Revista clinica espanola最新文献

{"title":"From obesity to comorbidities: a comprehensive care approach for improved health by the Spanish Society of Internal Medicine","authors":"J. Carretero Gómez ,&nbsp;J.M. Fernández Rodríguez ,&nbsp;A. Michan Doña ,&nbsp;J.P. Miramontes González ,&nbsp;J.J. González Soler ,&nbsp;M.I. Pérez Soto ,&nbsp;F.J. Carrasco Sánchez ,&nbsp;F. Gómez Delgado ,&nbsp;J.C. Arévalo Lorido ,&nbsp;P. Pérez Martínez ,&nbsp;en representación del grupo de Trabajo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna SEMI","doi":"10.1016/j.rceng.2025.502352","DOIUrl":"10.1016/j.rceng.2025.502352","url":null,"abstract":"<div><div>Obesity is currently recognized as a chronic, progressive, and relapsing disease, and constitutes a major global public health challenge. This document, promoted by the Spanish Society of Internal Medicine through its Working Group on Diabetes, Obesity, and Nutrition, outlines a comprehensive, multidisciplinary approach to care, with a specific focus on obesity-related comorbidities. Excess adipose tissue is conceptualized as a systemic pathogenic agent that actively contributes to the pathophysiology of numerous complications, including cardiovascular disease, heart failure, chronic kidney disease, osteoarthritis, obstructive sleep apnea, and metabolic dysfunction-associated steatotic liver disease (MASLD). Furthermore, the document reviews the current evidence base regarding pharmacological interventions for obesity, addressing both their overall efficacy in weight management and their specific therapeutic impact in the context of the distinct obesity-associated comorbidities for which clinical benefit has been demonstrated.</div><div>The document endorses the implementation of the Edmonton Obesity Staging System (EOSS) as a pivotal framework for the clinical stratification of risk in individuals with obesity, facilitating a more nuanced and personalized therapeutic approach that prioritizes the functional, metabolic, and prognostic dimensions of the disease. In this context, the document proposes a paradigm shift in the therapeutic objectives for obesity management, moving beyond a sole reliance on anthropometric metrics, such as body mass index (BMI) or absolute weight reduction. Instead, it emphasizes a pathophysiological and patient-centered approach focused on the prevention of obesity-related complications, the early detection and management of its comorbid conditions, and the sustained improvement of both quality-adjusted and overall life expectancy, while simultaneously promoting the elimination of stigma and discrimination.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502352"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002422","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":"Usefulness of monocyte distribution width in the diagnosis of sepsis in critically ill patients","authors":"C. Morales Indiano ,&nbsp;A. Herraiz Ruiz ,&nbsp;P. Marcos Neira ,&nbsp;R. Roig Pineda ,&nbsp;B. Catalán Eraso ,&nbsp;A. Martínez Iribarren ,&nbsp;A. Leis Sestayo ,&nbsp;F. Arméstar Rodríguez","doi":"10.1016/j.rceng.2025.502357","DOIUrl":"10.1016/j.rceng.2025.502357","url":null,"abstract":"<div><h3>Background</h3><div>The incidence and mortality of sepsis remain high in the intensive care units (ICU). WBC, CRP and PCT are frequently used as tools for sepsis detection; however, none of them is specific to sepsis. The aim of the current study was to evaluate whether monocyte distribution width (MDW) is useful for early sepsis detection in critically ill patients.</div></div><div><h3>Methods</h3><div>Prospective cohort study was conducted in a critical care unit. MDW, CRP, PCT and WBC were evaluated for sepsis detection at the time of intensive care unit admission.</div></div><div><h3>Results</h3><div>There were 344 critically ill patients enrolled consecutively and categorized as no sepsis (200), sepsis (76) and septic shock (68). MDW in patients with sepsis diagnoses in ICU was notably higher than non-sepsis group [29.7 (24.7–35.7) vs 20.4 (18.6−22.7); <em>P</em> &lt; .001] under the assumption of no mean difference between the groups. Compared to other parameters, MDW was the best to discriminate sepsis from all other conditions (area under curve [AUC], 0.877; 95% CI, 0.841 0.914), sensitivity 80.6, specificity 84.5 at a cut-off point of 24. MDW adjusted for age, sex and SOFA score was associated with mortality [OR 1.056 (95% CI: 1.004–1.09) <em>P</em> &lt; .01].