L. Corral Gudino ,&nbsp;G. López Muñiz ,&nbsp;J.C. Martín Escudero","doi":"10.1016/j.rce.2025.502297","DOIUrl":"10.1016/j.rce.2025.502297","url":null,"abstract":"<div><h3>Introduction</h3><div>We aim to analyze which factors predominantly influence the QALYs related to geriatric frailty syndrome (QALYs-frail) in octogenarians.</div></div><div><h3>Materials and methods</h3><div>Prospective observational study on 63 frail octogenarian patients admitted to the medical area. Clinical-demographic variables were collected, as well as quality of life (EuroQoL-5D-5L), nutritional status (MNA-SF), dependence (Barthel scale), comorbidity, and the ADLs related to frailty. Statistical models were carried out to study the association between the different variables and to find predictive factors.</div></div><div><h3>Results</h3><div>Patients with better nutritional status showed a positive correlation with the AVACs-frail (r<!--> <!-->=<!--> <!-->0.4; <em>P</em>=.003), as did patients with a lower degree of dependence (r<!--> <!-->=<!--> <!-->0.71; p&lt;<!--> <!-->0.001). When adding multimorbidity, a significant negative correlation was identified (r<!--> <!-->=<!--> <!-->−0.16; <em>P</em>=.002). The same happened with age (r<!--> <!-->=<!--> <!-->−0.43; <em>P</em>&lt;.001).</div></div><div><h3>Conclusions</h3><div>Managing fragility poses a challenge, but specific interventions could have an impactful and cost-effective effect on this vulnerable subgroup of the population.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502297"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289229","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 fibrilación auricular en pacientes con oclusiones vasculares retinianas: un metaanálisis","authors":"X. Chen ,&nbsp;Y. Zhou ,&nbsp;X. Li ,&nbsp;W. Zhu","doi":"10.1016/j.rce.2025.502309","DOIUrl":"10.1016/j.rce.2025.502309","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between atrial fibrillation (AF) and retinal vascular occlusions has been inconsistently reported. Therefore, we conducted a systematic review and meta-analysis to evaluate the occurrence of AF in individuals with and without retinal vascular occlusions.</div></div><div><h3>Methods</h3><div>A thorough search of the PubMed database was conducted for relevant studies published from its inception through November 2023. Inclusion criteria were set for studies that reported on AF occurrence in patients with retinal vascular occlusions. The pooled effect sizes were determined using either a fixed-effects or random-effects model, as dictated by the I² statistic.</div></div><div><h3>Results</h3><div>Our meta-analysis included 12 studies. In the meta-analysis, five studies (9,418 retinal artery occlusion [RAO] patients and 26,116,452 controls) showed a significantly higher prevalence of AF in RAO patients (odds ratio [OR]<!--> <!-->=<!--> <!-->1.74, 95% confidence interval [CI] 1.15–2.63, P<!--> <!-->=<!--> <!-->0.009, I² <!-->=<!--> <!-->94%). Four studies (1,622 retinal vein occlusion [RVO] patients and 92,910 controls) indicated a higher prevalence of AF in RVO patients (OR<!--> <!-->=<!--> <!-->2.28, 95% CI 1.93–2.69, P<!--> <!-->&lt;<!--> <!-->0.00001, I² <!-->=<!--> <!-->0%). For follow-up incidence, two studies (806 RAO patients and 7,840 controls) reported a higher rate of AF detection in RAO patients (hazard ratios [HR]<!--> <!-->=<!--> <!-->1.60, 95% CI 1.25–2.04, P<!--> <!-->=<!--> <!-->0.0002, I² <!-->=<!--> <!-->0%). Similarly, two studies (2,330 RVO patients and 8,641 RVO controls) revealed a higher rate of AF detection in RVO patients (HR<!--> <!-->=<!--> <!-->1.25, 95% CI 1.04–1.51, P<!--> <!-->=<!--> <!-->0.02, I² <!-->=<!--> <!-->49%).</div></div><div><h3>Conclusions</h3><div>Our evidence from this study suggests a significantly elevated prevalence and incidence of AF in patients with retinal vascular occlusions, indicating a potential association that warrants further investigation.