Revista clinica espanola最新文献

{"title":"En respuesta al artículo de Carretero Gómez J, et al. «La desnutrición en la insuficiencia cardíaca. La importancia de evaluar la congestión y la sarcopenia»","authors":"A. Gil-Rodrigo , R. Escribano-Castillo , M. Veguillas-Benito","doi":"10.1016/j.rce.2026.502513","DOIUrl":"10.1016/j.rce.2026.502513","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502513"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620683","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":"Actuación frente a la detección de rasgo falciforme (hemoglobinopatía S heterocigota) en el cribado neonatal en España","authors":"A. Gondra Sangroniz ,&nbsp;S. Payán-Pernía ,&nbsp;E.J. Bardón Cancho ,&nbsp;A. Collado Gimbert ,&nbsp;A. Ruiz Llobet ,&nbsp;M.M. Mañú Pereira ,&nbsp;E. Cela de Julián ,&nbsp;en representación del grupo de trabajo de Eritropatología de la Sociedad Española de Hematología y Oncología Pediátricas (SEHOP)","doi":"10.1016/j.rce.2026.502509","DOIUrl":"10.1016/j.rce.2026.502509","url":null,"abstract":"<div><h3>Introduction</h3><div>Since 2021, sickle cell disease (SCD) has been included in all 17 neonatal screening programmes in Spain. The carrier state for haemoglobin S (HbS) is also detected collaterally; although clinically benign, it appears to increase the risk of certain complications, with genetic counselling being the main reason for its recognition. The Red Cells Disorders Working Group of the Spanish Society of Paediatric Haematology and Oncology (SEHOP) conducted this study to examine current practices in the management of its detection.</div></div><div><h3>Materials and methods</h3><div>A survey was carried out among representatives from the reference or follow-up clinical units in each autonomous community.</div></div><div><h3>Results</h3><div>In all programmes, HbS and haemoglobin C (HbC) carrier status is reported, and most also report other structural variants (94.1%). High-performance liquid chromatography (HPLC) is the most frequently used screening method (64.7%). In most regions, testing is repeated on a second sample (82.4%), generally obtained by venepuncture and analysed by capillary electrophoresis. Families are mainly informed by the pediatrician or hematologist in the follow-up unit (76.5%). None of the regions have implemented strategies to recall carrier status at reproductive age.</div></div><div><h3>Conclusions</h3><div>Families are informed of HbS/HbC carrier status, but the approach is variable and requires review and harmonization. Obtaining a second venous sample in carriers is considered excessive according to international consensus.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502509"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620731","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":"Síndrome postembolia pulmonar: una revisión narrativa práctica","authors":"C.M. Oblitas ,&nbsp;L. Barrera-López ,&nbsp;F. Galeano-Valle ,&nbsp;P. Demelo-Rodríguez","doi":"10.1016/j.rce.2026.502497","DOIUrl":"10.1016/j.rce.2026.502497","url":null,"abstract":"<div><div>Post-pulmonary embolism syndrome (SPEP) describes the spectrum of long-term sequelae following acute pulmonary embolism (PE), including persistent dyspnea, exercise intolerance, and psychological impairment, often in the absence of pulmonary hypertension (PH) or right ventricular (RV) abnormalities. Persistent RV dysfunction occurs in up to 18% of patients beyond three months and is associated with recurrent venous thromboembolism (VTE) and PE-related mortality. The FOCUS study introduced the concept of post-PE impairment (DPEP), defined by a combination of echocardiographic RV dysfunction and clinical or functional deterioration, which predicted higher mortality, rehospitalization rates, and impaired quality of life. Chronic thromboembolic disease (CTED) refers to symptomatic patients with residual perfusion defects but without PH. In contrast, chronic thromboembolic pulmonary hypertension (HPTEC) is defined by pre-capillary PH in the presence of residual obstruction, with a cumulative incidence of 0.5-4% within two years. Prognosis in HPTEC is driven primarily by RV dysfunction, but advances in multimodal therapies—surgical, interventional, and pharmacological—have improved survival, underscoring the importance of early recognition and systematic follow-up.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502497"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620735","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":"Crisis de favismo tras inicio de tratamiento con roflumilast","authors":"A. Arapiles-Muñoz","doi":"10.1016/j.rce.2026.502511","DOIUrl":"10.1016/j.rce.2026.502511","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 4","pages":"Article 502511"},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147620681","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":"Respuesta a: ¿Inicio de inhibidores del cotransportador de sodio-glucosa tipo 2 (iSGLT2) en pacientes con insuficiencia cardíaca aguda en urgencias?","authors":"P. Llorens","doi":"10.1016/j.rce.2026.502484","DOIUrl":"10.1016/j.rce.2026.502484","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502484"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429084","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":"Determinantes