Revista clinica espanola最新文献

{"title":"Relación entre las trayectorias del TyG y la enfermedad de Alzheimer: datos del Estudio de Framingham","authors":"C. Guan ,&nbsp;Z. Gu ,&nbsp;J. Sun ,&nbsp;W. Zhu ,&nbsp;M. Ye","doi":"10.1016/j.rce.2025.502331","DOIUrl":"10.1016/j.rce.2025.502331","url":null,"abstract":"<div><h3>Background</h3><div>The triglyceride-glucose (TyG) index is derived from a combination of fasting plasma glucose and triglyceride levels, making it a reliable indicator of insulin resistance. Prior studies have established a significant connection between insulin resistance and Alzheimer's disease (AD). Nevertheless, the relationship between the trajectory of the TyG index and AD onset is still not clearly understood.</div></div><div><h3>Methods</h3><div>This longitudinal prospective cohort study derived data from the Framingham Heart Study Offspring cohort. A total of 2,170 participants without AD at baseline were included and were prospectively followed until 2018. Groups of participants with comparable TyG index trajectories were identified through the application of latent class growth mixture modeling analysis.</div></div><div><h3>Results</h3><div>A cohort of 163 participants were diagnosed with AD during the follow-up. The incidence of AD in the low, moderate, and high trajectory groups was 0.38, 0.66, and 0.68 per 100 person-years respectively. Compared to the low trajectory group, both the moderate trajectory (hazard ratio [HR] 1.53, 95% confidence interval [CI]: 1.04-2.25) and high trajectory groups (HR<!--> <!-->=<!--> <!-->1.90, 95%<!--> <!-->CI: 1.09-3.31) exhibited an elevated risk of developing AD. These results remained consistent after adjusting for multiple covariates (moderate: HR<!--> <!-->=<!--> <!-->1.53, 95%<!--> <!-->CI: 1.02-2.29; high: HR<!--> <!-->=<!--> <!-->1.84, 95%<!--> <!-->CI: 1.03-3.27, respectively).</div></div><div><h3>Conclusion</h3><div>Higher TyG index trajectories exhibit a notable correlation with the development of AD. Early and continuous monitoring of the TyG index in individuals identified as high-risk for AD may help implement timely prevention measures.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502331"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779801","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":"Vacunación en la enfermedad pulmonar obstructiva crónica (EPOC): evidencia científica y estrategias para reducir riesgos","authors":"Ó. Porto Fuentes ,&nbsp;A. Muela Molinero ,&nbsp;M.B. Alonso Ortiz","doi":"10.1016/j.rce.2025.502330","DOIUrl":"10.1016/j.rce.2025.502330","url":null,"abstract":"<div><div>Patients with chronic obstructive pulmonary disease (COPD) are more vulnerable to infections that may favor disease progression. Vaccination in COPD is an effective intervention that helps reduce infectious exacerbations, as well as associated morbidity and mortality.</div><div>In recent years, the use of new vaccines has become widespread, not only targeting specific infections but also contributing to long-lasting immunity and slowing the process of immune aging (immunosenescence).</div><div>Current clinical practice guidelines recommend the administration of six vaccines (against <em>Streptococcus pneumoniae</em>, influenza virus, SARS-CoV-2, respiratory syncytial virus, <em>Bordetella pertussis</em>, and varicella-zoster virus) for all COPD patients.</div><div>However, vaccination rates in many countries still fall short of the established targets. Therefore, it is crucial to design a specific vaccination schedule tailored for COPD patients.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502330"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779630","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":"Objeción de conciencia a la prestación de ayuda para morir: conocimientos, actitudes y prácticas en atención primaria","authors":"R. Triviño-Caballero ,&nbsp;J. Franco ,&nbsp;L. Sordo","doi":"10.1016/j.rce.2025.502329","DOIUrl":"10.1016/j.rce.2025.502329","url":null,"abstract":"<div><h3>Background/objective</h3><div>The Euthanasia Regulation Law includes the right to conscientious objection (CO). However, there is hardly any information available on its exercise or the grounds for objection. The objective of this study was to identify knowledge, attitudes, and practices regarding CO to the provision of medical aid in dying (MAID) in primary care, which is the level of care where most provisions occur.</div></div><div><h3>Materials and methods</h3><div>Cross-sectional knowledge, attitudes, and practices model study. A total of 434 active general practitioners working in health centres across Spain were surveyed through self-administered questionnaires on knowledge, attitudes, and practices related to CO. A descriptive analysis of the responses in each domain was performed, followed by multivariate analyses to determine the factors related to having objected or considering doing so.