</div></div><div><h3>Conclusion</h3><div>The measurement of MDW is a tool that can help in the early diagnosis of sepsis in ICU settings and its value is a factor associated with the prognosis of septic patients.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502357"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984973","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 impact of the school lunchroom as a health tool: synergies between public policy and the E-DUCASS program","authors":"P. Pérez-Martínez ,&nbsp;E. Porras-Pérez ,&nbsp;J.L. Romero-Cabrera","doi":"10.1016/j.rceng.2025.502355","DOIUrl":"10.1016/j.rceng.2025.502355","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 8","pages":"Article 502355"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002444","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":"Multimodal analysis of congestion and prognostic utility of the VExUS protocol in hospitalized heart failure patients at a tertiary care hospital","authors":"A. Campos Sáenz de Santamaría ,&nbsp;A. Alcaine Otín ,&nbsp;S. Crespo Aznarez ,&nbsp;C. Josa Laorden ,&nbsp;L. Esterellas Sánchez ,&nbsp;M. Sánchez Marteles ,&nbsp;V. Garcés Horna ,&nbsp;Z. Albines Fiestas ,&nbsp;I. Giménez López ,&nbsp;J. Rubio Gracia","doi":"10.1016/j.rceng.2025.502332","DOIUrl":"10.1016/j.rceng.2025.502332","url":null,"abstract":"<div><h3>Background</h3><div>Multimodal assessment of congestion and venous excess ultrasound protocol (VExUS) play a determinant role for volume assessment and decongestive therapy in patients with acute heart failure (AHF).</div></div><div><h3>Methods</h3><div>Prospective, unicentrical and observational study in patients admitted for AHF at the Internal Medicine ward, designed to explore the prevalence, predictors and clinical outcomes of congestion (VExUS score) and the prevalence of congestive nephropathy.</div></div><div><h3>Results</h3><div>A total of 100 patients were included (mean age 86<!--> <!-->±<!--> <!-->8 years were and 51% females). According to VExUS protocol, 49% exhibited moderate to severe congestion (VExUS 2-3). These patients were more clinical congested, showed higher concentrations of CA125 and microalbumin/creatinine ratio, and need greater doses of loop diuretics during hospitalization. The prevalence of congestive nephropathy on admission was 38%. Patients with VExUS score on admission ≥ 2 had a 2.5-fold increased risk for all-cause mortality and/or HF hospitalization at 1<!--> <!-->year (OR 2.52, 95% CI 1.02–6.26, <em>p</em> <!-->=<!--> <!-->0.046). In multivariable analysis elevated urea levels, larger inferior vena cava diameter and male gender, were identified as independent predictors on top of VExUS score for one-year mortality with an area under the curve for the final model of 0.740 (<em>p</em> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusions</h3><div>Moderate to severe congestion (VExUS grade 2-3) is associated with higher clinical congestion scores, greater need for diuretic treatment, and worse clinical outcomes, including increased mortality and rehospitalization rates in AHF. Furthermore, one-third of AHF showed congestion nephropathy a situation with clinical relevance that can influence decongestive treatments and final outcomes.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502332"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304263","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 future impact of advanced imaging and artificial intelligence on the diagnosis and R&D of rare diseases","authors":"M. Moreno-Higueras ,&nbsp;G. Fatoul-Del Pino ,&nbsp;S. García-Linares ,&nbsp;T. Martín-Noguerol","doi":"10.1016/j.rceng.2025.502327","DOIUrl":"10.1016/j.rceng.2025.502327","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502327"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337410","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 in chronic obstructive pulmonary disease (COPD): Scientific evidence and strategies to reduce risks","authors":"Ó. Porto Fuentes ,&nbsp;A. Muela Molinero ,&nbsp;M.B. Alonso Ortiz","doi":"10.1016/j.rceng.2025.502330","DOIUrl":"10.1016/j.rceng.2025.502330","url":null,"abstract":"<div><div>Patients with chronic obstructive pulmonary disease (COPD) are more vulnerable to infections that may favor disease progression. Vaccination in COPD is an effective intervention that helps reduce infectious exacerbations, as well as associated morbidity and mortality.