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502309"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288731","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":"Comparación de pacientes reales y estandarizados en el Grado de Medicina: un estudio de intervención aleatorizado y controlado","authors":"N. Díez ,&nbsp;B. Franchez ,&nbsp;M.C. Rodríguez-Díez ,&nbsp;M. Vidaurreta ,&nbsp;M.T. Betés ,&nbsp;S. Fernández ,&nbsp;P. Palacio ,&nbsp;F.J. Pueyo ,&nbsp;N. Martín-Calvo","doi":"10.1016/j.rce.2025.502306","DOIUrl":"10.1016/j.rce.2025.502306","url":null,"abstract":"<div><h3>Introduction</h3><div>Simulated clinical scenarios allow students to learn in a safe environment. Although it is recommended that standardized patients (SP) participate in these scenarios, few studies compare the impact of SP and real patients (RP) on medical education.</div></div><div><h3>Methods</h3><div>Forty medical students per course (4<!--> <!-->th, 5<!--> <!-->th, and 6<!--> <!-->th) were selected and randomly assigned (1:1) to two groups: a scenario with RP or SP. The students and the external observer were unaware of the type of patient participating in the scenario. The students completed questionnaires on perceptions and knowledge, and the responsible professors and external observer completed questionnaires on perceptions. Qualitative information was collected through focus groups with the students.</div></div><div><h3>Results</h3><div>No significant differences were found between both groups in perceptions and acquired knowledge, but there was a significant difference in the probability of correctly identifying the type of patient (<em>P</em> <!-->&lt;<!--> <!-->.001): most students in the scenario with SP identified it as RP. No differences were found between groups in the professor and external observer questionnaires. Students were more prepared and involved if they believed they were facing a RP and considered the patient's feedback enriching, regardless of the type of patient.</div></div><div><h3>Conclusions</h3><div>Medical students do not differentiate SP from RP in scenarios and evaluate them similarly. Given the difficulty of having PR with diverse pathologies and severity levels, SP is a good alternative for training medical students.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502306"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288735","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":"Envejecimiento con VIH: un análisis transversal de las comorbilidades","authors":"M.C. Montes ,&nbsp;J.A. Rueda-Camino ,&nbsp;N. Rallón ,&nbsp;S. Nistal-Juncos ,&nbsp;R. Barba Martín","doi":"10.1016/j.rce.2025.502310","DOIUrl":"10.1016/j.rce.2025.502310","url":null,"abstract":"<div><h3>Background</h3><div>People living with HIV (PLHIV) are at increased risk of multimorbidity compared to the general population. The goal of this study is to evaluate the prevalence of non-infectious comorbidities and geriatric syndromes in PLHIV older than 50 years old.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis was conducted on a cohort of PLHIV regularly followed at an outpatient clinic in a university hospital in Spain, focusing on PLHIV aged 50 and above. Participants were categorized by age into 10-year intervals. Crude and standardized prevalence of each comorbidity and its trend across age groups were estimated. The prevalence of multimorbidity (&gt;<!--> <!-->2 diseases) was also evaluated. All prevalence were estimated with the exact method.</div></div><div><h3>Results</h3><div>We evaluated 122 PLHIV, of which 25.4% were women and 13% resided in nursing homes. The median time between HIV diagnosis and the last documented visit was 19 (9-29) years. Overall prevalence of multimorbidity was 37% (95% <span>C</span>I<span>:</span> 28.4-45.6%), being the most prevalent comorbidities cardiovascular risk factors dyslipidemia (37.7%; 95% CI: 29.6-46.6%), hypertension (26.2%; 95% CI: 19.2-34.7%), diabetes mellitus (14.8%; 95% CI: 9.5-22.1%) and non-AIDS defining cancers (15.6%; 95% CI: 10.2-23.0%). The most common geriatric syndromes were fractures/osteoporosis (9.8%; 95% CI: 5.7-16.4%), dementia (8.2%; 95% CI: 4.5-14.4%) and frailty (8.2%; 95% CI: 4.5-14.4%). The prevalence of most comorbidities and multimorbidity showed a significantly increasing trend across age groups.