Revista clinica espanola最新文献

{"title":"Challenges and opportunities for generalist practice in the era of technology and AI.","authors":"F BorrellCarrió, Josep Vidal Alaball","doi":"10.1016/j.rceng.2025.502367","DOIUrl":"https://doi.org/10.1016/j.rceng.2025.502367","url":null,"abstract":"<p><p>After decades of specialization, new opportunities are opening up for general clinical practice thanks to three key tools: continuing education focused on transforming clinical habits, access to advanced technology at the service of each professional, and the use of artificial intelligence to support more personalized clinical reflection. These tools could empower physicians to offer more complex, evidence-based, and personalized care. Some erroneous beliefs about artificial intelligence -such as the idea that it will make studying unnecessary- are simply manifestations of resistance to change. However, it is also important to recognize the challenges it poses, such as the risk of over-reliance on its proposals or accepting them without critical judgment. In any case, the ultimate responsibility for the outcome of a consultation rests with the medical professional. Technological advances should complement, not replace, the humanistic values ​​of medicine. To make the most of these opportunities, it is essential to have continuing education, institutional support, and personal judgment based on clinical experience and semiological observation.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502367"},"PeriodicalIF":0.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246281","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":"Executive summary of the 2025 consensus on the diagnosis and treatment of hypertension of the International Forum on Internal Medicine.","authors":"Rodrigo Sabio, Pascual Valdez, Emilio Casariego Vales, Luis Cámera, Homero Luis Puello Galarcio, Miguel Camafort","doi":"10.1016/j.rceng.2025.502368","DOIUrl":"https://doi.org/10.1016/j.rceng.2025.502368","url":null,"abstract":"<p><p>The diagnosis and treatment of hypertension is a challenge for any healthcare system. Given the difficulties, limitations, and differences among Spanish- and Portuguese-speaking countries, the International Forum of Internal Medicine (FIMI) has promoted this Consensus, which includes 23 scientific societies from 21 countries in Europe and the Americas. The objective was to develop a proposal capable of establishing an updated, robust, and common framework for the diagnosis and treatment of hypertension, aimed at internists and hospitalists and useful in Latin America, Spain, and Portugal. The document we present includes the executive summary of FIMI recommendations that, for the various aspects of the disease, aim to guarantee effective, safe, efficient, sustainable, and proportionate healthcare interventions based on the best available scientific evidence. The authors consider that this document should be updated within a maximum of two years.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502368"},"PeriodicalIF":0.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145246060","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":"Evolution of angiogenic and inflammatory biomarkers in patients with hereditary hemorrhagic telangiectasia during treatment with bevacizumab: study protocol.","authors":"Bernat Villanueva, Agnès Figueras, Raquel Torres-Iglesias, Miriam Muñoz, Sara Moreno, Nuria Trullen, Alfredo Martínez, Francesc Viñals, Antoni Riera-Mestre","doi":"10.1016/j.rceng.2025.502370","DOIUrl":"https://doi.org/10.1016/j.rceng.2025.502370","url":null,"abstract":"<p><strong>Background: </strong>Hereditary haemorrhagic telangiectasia (HHT) is a rare disease characterized by mucocutaneous telangiectasia and visceral vascular malformations. Treatment with bevacizumab is recommended in patients with liver involvement and high output heart failure (HOHF) or those with severe gastrointestinal (GI) involvement. However, there is no evidence on how to monitor such treatment using biomarkers.