Revista clinica espanola最新文献

{"title":"Deficiencia de acil-CoA deshidrogenasa de cadena media diagnosticada en edad adulta","authors":"V. Manzano-Gamero, A. Rosales-Castillo","doi":"10.1016/j.rce.2026.502567","DOIUrl":"10.1016/j.rce.2026.502567","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502567"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146574","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":"Estrategias farmacológicas e intervencionistas en la cardiomiopatía chagásica crónica: revisión sistemática de desenlaces clínicos","authors":"R.-O. Germán ,&nbsp;M.N. Clara ,&nbsp;F.T. Manuel ,&nbsp;M.S. David","doi":"10.1016/j.rce.2026.502546","DOIUrl":"10.1016/j.rce.2026.502546","url":null,"abstract":"<div><h3>Background</h3><div>Chronic Chagas Cardiomyopathy (CCC), the main chronic manifestation of <em>Trypanosoma cruzi</em> infection, is a major global health burden causing heart failure, arrhythmias, and sudden death. Despite recommendations for conventional heart failure therapies, specific evidence for non-antiparasitic interventions in CCC is limited, creating significant clinical uncertainty.</div></div><div><h3>Objectives</h3><div>This systematic review aimed to synthesize the available evidence from Randomized Controlled Trials (RCTs) regarding the efficacy and safety of non-antiparasitic pharmacological and device-based therapies in CCC, specifically focusing on hard clinical outcomes such as mortality and hospitalizations.</div></div><div><h3>Methods</h3><div>We conducted a systematic search following PRISMA guidelines in PubMed, Web of Science, LILACS, MEDLINE, and BVS on May 1, 2025 (coverage through April 30, 2025; <span><span>supplementary material</span></span>). Blinded RCTs in adults with CCC evaluating non-antiparasitic therapies were included. The methodological quality was assessed using the Cochrane Risk of Bias (RoB) tool, and a narrative synthesis was performed due to clinical heterogeneity.</div></div><div><h3>Results</h3><div>Six blinded RCTs were included. The primary finding is a <em>notable gap:</em> none of the six included RCTs reported data on all-cause mortality or cardiovascular hospitalizations. Conventional agents (e.g., carvedilol, ACE inhibitors) did not demonstrate consistent benefit in improving myocardial function. Antiarrhythmic drugs showed partial efficacy but were associated with unfavorable risk-benefit profiles or a high/uncertain risk of bias.</div></div><div><h3>Conclusions</h3><div>There is a limited evidence of robust, reliable evidence from blinded RCTs to guide non-antiparasitic therapeutic strategies in CCC. This <em>notable gap</em> precludes establishing evidence-based recommendations for prognostic management. Consequently, management must continue to rely on extrapolated data from general heart failure guidelines. Urgent funding and execution of adequately powered RCTs that address hard clinical endpoints are necessary.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502546"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146578","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":"Resumen ejecutivo del documento de consenso 2026. Planificando el futuro de la medicina interna: toma de posición del Foro Internacional de Medicina Interna (FIMI)","authors":"P. Valdez ,&nbsp;L. Cámera ,&nbsp;H.L. Puello Galarcio ,&nbsp;D. Manfellotto ,&nbsp;A. Fadhil Hlaihel ,&nbsp;F. Benmediouni ,&nbsp;D. Johnson ,&nbsp;G. Dalekos ,&nbsp;E. Casariego-Vales ,&nbsp;en nombre del Grupo de trabajo «Futuro de la Medicina Interna» (FIMI)","doi":"10.1016/j.rce.2026.502572","DOIUrl":"10.1016/j.rce.2026.502572","url":null,"abstract":"<div><div>The International Forum of Internal Medicine (FIMI) presents a position paper that analyzes the current state and projects the future of Internal Medicine in a global context marked by population aging, multimorbidity, fragmentation of health systems, and rapid technological transformation. The document emerged from a collaborative process involving 52 scientific societies from 43 countries, with representation from all five continents. Drawing on Ibero-American research and the consensus of international leaders, it describes the central role of the internist in comprehensive, longitudinal, and person-centered care for adults, particularly those with complex conditions. Key strengths are identified, including integrative clinical reasoning and interdisciplinary coordination, alongside persistent weaknesses such as heterogeneity in training, adverse working conditions, and professional burnout. The challenges and opportunities posed by telemedicine, point-of-care ultrasound, and artificial intelligence are also examined. Finally, a structured Improvement Plan is proposed, encompassing clinical care, education, research, management, and professional well-being.