</div><div>In recent years, the use of new vaccines has become widespread, not only targeting specific infections but also contributing to long-lasting immunity and slowing the process of immune aging (immunosenescence).</div><div>Current clinical practice guidelines recommend the administration of six vaccines (against <em>Streptococcus pneumoniae</em>, influenza virus, SARS-CoV-2, respiratory syncytial virus, <em>Bordetella pertussis</em>, and varicella-zoster virus) for all COPD patients.</div><div>However, vaccination rates in many countries still fall short of the established targets. Therefore, it is crucial to design a specific vaccination schedule tailored for COPD patients.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502330"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532375","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":"Relationship between TyG trajectories and Alzheimer’s disease: data from the Framingham Heart Study","authors":"C.K. Guan ,&nbsp;Z.B. Gu ,&nbsp;J.Y. Sun ,&nbsp;W.G. Zhu ,&nbsp;M. Ye","doi":"10.1016/j.rceng.2025.502331","DOIUrl":"10.1016/j.rceng.2025.502331","url":null,"abstract":"<div><h3>Background</h3><div>The triglyceride-glucose (TyG) index is derived from a combination of fasting plasma glucose and triglyceride levels, making it a reliable indicator of insulin resistance. Prior studies have established a significant connection between insulin resistance and Alzheimer's disease (AD). Nevertheless, the relationship between the trajectory of the TyG index and AD onset is still not clearly understood.</div></div><div><h3>Methods</h3><div>This longitudinal prospective cohort study derived data from the Framingham Heart Study Offspring cohort. A total of 2170 participants without AD at baseline were included and were prospectively followed until 2018. Groups of participants with comparable TyG index trajectories were identified through the application of latent class growth mixture modeling analysis.</div></div><div><h3>Results</h3><div>A cohort of 163 participants were diagnosed with AD during the follow-up. The incidence of AD in the low, moderate, and high trajectory groups was 0.38, 0.66, and 0.68 per 100 person-years respectively. Compared to the low trajectory group, both the moderate trajectory (hazard ratio [HR] 1.53, 95% confidence interval [CI] 1.04−2.25) and high trajectory groups (HR = 1.90, 95%CI: 1.09–3.31) exhibited an elevated risk of developing AD. These results remained consistent after adjusting for multiple covariates (moderate: HR = 1.53, 95%CI: 1.02–2.29; high: HR = 1.84, 95%CI: 1.03–3.27, respectively).</div></div><div><h3>Conclusion</h3><div>Higher TyG index trajectories exhibit a notable correlation with the development of AD. Early and continuous monitoring of the TyG index in individuals identified as high-risk for AD may help implement timely prevention measures.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502331"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304264","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":"Comment to the special article \"Utility of point-of-care ultrasound (POCUS) in hospitalized patients with acute confusional syndrome of unclear etiology\"","authors":"J.A. Mariz","doi":"10.1016/j.rceng.2025.502334","DOIUrl":"10.1016/j.rceng.2025.502334","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502334"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478388","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":"Counter-reply: Comment to the special article “Utility of point-of-care ultrasound (POCUS) in hospitalized patients with acute confusional syndrome of unclear etiology”","authors":"S. Carrasco-Molina ,&nbsp;Á. Robles-Marhuenda ,&nbsp;J.J. Ríos-Blanco ,&nbsp;Y. Tung-Chen","doi":"10.1016/j.rceng.2025.502337","DOIUrl":"10.1016/j.rceng.2025.502337","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502337"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478389","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":"Peer-assisted learning enhances non-technical skills in pediatric physical therapy education","authors":"T.T. Ma ,&nbsp;Q. Zhang ,&nbsp;H.B. Zhao ,&nbsp;H.X. Li","doi":"10.1016/j.rceng.2025.502328","DOIUrl":"10.1016/j.rceng.2025.502328","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 7","pages":"Article 502328"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478390","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}