Revista clinica espanola最新文献

{"title":"Ultrasound of the salivary glands in Sjögren's syndrome: a narrative review of its diagnostic and prognostic utility and clinical role.","authors":"J A Peregrina Rivas, S Rodríguez Suárez, A Benavente Fernández, J Hernández Quero, J Salvatierra","doi":"10.1016/j.rceng.2026.502623","DOIUrl":"10.1016/j.rceng.2026.502623","url":null,"abstract":"<p><p>Sjögren's Disease (SjD) is a systemic autoimmune disease whose classification criteria include a minor salivary gland biopsy (MSGB), an invasive procedure. Salivary gland ultrasound (SGUS) has emerged as a non-invasive, accessible and reliable tool for the evaluation of SjD. This narrative review analyses the evolution of SGUS, from the first scoring systems to the current consensus of the OMERACT group, which has enabled standardisation of the evaluation. The evidence on the diagnostic accuracy of SGUS, its correlation with MSGB and autoantibodies, and its ability to predict patient classification according to the 2016 ACR/EULAR criteria are analysed. In selected patients, SGUS may reduce the need for minor salivary gland biopsy, particularly in those positive for anti-Ro/SSA antibodies. In addition, it explores its potential role in prognostic stratification, lymphoma prediction, and treatment response monitoring, proposing an algorithm for its integration into daily clinical practice.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502623"},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SEMI 2026 standards for internal medicine departments: Organization, healthcare processes and quality of care.","authors":"M M Chimeno Viñas, J M Porcel, P Pérez Martínez, J L Bianchi Llave, J Moreno Díaz, E Casariego-Vales, F J Elola-Somoza","doi":"10.1016/j.rceng.2026.502622","DOIUrl":"10.1016/j.rceng.2026.502622","url":null,"abstract":"<p><p>In 2025, the Spanish Society of Internal Medicine (SEMI) updated the standards for the organization and operation of Internal Medicine Departments (IMDs) originally published in 2016. The revision was conducted using an expert consensus methodology based on a literature review, the participation of a Steering Committee and an Extended Committee of internists, and successive Delphi rounds for the development and validation of the proposals. The update focused on the key clinical and strategic processes of IMDs, incorporating the changes that have occurred in healthcare organization over the last decade. The main innovations include the incorporation of hospital-at-home as a consolidated model of care, the further development of non-face-to-face ambulatory care, the specific focus on patients with complex chronic conditions, the reinforcement of person-centred care, and the proposal of performance dashboards to support the evaluation of clinical activity and healthcare outcomes.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502622"},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary embolism: what does the new AHA/ACC 2026 guide add","authors":"Winnifer Briceño,&nbsp;David Jiménez","doi":"10.1016/j.rceng.2026.502610","DOIUrl":"10.1016/j.rceng.2026.502610","url":null,"abstract":"<div><div>Recently, the 2026 American Heart Association (<strong>AHA</strong>)/American College of Cardiology (<strong>ACC</strong>)/American College of Chest Physicians/American College of Chest Physicians/Society for Cardiovascular Angiography and Interventions/Society of Hospital Medicine/Society of Interventional Radiology/Society of Vascular Medicine/Society for Vascular Nursing Guideline for Evaluation and Management of Acute Pulmonary Embolism in Adults (AHA/ACC Acute PE Guideline) has been published. We aimed to critically evaluate the most significant sections of the guidelines. The new risk classification provides granularity, although the new categories require validation. We concur with the guidelines' recommendations regarding the use of low-molecular-weight heparins (parenteral treatment) and direct oral anticoagulants (oral treatment) as the preferred anticoagulants for the vast majority of patients with acute PE. Finally, the guidelines suggest reperfusion therapies for scenarios that currently lack robust scientific evidence; therefore, the results of ongoing clinical trials must be awaited to determine their precise indications.