sociales de la salud: una prioridad para la medicina interna. Documento de posicionamiento de la Sociedad Española de Medicina Interna (SEMI) y la Sociedad Portuguesa de Medicina Interna (SPMI)","authors":"M.M. Chimeno ,&nbsp;L. Duarte Costa ,&nbsp;V. Barreto ,&nbsp;J.L. Bianchi ,&nbsp;L. Campos ,&nbsp;J. Araújo Correia ,&nbsp;J. Moreno Díaz ,&nbsp;J.M. Porcel ,&nbsp;J. Porto ,&nbsp;L. Santos ,&nbsp;P. Pérez-Martínez","doi":"10.1016/j.rce.2026.502468","DOIUrl":"10.1016/j.rce.2026.502468","url":null,"abstract":"<div><h3>Introduction</h3><div>Internal medicine, owing to its comprehensive and cross-sectional approach, is uniquely positioned to lead the integration of social determinants of health (SDOH) into clinical practice.</div></div><div><h3>Methods</h3><div>Based on the Delphi methodology promoted by the Spanish Society of Internal Medicine (SEMI) and the Portuguese Society of Internal Medicine (SPMI), this study explored perceptions, barriers, and strategies for integrating SDOH into hospital care. Experts from both countries participated in a two-round consultation process, followed by a consensus meeting, which resulted in a prioritized roadmap of action.</div></div><div><h3>Results</h3><div>Our findings show strong agreement on the relevance of SDOH for health outcomes, the need for mandatory and transversal training at all educational levels, and the importance of validated tools for systematic screening. Key barriers include lack of time, insufficient specific training, limited human resources, and the absence of structured SDOH data in electronic health records. Additionally, the results emphasize the importance of interdisciplinary teams, coordination with social services, and adapting care pathways to patients’ social contexts. Emerging determinants include population aging, mental health, climate change, and digital transformation, including artificial intelligence.</div></div><div><h3>Conclusions</h3><div>This decalogue provides a practical and prioritized roadmap to transform Internal Medicine care towards a more equitable, comprehensive, and SDOH-sensitive model, with training, service organization, technological resources, and collaboration as fundamental pillars.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502468"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429079","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":"Evolución de las alteraciones radiológicas en los pacientes no vacunados con neumonía por COVID-19 y predicción del desarrollo de fibrosis pulmonar a los 6 meses según un modelo predictivo","authors":"S. Cuenca Peris ,&nbsp;M. Marín Royo ,&nbsp;S.F. Marco Domenech","doi":"10.1016/j.rce.2026.502488","DOIUrl":"10.1016/j.rce.2026.502488","url":null,"abstract":"<div><h3>Introduction</h3><div>Alteration in pulmonary function tests and radiological abnormalities are present in a significant percentage of COVID-19 survivors. Our aim is to evaluate radiological findings and functional respiratory parameters involved in lung fibrosis at six months after SARS-CoV-2 pneumonia and use initial score of the predictive model to predict fibrotic-like changes at 6 months.</div></div><div><h3>Material and methods</h3><div>Prospective observational study including unvaccinated patients with COVID-19 pneumonia. Pulmonary function tests and chest CT were performed six months after acute pneumonia.</div></div><div><h3>Results</h3><div>One hundred nine patients were included. Bilateral ground-glass opacities (94%) were the most frequent radiological finding, followed by bilateral consolidations (36%) and crazy paving patterns (28%). Ct tracking shows a significant decrease in bilateral ground glass, consolidations and bilateral crazy paving at 6 months. In contrast, architectural distortion tends to increase over time. The presence of bronchial dilatation, subpleural curved line and parenchymal bands on initial CT were associated with radiological signs of lung fibrosis at 6 months. An initial score of the predictive model &gt;<!--> <!-->0.6 predicts fibrotic-like changes at 6 months (AUC: 77.8%; Specificity: 85.4%; Sensitivity: 58.1%). The proportion of patients with DLCO<!--> <!-->&lt;<!--> <!-->80% was 55%.</div></div><div><h3>Conclusions</h3><div>In 50 patients, 6 months CT detected signs of fibrotic-like changes. The presence of bronchial dilatation, subpleural curved line and parenchymal bands could be used as early predictors of fibrotic-like changes in patients with COVID-19 pneumonia. Initial score of the predictive model<!--> <!-->&gt; 0,6 allows the selection of patients at risk of developing pulmonary fibrotic-like changes. DLCO was the one most frequently impaired at 6 months.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502488"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429080","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 nivel educativo como modulador de la relación entre índice de masa corporal, presión arterial y síntomas depresivos en población peruana: un análisis de mediación moderada","authors":"A. Guevara-Tirado","doi":"10.1016/j.rce.2026.502473","DOIUrl":"10.1016/j.rce.2026.502473","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze whether systolic blood pressure influences the relationship between body mass index and depressive symptoms, and whether educational level moderates these associations in Peruvian adults.