Revista clinica espanola最新文献

{"title":"Tratamiento basal con betabloqueantes e inhibidores del sistema renina angiotensina y su asociación con eventos adversos en insuficiencia cardíaca aguda","authors":"A. Haro ,&nbsp;J. Jacob ,&nbsp;X. Rossello ,&nbsp;A. Alquézar-Arbe ,&nbsp;P. Llorens ,&nbsp;Ò. Miró ,&nbsp;en representación del grupo Icasemes","doi":"10.1016/j.rce.2026.502487","DOIUrl":"10.1016/j.rce.2026.502487","url":null,"abstract":"<div><h3>Introduction</h3><div>Baseline treatment with beta-blockers (BB) and/or renin-angiotensin system inhibitors (RASi) has been extensively studied in the context of heart failure, given its fundamental role in modulating the neurohormonal axis and improving survival.</div></div><div><h3>Objective</h3><div>To investigate whether there is an association between receiving baseline treatment with BB or RASi, either alone or in combination, and the short-term prognosis of an episode of acute heart failure (AHF).</div></div><div><h3>Method</h3><div>Patients from the EAHFE registry (Epidemiology of Acute Heart Failure in Spanish Emergency Departments) were analyzed. This is a multicenter, prospective, multipurpose registry that collects all AHF episodes presenting to participating hospital emergency departments over a period of 1 to 2 months between 2007 and 2018. The primary outcome variable investigated was in-hospital all-cause mortality during the emergency departments stay or hospitalization. Adjusted analyses were conducted using multiple logistic regression and multiple imputation to control for potential confounding factors.</div></div><div><h3>Results</h3><div>The study included a total of 17,916 episodes of AHF. A total of 26.2% of patients did not receive treatment with either BB or RASi, constituting the reference group. Overall, 17.8% of patients received BB only, 30.4% were treated exclusively with RASi, and 25.7% received a combination of both drugs. The mean age of the patients was 80.4 years (standard deviation 10.2 years), and 55.7% were women. In-hospital mortality was 7.3%. After multivariable adjustment, a significant association with lower mortality was found for treatment with BB alone (odds ratio [OR]<!--> <!-->=<!--> <!-->0.826, 95% confidence interval [CI]: 0.685-0.996), OR<!--> <!-->=<!--> <!-->0.709 (95%CI: 0.600-0.837) RASi alone and for combined treatment with RASi and BB (OR<!--> <!-->=<!--> <!-->0.699, 95%CI: 0.580-0.843). In the adjusted model with multiple imputation, the results remained significant.</div></div><div><h3>Conclusions</h3><div>In patients with an episode of AHF, baseline treatment with BB, RASi, or both is associated with lower all-cause mortality. This association is strongest in the group of patients receiving both treatments combined, and the results remain significant after multivariate adjustment.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502487"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429078","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":"¿Inicio de inhibidores del cotransportador de sodio-glucosa tipo 2 (iSGLT2) en pacientes con insuficiencia cardiaca aguda en urgencias?","authors":"P. Herrero-Puente ,&nbsp;Á. González Franco","doi":"10.1016/j.rce.2026.502470","DOIUrl":"10.1016/j.rce.2026.502470","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502470"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429085","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":"Metodología GRADE en los consensos y guías de práctica clínica para el manejo de la oclusión venosa retiniana","authors":"C. Burgueño-Montañes ,&nbsp;R. Bouchikh-El Jarroudi ,&nbsp;M. Zavaleta-Mercado ,&nbsp;J. Galvez-Olortegui","doi":"10.1016/j.rce.2026.502469","DOIUrl":"10.1016/j.rce.2026.502469","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502469"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429083","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":"Consultas en urgencias de los pacientes mayores que viven con VIH: una aproximación a partir del registro EDEN","authors":"Ò. Miró ,&nbsp;L. Sentís ,&nbsp;M. Carbó ,&nbsp;E. Miró ,&nbsp;D. Mérida ,&nbsp;J. González del Castillo ,&nbsp;(en representación del grupo SIESTA)","doi":"10.1016/j.rce.2026.502474","DOIUrl":"10.1016/j.rce.2026.502474","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the incidence, sociodemographic characteristics, baseline status and evolution of elderly people living with Human immunodeficiency virus (HIV) infection (PLHIV) attended in Spanish hospital emergency departments (ED).</div></div><div><h3>Methods</h3><div>Patients included in the EDEN (Emergency Department and Elder Needs) registry, which includes all patients aged 65 or older attended in 52 Spanish EDs during 7 consecutive days in 2019, were analyzed. Two groups were constructed according to whether or not they had known HIV infection (PLHIV and non-LHIV). We collected 6 sociodemographic factors and 8 referring to the patient's baseline situation. We recorded whether the episode of ED care required hospitalization, intensive care unit (ICU) admission, prolonged ED and inpatient stay, and in-hospital mortality, as well as reconsultation to the ED, rehospitalization, and death from any cause during the 3 years after discharge. The sociodemographic and baseline characteristics and the evolution of patients in the PLHIV and non-PLHIV groups were compared.