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502610"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for the development of in-hospital complications in pluripathological patients","authors":"Y. Jamal-Ismail Ortiz,&nbsp;S. García-Gutiérrez,&nbsp;A. Renom-Guiteras,&nbsp;J.E. Ternero-Vega,&nbsp;M.J Legarreta-Olabarrieta,&nbsp;D. Mestre,&nbsp;M.D. Martín-Escalante,&nbsp;R. Quirós-López,&nbsp;on behalf of RePluris working group","doi":"10.1016/j.rceng.2026.502595","DOIUrl":"10.1016/j.rceng.2026.502595","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Multimorbid patients (MP) represent a major challenge for health care systems due to their high prevalence, resource utilization, and poorer prognosis. In the hospital setting, they account for approximately one in four admissions. Although complications are common in this population, there is limited information regarding their type, frequency, impact, and associated factors. The aim of this study was to analyze in-hospital complications in multimorbid patients and their impact on health outcomes.</div></div><div><h3>Materials and Methods</h3><div>Prospective observational study conducted between February 2022 and June 2023. Multimorbid patients aged ≥18 years admitted for any reason were included after providing informed consent; patients who died during hospitalization were excluded. Variables collected included sociodemographic characteristics, comorbidities, reason for admission, multimorbidity criteria, type and frequency of complications, frailty, length of stay, readmissions, and 30-day mortality.</div></div><div><h3>Results</h3><div>A total of 535 patients were included (mean age 82.2 years); 334 (62.4%) developed at least one complication, accounting for 682 events. The most frequent were neurological (25.4%), digestive (19%), hematological (16%), and cardiovascular (15.7%). Patients with complications had a longer length of stay (11.6 vs. 7.3 days; <em>P</em> &lt; .001) and higher 30-day mortality (10.5% vs. 4.5%; <em>P</em> &lt; .05). In multivariate analysis, cognitive impairment, prostate disease, VIG-Frail index &gt;0.4, anemia at admission, and hospital stay &gt;6 days were associated with increased risk (AUC 0.713; 95% CI 0.669–0.756).</div></div><div><h3>Conclusions</h3><div>In-hospital complications are common among multimorbid patients and are associated with worse outcomes. Early identification of high-risk patients may enable preventive strategies and improve outcomes in this vulnerable population.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502595"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccination status of patients undergoing HIV treatment in a hospital in Madrid","authors":"A. Alcaide-Jiménez,&nbsp;J.E. Losa,&nbsp;V. Hernández-Múgica,&nbsp;J.G. Sánchez,&nbsp;G. Rodríguez-Caravaca,&nbsp;P. Cárdenas-Soriano,&nbsp;A.M. Pedraza-Flechas","doi":"10.1016/j.rceng.2026.502597","DOIUrl":"10.1016/j.rceng.2026.502597","url":null,"abstract":"<div><h3>Introduction</h3><div>People living with HIV (PLHIV) are considered at high-risk for acquiring infections or experiencing severe disease. The Spanish Ministry of Health advises vaccination against pneumococcus, meningococcus, hepatitis A and B, tetanus, human papillomavirus (HPV), herpes zoster (HZ), varicella, and measles, mumps, and rubella (MMR) for PLHIV.</div><div>We aimed at determining the vaccination status of PLHIV on antiretroviral therapy (ART) in a hospital in Madrid in 2023.</div></div><div><h3>Methods</h3><div>Cross-sectional study in 96 PLHIV receiving ART. Vaccination status was evaluated regarding oficial reccommendations. Coverage was calculated according to schedule.</div></div><div><h3>Results</h3><div>78.1% had received at least one dose of a vaccine as part of the recommended schedule. Completed schedule was more frequent for HZ (68.75%), followed by pneumococcus (38.54%) and meningococcus (2.01%). 12.50% had received at least on dose of the HPV vaccine and 20.83% had received a diphtheria/tetanus vaccine dose within the last 10 years. Immunity to hepatitis B and A was observed in 57.30% and 56.30%, respectively. Vaccination coverage during the 2022–2023 campaign was 50% for both, COVID-19 and influenza.</div></div><div><h3>Conclusions</h3><div>Patients’ compliance with vaccination schedules was acceptable in general, and low regarding meningococcal vaccination. Patient engagement and awareness strategies are essential to promote vaccination uptake in this population.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502597"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sulfonylureas and fracture risk in patients with type 2 diabetes mellitus: a systematic review and meta-analysis","authors":"L. Xu,&nbsp;R. Yuan,&nbsp;H. Yue,&nbsp;M. Wang,&nbsp;W. Cai","doi":"10.1016/j.rceng.2026.502596","DOIUrl":"10.1016/j.rceng.2026.502596","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between sulfonylureas and fracture risk in patients with type 2 diabetes mellitus (T2DM).