</div></div><div><h3>Results</h3><div>Of the general practitioners surveyed, 46.3% practised in Madrid; 75.2% were women, with an average age of 47; 84.8% had received training in bioethics; 54.9% reported knowing the law, only 29% correctly answered questions about CO in end-of-life practices; 35% had objected or considered objecting. Higher rates of objection were observed among those practising in Madrid (aOR<!--> <!-->=<!--> <!-->2.98; 95% CI 1.16-5.34), those with religious beliefs (aOR<!--> <!-->=<!--> <!-->5.23; 95% CI 2.78-9.80), and those opposed to MAID (aOR<!--> <!-->=<!--> <!-->12.63; 95% CI 5.80-27.50).</div></div><div><h3>Conclusions</h3><div>The main reasons for objecting are moral and emotional, although other contextual factors also emerge. Given the high level of ignorance of the practices to which one can object, improvements in training and institutional involvement are needed for responsible practice and to guarantee the MAID.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502329"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779959","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 contribución del PET/MRI en la diferenciación entre nódulos benignos y malignos en incidentalomas tiroideos detectados en imágenes FDG PET/CT","authors":"A. Nazari ,&nbsp;S. Sager ,&nbsp;S. Schenke ,&nbsp;L.U. Beşli ,&nbsp;C. Samancı ,&nbsp;T. Öztürk ,&nbsp;H.B. Sayman","doi":"10.1016/j.rce.2025.502333","DOIUrl":"10.1016/j.rce.2025.502333","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Incidentalomas of the thyroid gland are frequently observed in oncological patients undergoing FDG PET/CT imaging for staging or treatment response assessment. This study aims to investigate the utility of SUVmax and ADC values measured by PET/MRI in distinguishing between benign and malignant thyroid nodules.</div></div><div><h3>Materials and methods</h3><div>We selected 108 patients (72 females, 36 males; mean age 54<!--> <!-->±<!--> <!-->12 years) who underwent routine oncological FDG PET/CT scans for staging or treatment response assessment, with nodule sizes greater than 1<!--> <!-->cm. A one-bed neck PET/MRI scan followed the whole-body PET/CT. SUVmax values were measured, and ADC maps were created using DWI with b factors of 50 and 1000<!--> <!-->s/mm². SUVmax and ADC values were correlated with FNAC results.</div></div><div><h3>Results</h3><div>FNAC results revealed 76 (70.4%) benign and 32 (29.6%) malignant nodules among the 108 patients. The mean SUVmax of malignant nodules was significantly higher than that of benign nodules (10.6<!--> <!-->±<!--> <!-->8.3 vs. 5.94<!--> <!-->±<!--> <!-->5.2; <em>P</em>&lt;.001). Similarly, the mean ADC value was lower in malignant nodules compared to benign ones (1.4<!--> <!-->±<!--> <!-->0.6<!--> <!-->×<!--> <!-->10^-3 <!-->mm²/s vs. 1.8<!--> <!-->±<!--> <!-->0.4<!--> <!-->×<!--> <!-->10^-3 <!-->mm²/s; <em>P</em>&lt;.001). A significant but weak correlation was found between FNAC results and mean SUVmax (r<!--> <!-->=<!--> <!-->0.335), as well as a significant weak negative correlation with mean ADC values (r<!--> <!-->=<!--> <!-->−0.355). Using a cut-off value of 6 for SUVmax and 1.56<!--> <!-->×<!--> <!-->10^-3 mm²/s for ADC, the sensitivity, specificity, and accuracy for SUVmax were 68.7, 73.6, and 72.1%, respectively, while for ADC, they were 71.8, 69.7, and 70.4%, respectively. The PET/MRI system demonstrated a relative sensitivity, specificity, accuracy, PPV, and NPV of 90.62, 51.32, 62.96, 43.94, and 92.86%.</div></div><div><h3>Conclusion</h3><div>This study is one of the first in the literature to explore the use of FDG PET/MRI, a single-stop device, in distinguishing between benign and malignant thyroid nodules with high sensitivity and NPV.</div><div>.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502333"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779629","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":"Consenso de expertos sobre la enfermedad pulmonar intersticial asociada a enfermedades autoinmunes sistémicas. Resumen ejecutivo","authors":"A. González-García ,&nbsp;M. Akasbi ,&nbsp;P. Brito-Zerón ,&nbsp;J.L. Callejas ,&nbsp;I. Cusacovich ,&nbsp;F. Jiménez Segovia ,&nbsp;M. Martín Cascón ,&nbsp;S. Prieto-González ,&nbsp;L. Sáez Comet ,&nbsp;C.P. Simeón ,&nbsp;R. Solans Laque ,&nbsp;J.S. García Morillo ,&nbsp;en representación del grupo de Enfermedades Autoinmunes Sistémicas (GEAS) de la Sociedad Española de Medicina Interna (SEMI)","doi":"10.1016/j.rce.2025.502326","DOIUrl":"10.1016/j.rce.2025.502326","url":null,"abstract":"<div><div>Interstitial lung disease is a frequent and potentially fatal manifestation of systemic autoimmune diseases. Early screening, diagnosis, and treatment with immunomodulators, and in some cases, antifibrotics, as well as appropriate follow-up, are essential to improving patients’ quality of life and survival. The complexity of these diseases and the limited robust evidence to guide clinical decision-making lead to significant variability in management guidelines. In this article, a group of experts in systemic autoimmune diseases has developed recommendations for the screening, diagnosis, treatment, and follow-up of interstitial lung disease, considering the latest evidence, their clinical experience, and the results of a survey conducted among specialists. The diseases included are systemic sclerosis, Sjögren's disease, idiopathic inflammatory myopathy, ANCA-associated vasculitis, sarcoidosis and systemic lupus erythematosus.