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502572"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146571","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 elevación de cetonas durante el tratamiento con inhibidores de SGLT2 está impulsada por la enfermedad aguda más que por la indicación terapéutica","authors":"M. Constanti ,&nbsp;V. Liakopoulos ,&nbsp;K. Kotsa ,&nbsp;T. Koufakis","doi":"10.1016/j.rce.2026.502565","DOIUrl":"10.1016/j.rce.2026.502565","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502565"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146575","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":"Utilidad pronóstica de los índices FIB-4 y FIB-5 en pacientes hospitalizados por insuficiencia cardíaca aguda. Análisis del registro RICA-2","authors":"G. Ropero-Luis ,&nbsp;M. Méndez-Bailón ,&nbsp;R. Ruiz-Hueso ,&nbsp;A. Armengou ,&nbsp;P. Llácer ,&nbsp;M. Yebra-Yebra ,&nbsp;D. Chivite ,&nbsp;M. Sánchez-Marteles ,&nbsp;J. Pérez-Silvestre ,&nbsp;J.C. Trullàs ,&nbsp;en representación de los investigadores del registro RICA-2 (anexo A)","doi":"10.1016/j.rce.2026.502547","DOIUrl":"10.1016/j.rce.2026.502547","url":null,"abstract":"<div><h3>Background</h3><div>Acute heart failure (AHF) is a leading cause of hospitalization in elderly patients with multiple comorbidities. Hepatic congestion reflects hemodynamic severity and prognosis, but its clinical assessment is limited. The noninvasive serum indices FIB-4 and FIB-5, originally developed in hepatology to estimate liver fibrosis, may provide prognostic information in AHF.</div></div><div><h3>Methods</h3><div>We conducted a prospective analysis of patients hospitalized for AHF included in the RICA-2 registry (December 2022-May 2025). FIB-4 and FIB-5 indices were calculated from routine clinical and laboratory variables. Associations with baseline characteristics, echocardiographic parameters, and short-term mortality (in-hospital or 30-day) were evaluated using univariate, multivariate, and penalized regression models, as well as survival analyses and ROC curves.</div></div><div><h3>Results</h3><div>A total of 401 patients with FIB-4 and 326 with FIB-5 were included (median age 83 years; high comorbidity burden). Median values were 2.12 for FIB-4 and −1.23 for FIB-5. High-risk subgroups showed worse renal function, elevated NT-proBNP, and right ventricular dysfunction. In penalized regression, FIB-4 was associated with higher pulmonary artery systolic pressure, lower TAPSE, and higher NT-proBNP; FIB-5 showed no consistent predictors. In-hospital and thirty-day mortality was higher in the high-risk FIB-5 subgroup (HR 7.3; p<!--> <!-->=<!--> <!-->0.03 log-rank). Both indices demonstrated moderate prognostic discrimination (AUC<!--> <!-->≈<!--> <!-->0.7).</div></div><div><h3>Conclusions</h3><div>In elderly patients hospitalized for AHF, FIB-4 and FIB-5 are simple and inexpensive prognostic tools. FIB-5 identified patients at higher short-term mortality risk, whereas FIB-4 correlated with markers of congestion and right ventricular dysfunction. These indices may complement risk stratification but require validation in larger cohorts.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502547"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146569","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":"Impacto de la semaglutida oral sobre los marcadores inflamatorios en los pacientes de alto riesgo cardiovascular en vida real","authors":"S. Mariscal Vázquez ,&nbsp;C. Jiménez-Méndez ,&nbsp;A. Pérez Asensio ,&nbsp;E. Silva ,&nbsp;P. Rodríguez Delgado ,&nbsp;L. García Fernández ,&nbsp;M.R. Bulo Concellón ,&nbsp;J.A. Panera de la Mano ,&nbsp;A. Garrido Vital ,&nbsp;G. Calle Pérez","doi":"10.1016/j.rce.2026.502562","DOIUrl":"10.1016/j.rce.2026.502562","url":null,"abstract":"<div><h3>Background and objective</h3><div>Inflammation plays a central role in the pathophysiology of atherosclerosis and contributes to residual cardiovascular risk (CVR). High-sensitivity C-reactive protein (hs-CRP) and fibrinogen are considered key biomarkers in this context. Although GLP-1 receptor agonists have demonstrated anti-inflammatory effects, real-world evidence on oral semaglutide is limited. The objective of this study was to evaluate the impact of oral semaglutide on inflammatory markers in patients with high cardiovascular risk (CVR) in routine clinical practice.</div></div><div><h3>Materials and methods</h3><div>This was an observational study that included adult patients receiving treatment with oral semaglutide. The primary endpoint was the change in hs-CRP and fibrinogen levels. Secondary objectives included evaluating modifications in glycated hemoglobin, safety, and predictors of sustained anti-inflammatory response, defined as hs-CRP<!