</div></div><div><h3>Methods</h3><div>PubMed, Web of Science, the Cochrane Library and Embase were systematically searched for observational studies evaluating sulfonylurea-associated fracture risk in patients with T2DM. Pooled relative risk (RR) and its 95% confidence interval (CI) were calculated.</div></div><div><h3>Results</h3><div>Twelve observational studies involving 5,854,139 patients were included. Sulfonylurea use was significantly associated with increased risks of overall fractures (RR = 1.28; 95% CI: 1.11–1.47) and osteoporotic fractures (RR = 1.38; 95% CI: 1.05–1.80). Site-specific analyses revealed a 23% increase in hip fracture risk (RR = 1.23; 95% CI: 1.03–1.46) and a 47% increase in vertebral fracture risk (RR = 1.47; 95% CI: 1.24–1.74). Fracture risk profiles varied across sulfonylurea subtypes.</div></div><div><h3>Conclusion</h3><div>Sulfonylureas are associated with a significant increase in the overall risk of fractures and the risk of osteoporotic fractures in patients with T2DM, and this risk is particularly prominent in hip and vertebral fractures.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502596"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training in internal medicine in the age of artificial intelligence","authors":"J. García-Alegría,&nbsp;D. Ruiz-Hidalgo,&nbsp;M. Rodríguez-Carballeira","doi":"10.1016/j.rceng.2026.502609","DOIUrl":"10.1016/j.rceng.2026.502609","url":null,"abstract":"<div><div>Artificial intelligence (AI) is transforming knowledge management in medicine, with a radical impact on training and the acquisition of professional skills. This review aims to guide and optimise the use of AI in the training of internal medicine residents, with an emphasis on the reliability of information, clinical safety, ethical considerations, the clinical process, prompt engineering, the role of simulation, training risks, shared decision-making with patients, the role of tutors, and opportunities for the speciality, all with the central premise that AI complements but does not replace clinical training.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502609"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and social trajectory and quality of life 12 months after a femoral fracture: a prospective cohort study","authors":"G. Badosa-Collell,&nbsp;E. Ruiz-Ruiz,&nbsp;J. Amblàs-Novellas,&nbsp;J.C. Trullàs","doi":"10.1016/j.rceng.2026.502608","DOIUrl":"10.1016/j.rceng.2026.502608","url":null,"abstract":"<div><h3>Introduction</h3><div>Femoral fracture (FF) is a prevalent condition associated with high morbidity and mortality. The aim of this study was to describe and analyze the factors associated with the functional and social trajectory, as well as quality of life, 12 months after FF in patients over 65 years of age.</div></div><div><h3>Materials and methods</h3><div>This is a prospective observational cohort study including patients over 65 years of age admitted for FF. Quality of life (WHOQOL-Bref), functionality (Barthel Index), and social resources were assessed at baseline and at 12 months. Descriptive, univariate, and multivariate analyses were performed to identify factors associated with functional decline and institutionalization at 12 months.</div></div><div><h3>Results</h3><div>A total of 150 patients were included (mean age 88 years; 78% women). The mean [SD] Barthel Index score at baseline and 12 months was 70 [26.1] and 57.0 [32.3], respectively (<em>p</em> &lt; 0.001), and the WHOQOL-Bref score was de 86.0 [11.9] and 83.4 [13.8], respectively (<em>p</em> = 0.005). The need for institutionalization increased from 15% at baseline to 35% at 12 months. In the multivariate analysis, the FRAGIL-VIG frailty index was independently associated with greater functional decline and increased need for institutionalization at 12 months.</div></div><div><h3>Conclusions</h3><div>The IF-VIG index is a good predictor of functional decline and risk of institutionalization 12 months after a femur fracture in the geriatric population.