</p><p><strong>Material and methods: </strong>This is an exploratory, observational, prospective, single-centre study carried out in an HHT referral unit. The inclusion period for the start of bevacizumab was from January 2022 to May 2023. Patients with an indication for starting bevacizumab were selected and underwent blood tests at baseline and during the induction (36 weeks) and maintenance phases to analyse 21 biomarkers related to angiogenesis and inflammation. In addition, control HHT patients without indication for bevacizumab and healthy controls matched 1:1:1 by age, sex, and genetic subtype (for HHT patients) underwent a baseline biomarker study. The main objective was to analyse the evolution of these biomarkers in patients with HHT treated with bevacizumab. As secondary objectives, baseline differences in the concentration of these biomarkers between the three groups and correlation with the haemoglobin levels were analysed.</p><p><strong>Groups description: </strong>During the study period, nine patients with an indication for bevacizumab were included, seven due to anaemia of GI origin and two due to liver involvement with HOHF, with an overall mean age of 70 ± 8.4 years. Subsequently, the respective nine patients with HHT without bevacizumab and nine controls without HHT were selected.</p><p><strong>Conclusions: </strong>The results of this exploratory study will provide new knowledge regarding potential biomarkers for monitoring the response to treatment with bevacizumab. Furthermore, it could generate new hypotheses about the role of certain biomarkers at the pathophysiological, diagnostic, and therapeutic levels.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502370"},"PeriodicalIF":0.0,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245932","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":"Usage of lipid-lowering therapies in patients at high and very high cardiovascular risk from Spain: one-year follow-up of the Spanish subpopulation from the European SANTORINI study","authors":"J.M. Mostaza ,&nbsp;C. Lahoz ,&nbsp;M.G. de Yébenes Castro ,&nbsp;J.M. Rubio Campal ,&nbsp;E. Velásquez ,&nbsp;A. Ibarra Gutiérrez ,&nbsp;J.F. Díaz ,&nbsp;N. Plana ,&nbsp;M. Rodríguez-Mañero ,&nbsp;J. de Dios García-Díaz ,&nbsp;F. Martínez Debén ,&nbsp;I. Pavón de Paz ,&nbsp;A.L. Catapano ,&nbsp;G. Díaz Moya ,&nbsp;K.K. Ray ,&nbsp;en representación del grupo de investigadores de SANTORINI España","doi":"10.1016/j.rceng.2025.502344","DOIUrl":"10.1016/j.rceng.2025.502344","url":null,"abstract":"<div><h3>Introduction</h3><div>Real-world studies evaluating the impact of 2019 European Societies of Cardiology (ESC) and Atherosclerosis (EAS) guidelines on the use of lipid-lowering treatments (LLTs) are scarce. This manuscript shows baseline and 1-year follow-up data on LLT usage and low-density lipoprotein cholesterol (LDL-C) goal attainment in the Spanish subpopulation from SANTORINI study and put them in perspective with the European cohort without Spanish participants.</div></div><div><h3>Methods</h3><div>SANTORINI was a multinational, prospective, non-interventional study. The Spanish subpopulation involved up to 1018 patients at high and very high cardiovascular (CV) risk.</div></div><div><h3>Results</h3><div>Of 956 patients in LDL-C dataset, mean LDL-C levels decreased from baseline (82.7 ± 40.6 mg/dL) to 1-year follow-up (72.3 ± 32.6 mg/dL), in patients at high and very high risk. The percentage of patients who achieved 2019 ESC/EAS LDL-C goals increased from 26.5% at baseline to 34.1% at 1-year follow-up, in patients at high (23.1% versus 27.3%) and very high risk (27.9% versus 37.0%). Attainment to LDL-C targets improved while initiating treatment with a LLT in patients not receiving it at baseline or following change to a combination therapy in those who were receiving it. During the follow-up, seven patients died due to CV causes, and 46 and 24 had at least one four- or three-component major adverse CV events, respectively.</div></div><div><h3>Conclusions</h3><div>Follow-up data from SANTORINI Spain show that LLT usage increased from baseline, including monotherapy and combination therapy. Despite recommendations, patients at highest CV risk continue not receiving the most adequate LLT for reducing LDL-C levels in routine clinical practice.