--> <!-->≤<!--> <!-->2<!--> <!-->mg/l.</div></div><div><h3>Results</h3><div>A total of 164 patients were included (mean age 68<!--> <!-->±<!--> <!-->9 years; 37.6% women). After a mean follow-up of 370<!--> <!-->±<!--> <!-->42 days, hs-CRP decreased from 6.7<!--> <!-->±<!--> <!-->9.1 to 2.9<!--> <!-->±<!--> <!-->6.1<!--> <!-->mg/l (<em>P</em>&lt;.001) and fibrinogen decreased from 428<!--> <!-->±<!--> <!-->130 to 370<!--> <!-->±<!--> <!-->113<!--> <!-->mg/dl (<em>P</em>&lt;.001). Sixty percent (60%) achieved hs-CRP<!--> <!-->≤<!--> <!-->2<!--> <!-->mg/l, with a favourable safety profile. In multivariate analysis, baseline hs-CRP and continuity of semaglutide treatment emerged as independent predictors of hs-CRP<!--> <!-->≤<!--> <!-->2<!--> <!-->mg/l.</div></div><div><h3>Conclusions</h3><div>Under real-world conditions, treatment with oral semaglutide significantly reduced hs-CRP and fibrinogen levels in patients with high CVR. This effect may help to explain the cardiovascular benefit observed in clinical trials.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502562"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146572","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":"Fiebre de origen desconocido","authors":"A. Rosales-Castillo,&nbsp;S. Igartua Urzelai,&nbsp;I. Gallego Romero","doi":"10.1016/j.rce.2026.502568","DOIUrl":"10.1016/j.rce.2026.502568","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502568"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146573","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":"Psoriasis ostrácea generalizada","authors":"J.C. Salas-Alanís ,&nbsp;P. Martínez-Fernández ,&nbsp;G. Rivera-Silva","doi":"10.1016/j.rce.2026.502570","DOIUrl":"10.1016/j.rce.2026.502570","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502570"},"PeriodicalIF":1.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146660","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 escorbuto olvidado: relación entre la toma crónica de corticoide y el metabolismo de la vitamina C","authors":"Eugenia López-Sanchez,&nbsp;Dolores Rico-Lopez,&nbsp;Alberto Ortiz-Parra","doi":"10.1016/j.rce.2026.502537","DOIUrl":"10.1016/j.rce.2026.502537","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502537"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757070","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":"Prevalencia de EPOC y tabaquismo en España: un estudio ecológico por comunidades autónomas, 2023","authors":"F.M. Escandell Rico ,&nbsp;L. Pérez Fernández","doi":"10.1016/j.rce.2026.502524","DOIUrl":"10.1016/j.rce.2026.502524","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the reported prevalence of chronic obstructive pulmonary disease (COPD) and daily tobacco use in the adult population of Spain during 2023, considering differences by sex and autonomous community. As a secondary objective, the ecological association between both indicators was explored at the regional level, without assuming individual-level causal relationships.</div></div><div><h3>Methods</h3><div>A cross-sectional ecological analytical study was conducted using aggregated data at the autonomous community level. The reported prevalence of COPD was obtained from the Primary Care Clinical Database, while the prevalence of smoking was obtained from the Spanish National Health Survey and the European Health Survey. Seventeen autonomous communities were analyzed, stratified by sex. Means, ranges, and standard deviations were calculated, and the relationship between both indicators was evaluated using correlational analyses (Pearson and Spearman) and simple linear regression models.</div></div><div><h3>Results</h3><div>The reported prevalence of COPD was 3.56% at the national level, with a higher prevalence in men (4.75%) than in women (2.47%). The prevalence of daily tobacco use was 16.64%, with a male predominance (20.22%). A positive relationship was observed between smoking and recorded COPD, more pronounced in men (r<!--> <!-->=<!--> <!-->0.52; <em>P</em> <!-->=<!--> <!-->.03) than in women (r<!--> <!-->=<!--> <!-->0.33; <em>P</em> <!-->=<!--> <!-->.17).</div></div><div><h3>Conclusions</h3><div>Although the prevalence of smoking has decreased, territorial and gender inequalities persist in the distribution of COPD and smoking. It is recommended to strengthen tobacco prevention programs, improve early detection of COPD, and consider regional differences to guide evidence-based health policies.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 5","pages":"Article 502524"},"PeriodicalIF":1.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757072","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}