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502326"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779631","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":"Comentario al artículo especial «Utilidad de la ecografía a pie de cama (POCUS) en el paciente hospitalizado con síndrome confusional agudo de etiología no aclarada»","authors":"J.A. Mariz","doi":"10.1016/j.rce.2025.502334","DOIUrl":"10.1016/j.rce.2025.502334","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502334"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779632","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":"Análisis multimodal de la congestión y utilidad pronóstica del protocolo VExUS en pacientes hospitalizados por insuficiencia cardiaca en un hospital terciario","authors":"A. Campos Sáenz de Santamaría ,&nbsp;A. Alcaine Otín ,&nbsp;S. Crespo Aznarez ,&nbsp;C. Josa Laorden ,&nbsp;L. Esterellas Sánchez ,&nbsp;M. Sánchez Marteles ,&nbsp;V. Garcés Horna ,&nbsp;Z. Albines Fiestas ,&nbsp;I. Giménez López ,&nbsp;J. Rubio Gracia","doi":"10.1016/j.rce.2025.502332","DOIUrl":"10.1016/j.rce.2025.502332","url":null,"abstract":"<div><h3>Background</h3><div>Multimodal assessment of congestion and venous excess ultrasound protocol (VExUS) play a determinant role for volume assessment and decongestive therapy in patients with acute heart failure (AHF).</div></div><div><h3>Methods</h3><div>Prospective, unicentrical and observational study in patients admitted for AHF at the Internal Medicine ward, designed to explore the prevalence, predictors and clinical outcomes of congestion (VExUS score) and the prevalence of congestive nephropathy.</div></div><div><h3>Results</h3><div>A total of 100 patients were included (mean age 86<!--> <!-->±<!--> <!-->8 years were and 51% females). According to VExUS protocol, 49% exhibited moderate to severe congestion (VExUS 2-3). These patients were more clinical congested, showed higher concentrations of CA125 and microalbumin/creatinine ratio, and need greater doses of loop diuretics during hospitalization. The prevalence of congestive nephropathy on admission was 38%. Patients with VExUS score on admission ≥<!--> <!-->2 had a 2.5-fold increased risk for all-cause mortality and/or HF hospitalization at 1<!--> <!-->year (OR 2.52, 95%<!--> <!-->CI: 1.02-6.26, <em>P</em> <!-->=<!--> <!-->.046). In multivariable analysis elevated urea levels, larger inferior vena cava diameter and male gender, were identified as independent predictors on top of VExUS score for one-year mortality with an area under the curve for the final model of 0.740 (<em>P</em> <!-->&lt;<!--> <!-->.001).</div></div><div><h3>Conclusions</h3><div>Moderate to severe congestion (VExUS grade 2-3) is associated with higher clinical congestion scores, greater need for diuretic treatment, and worse clinical outcomes, including increased mortality and rehospitalization rates in AHF. Furthermore, one-third of AHF showed congestion nephropathy a situation with clinical relevance that can influence decongestive treatments and final outcomes.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502332"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779961","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":"Contrarréplica: comentario al artículo especial «Utilidad de la ecografía a pie de cama (POCUS) en el paciente hospitalizado con síndrome confusional agudo de etiología no aclarada»","authors":"S. Carrasco-Molina ,&nbsp;Á. Robles-Marhuenda ,&nbsp;J.J. Ríos-Blanco ,&nbsp;Y. Tung-Chen","doi":"10.1016/j.rce.2025.502337","DOIUrl":"10.1016/j.rce.2025.502337","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502337"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779962","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 impacto futuro de la imagen avanzada y la inteligencia artificial en el diagnóstico e I + D de las enfermedades raras","authors":"M. Moreno-Higueras ,&nbsp;G. Fatoul-del Pino ,&nbsp;S. García-Linares ,&nbsp;T. Martín-Noguerol","doi":"10.1016/j.rce.2025.502327","DOIUrl":"10.1016/j.rce.2025.502327","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502327"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779964","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 aprendizaje asistido por pares mejora las habilidades no técnicas en la educación en fisioterapia pediátrica","authors":"T.T. Ma ,&nbsp;Q. Zhang ,&nbsp;H.B. Zhao ,&nbsp;H.X. Li","doi":"10.1016/j.rce.2025.502328","DOIUrl":"10.1016/j.rce.2025.502328","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502328"},"PeriodicalIF":1.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779963","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}