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502344"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661543","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":"Clinical characteristics and management of Spanish adult patients with phenylketonuria","authors":"M.A. Martínez Olmos ,&nbsp;E. Venegas Moreno ,&nbsp;M. Morales Conejo ,&nbsp;L. Ceberio Hualde ,&nbsp;B. Pérez ,&nbsp;M. de Tallo Forga ,&nbsp;F.J. Pérez-Sádaba ,&nbsp;P. Correcher Medina","doi":"10.1016/j.rceng.2025.502356","DOIUrl":"10.1016/j.rceng.2025.502356","url":null,"abstract":"<div><h3>Objectives</h3><div>To describe the sociodemographic and clinical characteristics and management of patients with phenylketonuria (PKU) followed in centres, services, and reference units (CSUR) or clinical excellence units specialised in inborn errors of metabolism (IEM). Additionally, to determine patients’ health-related quality of life (HRQoL).</div></div><div><h3>Methods</h3><div>Observational, cross-sectional, descriptive study conducted with Spanish PKU patients attending CSUR centres or clinical excellence units specialised in IEM during the study period.</div></div><div><h3>Results</h3><div>The study included 55 patients (54 adults and one teenager) with different PKU phenotypes. The mean (SD) age was 32.1 (9.7) years, with 69.1% women.</div><div>The most frequent phenotype at diagnosis was classical PKU (67.3%). Mean (SD) plasma Phe levels at diagnosis were 901.9 (606.1) µmol/L and 422.8 (288.9) µmol/L in the last year.</div><div>Neurological symptoms were present in 23.6% of patients, the most frequent being intellectual disability (21.8%). Psychological symptoms were present in 34.5% of patients, the most frequent being anxiety (14.5%) and depression (12.7%).</div><div>Of the patients, 85.5% responded to the EQ-5D-5L questionnaire. Of these, 44.7% of patients reported no anxiety or depression, while 34.0% had mild anxiety or depression. The mean (SD) EQ-VAS value was 80.9 (15.2).</div><div>Forty-one (74.5%) patients responded to the PKU-QoL questionnaire. The results indicated that PKU patients perceived the impact of their disease to be moderate across all domains included in the questionnaire.</div></div><div><h3>Conclusions</h3><div>Adults with PKU may experience neurological or psychological symptoms including intellectual disability, anxiety, and depression. However, their HRQoL was found to be good and comparable to that of the general population.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502356"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984933","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":"Anemia in non-celiac gluten sensitivity: a systematic review","authors":"N. Correa-Ventura","doi":"10.1016/j.rceng.2025.502351","DOIUrl":"10.1016/j.rceng.2025.502351","url":null,"abstract":"<div><h3>Background</h3><div>Non-celiac gluten sensitivity (NCGS) is characterized by a combination of intestinal and extra-intestinal symptoms triggered by gluten consumption, without evidence of celiac disease (CD) or wheat allergy (WA). Anemia, as an extra-intestinal manifestation, has been little studied in this context.</div></div><div><h3>Main objective</h3><div>To synthesize the available evidence on the association between NCGS and anemia.</div></div><div><h3>Secondary objective</h3><div>To evaluate studies applying the Salerno criteria as a diagnostic method.</div></div><div><h3>Methods</h3><div>Between November and December 2024, a search for scientific articles was conducted in the PubMed, Scopus, and Google Scholar databases, using the following terms: “anemia AND non-celiac gluten sensitivity”; “non-celiac gluten sensitivity AND clinical manifestations”; “non-celiac gluten sensitivity AND Salerno Experts.” Studies were included that either reported data on anemia in NCGS and/or used the Salerno criteria for the diagnosis of NCGS. The methodological quality of observational studies was assessed using the STROBE checklist, and the review was structured according to PRISMA 2020.</div></div><div><h3>Results</h3><div>18 studies were selected. The frequency of anemia in patients with NCGS ranged from 15% to 43%. Improvement in hemoglobin levels was reported after a gluten-free diet. Only 6 studies were developed according to the Salerno criteria.</div></div><div><h3>Conclusions</h3><div>NCGS should be considered in the differential diagnosis of anemia. The methodological quality of studies needs to be improved, ideally through double-blind controlled (DBPC) trials applying the Salerno criteria.