</div></div><div><h3>Conclusions</h3><div>PLHIV who are over 50 years of age have a high prevalence of non-infectious comorbidities and geriatric syndromes. Multimorbidity increases with age in this population group.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502310"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288730","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":"iSGLT2 tras insuficiencia cardiaca aguda: mucho beneficio, poca prescripción","authors":"R. Quirós-López","doi":"10.1016/j.rce.2025.502299","DOIUrl":"10.1016/j.rce.2025.502299","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502299"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288737","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 asociados con el uso de inhibidores del cotransportador de sodio-glucosa 2 (SGLT2) tras un episodio de insuficiencia cardiaca aguda e impacto pronóstico","authors":"P. Llorens ,&nbsp;A. Haro ,&nbsp;V. Gil ,&nbsp;A. Alquézar-Arbé ,&nbsp;J. Jacob ,&nbsp;B. Espinosa ,&nbsp;M.A. González de la Torre ,&nbsp;J. Núñez ,&nbsp;X. Rossello ,&nbsp;O. Miró ,&nbsp;en representación del grupo de investigación ICA-SEMES","doi":"10.1016/j.rce.2025.502300","DOIUrl":"10.1016/j.rce.2025.502300","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyze the factors associated with the use of sodium-glucose cotransporter<!--> <!-->2 inhibitors (SGLT2i) and the association between use SGLT2i and post discharge adverse clinical endpoints (composite of 30-day visit to emergency department or acute heart failure [AHF] readmission or death) and 1-year mortality.</div></div><div><h3>Methods</h3><div>We included all patients diagnosed with AHF in 40 Spanish emergency departments (ED) in November-December 2022 with available data on chronic treatment and at discharge and grouped them according to whether they received SGLT2i at discharge. Treatment with SGLT2i was categorized in never user, prior use and initiation during decompensation. In multivariable models adjusted for 31 independent variables, we investigated factors associated with SGLT2i use at discharge and with new initiation of SGLT2i treatment at discharge, and the relationship between SGLT2i treatment and 30-day adverse events and 1-year mortality.</div></div><div><h3>Results</h3><div>3,554 patients were included (median age: 85<!--> <!-->years, 56% women, 71% hospitalized): 495 (13.9%) were already receiving SGLT2i before decompensation and 733 (20.6%) were discharged with SGLT2i. The use of SGLT2i at discharge was directly associated with prior SGLT2i treatment, diabetes mellitus, hospitalization, and discharge prescription of other drugs recommended for heart failure, and inversely with previous episodes of AHF and dementia. Initiation of SGLT2i during decompensation was inversely associated with these factors and also inversely associated with chronic renal failure. Treatment with SGLT2i at discharge was associated with a lower risk of adverse events at 30<!--> <!-->days (adjusted HR: 0.80; 95%<!--> <!-->CI: 0.65-0.99) and death at 1<!--> <!-->year (0.78; 0.63-0.96). These beneficial effects were also observed when SGLT2i was initiated during decompensation (0.65; 0.49-0.87 and 0.71; 0.54-0.93, respectively), and the reduction in adverse events at 30<!--> <!-->days was even better in new-onset cases (interaction p: 0.02).</div></div><div><h3>Conclusion</h3><div>The use of SGLT2i after an AHF episode is low, is higher in patients who were hospitalized, and is associated with fewer 30-day adverse events and deaths at 1<!--> <!-->year compared with patients not receiving SGLT2i. Patients who initiate SGLT2i during decompensation have an even greater decrease in 30-day adverse events than patients on chronic therapy.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502300"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288733","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}