</div></div><div><h3>Results</h3><div>Of 25,557 patients in the EDEN registry, 78 were PLHIV (0.30%, 95% CI 0.24% to 0.38%). The annual ED frequentation rate of PLHIV and non-PVHIV was 811 and 573 per 1000 population, respectively. The sociodemographic and baseline conditions were similar between PLHIV and non-PLHIV, with only age differing (younger PLHIV). Older PLHIV had severe comorbidity (27%), some type of functional limitation (27%) and cognitive impairment (11%). The most frequent ED diagnoses in PLHIV were pneumonia or lower respiratory tract infection (11%), heart failure or cardiogenic <em>shock</em> (8%) and joint and axial pain (6%), and in the non-HIV group there were no new diagnoses of HIV infection. 24.4% of PLHIV were hospitalized, 27.3% had a prolonged stay in the ED, 50% had prolonged hospitalization, 7.7% had in-hospital mortality, and reconsultation to the ED, hospitalization, and death during the 3 years post-discharge were 67%, 45.6%, and 21.7%, respectively. No outcome differed between PLHIV and non-PLHIV.</div></div><div><h3>Conclusion</h3><div>Older PLHIV have sociodemographic and baseline characteristics like the general population, but their rate of ED visits is higher. The severity of the episodes leading to this ED consultation is similar between PLHIV and non-PLHIV and long-term follow-up also shows no differences.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502474"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147428022","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 efecto de la edad en la precisión de los criterios de Light","authors":"W.-Q. Zheng ,&nbsp;S. Bielsa ,&nbsp;Y. Niu ,&nbsp;J.-X. Wen ,&nbsp;L. Yan ,&nbsp;Z.-D. Hu ,&nbsp;J.M. Porcel","doi":"10.1016/j.rce.2026.502486","DOIUrl":"10.1016/j.rce.2026.502486","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to investigate the effects of age on the sensitivity, specificity, and accuracy of Light's criteria to differentiate exudative from transudative pleural effusion.</div></div><div><h3>Methods</h3><div>A testing cohort from China and a validation cohort from Spain were used for data analysis. The testing cohort included 302 patients (59 transudates and 243 exudates) with undiagnosed pleural effusion. The validation cohort comprised 400 patients (200 transudates and 200 exudates) divided into two groups according to age (200 patients aged 50-65<!--> <!-->years and 200 patients aged 80-95<!--> <!-->years). The effects of age on the sensitivity, specificity, and accuracy of Light's criteria were determined by sampling patients with different age limits.</div></div><div><h3>Results</h3><div>In the testing cohort, the sensitivity and specificity of Light's criteria for exudate were 0.91 and 0.73, respectively. In the validation cohort, the sensitivity was 0.99 and 0.97, and the specificity of Light's criteria for exudate was 0.73 and 0.68, respectively, by age group. The diagnostic accuracy metrics (sensitivity, specificity, and accuracy) of Light's criteria and its items tended to decrease with age.</div></div><div><h3>Conclusion</h3><div>Age should be considered when interpreting the Light's criteria.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502486"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429076","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: Metodología GRADE en los consensos y guías de práctica clínica para el manejo de la oclusión venosa retiniana","authors":"J. Pagán Escribano","doi":"10.1016/j.rce.2026.502482","DOIUrl":"10.1016/j.rce.2026.502482","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502482"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429081","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 procalcitonina y la región medial de la proadrenomedulina (MR-proADM) podrían ayudar a hacer más segura la hospitalización a domicilio de los pacientes atendidos en urgencias por sospecha de infección","authors":"J. Cabañas Morafraile ,&nbsp;L. Serrano Martín ,&nbsp;E. de Rafael González ,&nbsp;A. Julián-Jiménez ,&nbsp;en nombre del grupo URGEN-LABQMIC del CHUT del Instituto de Investigación Sanitaria de Castilla La Mancha (IDISCAM)","doi":"10.1016/j.rce.2026.502472","DOIUrl":"10.1016/j.rce.2026.502472","url":null,"abstract":"","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502472"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147428020","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":"Insuficiencia cardíaca con fracción de eyección preservada: actualización en estrategias diagnósticas y terapéuticas. Documento de consenso de la SEMI","authors":"J.M. Fernández Rodríguez ,&nbsp;M.B. Alonso-Ortíz ,&nbsp;J. Casado Cerrada ,&nbsp;D. Chivite Guillen ,&nbsp;P. Cubo Romano ,&nbsp;R. García Alonso ,&nbsp;A. Lorenzo Almorós ,&nbsp;J.P. Miramontes-González ,&nbsp;L. Soler Rangel ,&nbsp;J. Pérez-Silvestre","doi":"10.1016/j.rce.2026.502471","DOIUrl":"10.1016/j.rce.2026.502471","url":null,"abstract":"<div><div>Heart failure (HF) is associated with high morbidity and mortality. HF with preserved left ventricular ejection fraction (HF-pEF) accounts for up to 50% of all HF cases, being the most common in elderly patients. In addition, these subjects frequently present other comorbidities. For all these reasons, the diagnosis of patients with HF-pEF is complex and requires a careful approach. In addition, there are «secondary» or HF-pEF forms that must also be discarded. The treatment of HF-pEF has evolved very significantly in recent years due to evidence from clinical trials. Until a few years ago, the management was based on the treatment of congestive symptoms with diuretics and comorbidities, to this was added the indication of treatment with SGLT2 inhibitors, after being shown to reduce hospitalizations due to HF, and more recently new evidence of clinical benefit with other drugs such as finerenone, semaglutide or tirzepatide has been published. All this makes it necessary to update the recommendations regarding the management of patients with HF-pEF.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 3","pages":"Article 502471"},"PeriodicalIF":1.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147428017","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":"Asociación entre síndromes de Ehlers-Danlos y síndrome de activación mastocitaria. ¿Existe evidencia científica?","authors":"J.A. Cuenca-Gómez ,&nbsp;M.S. Dawid-Milner ,&nbsp;R. Sánchez-Martínez","doi":"10.1016/j.rce.2025.502457","DOIUrl":"10.1016/j.rce.2025.502457","url":null,"abstract":"<div><div>Ehlers-Danlos Syndromes (EDS) are hereditary connective tissue disorders that affect multiple systems. Mast Cell Activation Syndrome (MCAS) is a clinical condition characterized by chronic and aberrant activation of mast cells. This activation leads to the release of chemical mediators that cause a wide variety of symptoms across multiple organ systems. Both conditions share phenotypic similarities, particularly in symptoms associated with dysautonomia and immune-mediated manifestations.</div><div>Various studies have linked both disorders at the pathophysiological and clinical levels. For example, pathophysiologically, the close and bidirectional interaction between fibroblasts and mast cells in the extracellular matrix has been highlighted; clinically, there is a high prevalence of MCAS-related symptoms in patients with EDS, especially the hypermobile type. In recent years, emerging evidence also points to a potential molecular association.</div><div>The objective of this review is to evaluate the scientific evidence that exists between these two syndromes, at the pathophysiological, molecular and clinical levels.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502457"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102552","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 de los problemas sociales para el alta en hospitalización de agudos","authors":"A. Jiménez-Puente ,&nbsp;M.D. Martín-Escalante ,&nbsp;M. Noureddine-López ,&nbsp;F. Rivas-Ruiz ,&nbsp;A. Rubio-Gallo","doi":"10.1016/j.rce.2025.502456","DOIUrl":"10.1016/j.rce.2025.502456","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients who remain hospitalized due to the absence of adequate social support for discharge represent a growing challenge in an aging society where traditional family care networks are increasingly weakened.</div></div><div><h3>Methods</h3><div>We conducted a study in an acute care hospital in southern Spain, focusing on inpatients referred to the Social Work Department in whom social problems were identified as barriers to discharge (SPD). Data were reviewed from 2006 onwards, as well as across two 24-month periods: before and after the COVID-19 pandemic.</div></div><div><h3>Results</h3><div>2288 discharges with SPD were analyzed. From 2006 to 2024, the number of beds occupied by patients with SPD increased by an average of 0.62<!--> <!-->beds per day each year. The rise was particularly marked in 2022 and 2024, when 1.3% of all hospital discharges were delayed due to SPD, equivalent to 11<!--> <!-->beds occupied daily. Internal Medicine was the specialty with the highest proportion of patients with SPD: 4%.</div></div><div><h3>Conclusions</h3><div>Hospital stays prolonged by social problems represent a substantial burden and show a clear upward trend. The underlying causes are multifactorial, mainly related to social circumstances and the clinical complexity of patients.</div></div>","PeriodicalId":21223,"journal":{"name":"Revista clinica espanola","volume":"226 2","pages":"Article 502456"},"PeriodicalIF":1.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146102606","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}