</div></div><div><h3>Methods</h3><div>Cross-sectional study using data from the Peruvian Demographic and Health Survey (ENDES). Individuals aged ≥15 years were included. Depression was assessed with the PHQ-9 (continuous score); BMI and SBP were treated as continuous variables. A moderated mediation model (PROCESS model 59) was applied, adjusting for alcohol consumption, age, mother tongue, ethnic identity, and marital status.</div></div><div><h3>Results</h3><div>In the moderated analysis, BMI showed a positive association with SBP (B<!--> <!-->=<!--> <!-->0.61; 95% <span>C</span>I: 0.57–0.66), with a stronger effect in individuals with higher education (B<!--> <!-->=<!--> <!-->0.81) compared to those with basic education (B<!--> <!-->=<!--> <!-->0.61). Alcohol consumption (B<!--> <!-->=<!--> <!-->1.20), speaking an indigenous mother tongue (B<!--> <!-->=<!--> <!-->1.26), and age (B<!--> <!-->=<!--> <!-->0.42 per year) were associated with higher SBP, while living with a partner was protective (B<!--> <!-->=<!--> <!--> <!-->−<!--> <!-->2.05). In the model for depressive symptoms, BMI (B<!--> <!-->=<!--> <!-->0.04) and SBP (B<!--> <!-->=<!--> <!-->0.02) increased PHQ-9 scores; the effect of SBP was greater among higher-educated individuals (B<!--> <!-->=<!--> <!-->0.036) than those with basic education (B<!--> <!-->=<!--> <!-->0.022). The moderated mediation showed that the indirect component via SBP was higher in individuals with higher education (B<!--> <!-->=<!--> <!-->0.081) than in those with basic education (B<!--> <!-->=<!--> <!-->0.035), with a moderated mediation index of 0.040 (95% CI: 0.028–0.052).</div></div><div><h3>Conclusions</h3><div>Educational level modulates the relationship between BMI, blood pressure, and depression, highlighting health inequalities that can inform public health strategies and prevention policies.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502473"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147428021","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":"Un caso raro de linfangioma quístico del cuello en un paciente adulto","authors":"M. Colangeli ,&nbsp;M. Palmas ,&nbsp;P. Spinnato","doi":"10.1016/j.rce.2026.502490","DOIUrl":"10.1016/j.rce.2026.502490","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502490"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429082","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":"Situación actual y papel de los internistas en los comités de ética asistencial en España. Estudio PANACEAS","authors":"P. Durán del Campo ,&nbsp;G. Solano Iturri ,&nbsp;B. Alonso Ortiz ,&nbsp;J. Bertran Muñoz ,&nbsp;A.M. Bravo Blanco ,&nbsp;L. Briongos Figuero ,&nbsp;C. Carrera García ,&nbsp;A.D. Chacón Moreno ,&nbsp;A. Blanco Portillo ,&nbsp;J.M. Galván-Román ,&nbsp;como miembros del Grupo de Trabajo de Bioética y Profesionalismo de la Sociedad Española de Medicina Interna","doi":"10.1016/j.rce.2026.502483","DOIUrl":"10.1016/j.rce.2026.502483","url":null,"abstract":"<div><h3>Objectives</h3><div>To analyze the current situation of Healthcare Ethics Committees (HECs) in Spain, their composition and functions, as well as the implementation of Clinical Ethics Consultancy (CEC). Finally, to assess the involvement of internists in HECs.</div></div><div><h3>Materials and methods</h3><div>A cross-sectional descriptive study conducted through a self-administered online survey distributed between February and May 2025 to all identified HECs in the country.</div></div><div><h3>Results</h3><div>A total of 112 HECs (47.66%) out of the 235 accredited nationwide participated. The average number of members per committee was 16 (range: 6-29). The most represented professional profiles were nursing and medicine. In 99.1% of the committees, at least one member had postgraduate training in Bioethics. The most frequent range of meetings per year was between 7 and 12 (46.8%). Most HECs (91.1%) were involved in educational activities, and 58% had produced ethical documents. The majority reviewed between 1 and 5 cases annually (69.6%). The CEC role was established in 40.2% of HECs and in the process of implementation in 18.8%. Internists were present in 54% of HECs. In 65% of cases, the internist is part of the CEC.</div></div><div><h3>Conclusions</h3><div>HECs in Spain demonstrate significant involvement in educational activities and the development of ethical documents; however, they receive a relatively low number of annual consultations. CEC is gradually being integrated into the structure of HECs, which may enhance the management of ethical inquiries. Internists are members of more than half of the HECs and play a very active role in their operations.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502483"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147428019","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}