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 8","pages":"Article 502608"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148458341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of the Edmonton Obesity Staging System among people hospitalized with obesity.","authors":"J Ena, J Carretero Gomez, F J Sanchez Lora, M V Bonilla Hernandez, A Bustos Merlo, V Lobo-Antuña, J P Miramontes Gonzalez, P Gonzalez Gonzalez, P Nadal Gomez, C Hernández-Cerón, J M Fernandez Rodriguez, B Martinez Muriel, P Arcos Pereda, A Rodrigo Martinez","doi":"10.1016/j.rceng.2026.502619","DOIUrl":"10.1016/j.rceng.2026.502619","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a heterogeneous clinical condition whose severity is not adequately reflected by body mass index (BMI). We used the Edmonton Obesity Staging System (EOSS), which integrates obesity-related comorbidities and functional impairment, to assess the prognosis of hospitalised patients with obesity.</p><p><strong>Methods: </strong>Prospective cohort study conducted in 26 Spanish hospitals. Hospitalised individuals with a BMI > 30 kg/m² were included. We evaluated sociodemographic and anthropometric variables, comorbidities, laboratory parameters, baseline treatment and treatment prescribed at discharge, EOSS stage, and outcomes at 90 days after discharge (readmissions and mortality).</p><p><strong>Results: </strong>Of 3218 screened individuals, 496 (15.4%) were obese. The mean age was 75 years, and 50.1% were women. Most patients with obesity were classified into EOSS stages 2 (35.9%) and 3 (33.1%). Advanced stages were associated with higher comorbidity burden, worse laboratory profile (renal dysfunction, anaemia), and greater therapeutic complexity. As the EOSS stage increased, the trend analysis demonstrated a progressive increase in the risk of readmission (p = 0.026) and death (p = 0.023). In the discharge report, we recorded a significant relative increase in prescriptions of medications with cardiometabolic benefit and effect on body weight (relative increase of 33% for SGLT2 inhibitors and 11.8% for GLP-1/GLP1-GIP receptor agonists).</p><p><strong>Conclusions: </strong>The EOSS classification system applied to hospitalised patients may identify subgroups of patients with worse prognosis helping physicians to initiate specific treatment to improve health outcomes.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502619"},"PeriodicalIF":0.0,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of an extended 12-autoantibody panel in systemic sclerosis: Clinical and prognostic implications in a real-life cohort.","authors":"P López de Turiso Giner, L Fumanal Idocin, L Martínez-Lostao, L Corredor Sánchez, L Sáez Cómet, J Velilla Marco","doi":"10.1016/j.rceng.2026.502620","DOIUrl":"10.1016/j.rceng.2026.502620","url":null,"abstract":"<p><strong>Background and objective: </strong>Systemic sclerosis (SSc) is a highly heterogeneous autoimmune disease in which early prognostic stratification is essential. We analysed the clinical and evolutionary associations of 12 SSc-related autoantibodies (Scl-70, CENP-A, CENP-B, RNApol-III, U3-RNP, Th/To, NOR90, U1-RNP, PM/Scl100, PM/Scl75, Ku, and Ro52) in patients with suspected or diagnosed SSc.</p><p><strong>Patients and methods: </strong>A study was conducted on 186 patients (110 of whom met SSc classification criteria) who tested positive for at least one of 12 antigens detected simultaneously via immunoblotting between 2019 and 2022. We analysed the phenotypic associations of each autoantibody and the time to development of interstitial lung disease (ILD) or elevated pulmonary artery systolic pressure (PASP).</p><p><strong>Results: </strong>Most patients were female (81.7%), with a mean age at onset of 50.4 ± 15.1 years. Anti-Scl-70 was associated with diffuse SSc and was the main predictor of risk for ILD (HR: 2.43; 95% CI: 1.58-3.75) and elevated PASP (HR: 2.61; 95% CI: 1.09-3.68). Anti-CENP antibodies were linked to limited SSc and a lower incidence of ILD and elevated PASP (HR: 0.20; P < .001 and HR: 0.33; P = .013, respectively). Anti-RNApol-III showed high early pulmonary morbidity (52.9% for ILD and 47.1% for elevated PASP), with one-third of the events occurring within the first three years of evolution. Isolated anti-Ro52 positivity was associated with lower clinical expressivity and fewer evolutionary complications.</p><p><strong>Conclusions: </strong>Autoantibody profiling via immunoblotting identifies distinct clinical and evolutionary phenotypes in patients with suspected or diagnosed SSc. Anti-RNApol-III is associated with early pulmonary involvement, while anti-Ro52 monospecificity is linked to a more favourable clinical course.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502620"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}