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502351"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002459","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":"The Barcelona College of Physicians’ model of comprehensive care for female doctors who are victims of male violence","authors":"L. Aragonès Rodríguez ,&nbsp;E. Bisbe Vives","doi":"10.1016/j.rceng.2025.502353","DOIUrl":"10.1016/j.rceng.2025.502353","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502353"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002396","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":"Update of the SEIOMM clinical guideline of osteoporosis: abaloparatide","authors":"J.A. Riancho ,&nbsp;M. Martín Millán ,&nbsp;P. Peris ,&nbsp;G. Martínez ,&nbsp;en nombre de la Comisión de Redacción de las Guías de Osteoporosis de la SEIOMM","doi":"10.1016/j.rceng.2025.502338","DOIUrl":"10.1016/j.rceng.2025.502338","url":null,"abstract":"<div><h3>Introduction</h3><div>Osteoporosis is a highly prevalent condition. SEIOMM has published guidelines for managing these patients in 2022. The recent introduction of a new drug in Europe, abaloparatide, makes it advisable to consider its role among therapeutic options.</div></div><div><h3>Objective and results</h3><div>This article summarizes the existing information on the efficacy and safety of abaloparatide and it updates the therapeutic algorithms proposed in the guidelines.</div></div><div><h3>Conclusion</h3><div>Abaloparatide is an osteoanabolic drug with efficacy and safety similar to teriparatide. It represents a new option for treating patients with severe osteoporosis and a very high risk of fracture.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502338"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661542","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":"Macaroni sign and Takayasu arteritis: point-of-care ultrasound utility","authors":"M.Á. Cornejo-Saucedo,&nbsp;J.M. Aparicio-Oliver,&nbsp;D. García-Gil","doi":"10.1016/j.rceng.2025.502354","DOIUrl":"10.1016/j.rceng.2025.502354","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502354"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002428","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":"Significance of aortic arch calcification as a cardiovascular risk marker: analysis of a cohort of hospitalized patients in internal medicine","authors":"A. García Tellado ,&nbsp;A. Castillo Leonet ,&nbsp;J. Queipo Menéndez ,&nbsp;M. de la Fuente Vázquez ,&nbsp;E. Julián Gómez ,&nbsp;C. Valero ,&nbsp;C. García Ibarbia ,&nbsp;J. Pardo Lledias ,&nbsp;J.L. Hernández Hernández","doi":"10.1016/j.rceng.2025.502350","DOIUrl":"10.1016/j.rceng.2025.502350","url":null,"abstract":"<div><h3>Introduction</h3><div>Aortic arch calcification (AAC) is an underestimated marker of cardiovascular risk, associated with a higher incidence of major cardiovascular events and mortality.</div></div><div><h3>Materials and methods</h3><div>This retrospective, descriptive study included 292 patients admitted in May 2021 to the Internal Medicine Department of Marqués de Valdecilla University Hospital. The presence of AAC was assessed via chest X-rays, alongside clinical data, risk factors, and previous and 12-month cardiovascular events.</div></div><div><h3>Results</h3><div>AAC was present in 51% of patients. Age over 65, dyslipidemia, and smoking were independent predictors (p &lt; 0.05). AAC was significantly associated with a higher prevalence of cardiovascular events: stroke (23.3% vs. 13.3%; OR 1.9, 95% CI 1.07–3.6), acute coronary syndrome (23.3% vs. 8.5%; OR 3.2, 95% CI 1.6–6.4), and peripheral arterial disease (20.9% vs. 7.3%; OR 3.3, 95% CI 1.6–6.9). At 12-month follow-up, patients with AAC had a higher incidence of new cardiovascular events (22.5% vs. 10.9%; OR 2.3, 95% CI 1.2–4.9; p = 0.007). Although overall survival was lower in this group, only age and chronic kidney disease were independent predictors of mortality.</div></div><div><h3>Conclusions</h3><div>AAC is a common finding among hospitalized patients and is associated with increased cardiovascular risk. Its detection on chest X-rays may serve as an accessible tool for risk stratification in high-risk populations.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502350"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002484","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}