Revista clinica espanola最新文献

{"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, A Alcaine Otín, S Crespo Aznarez, C Josa Laorden, L Esterellas Sánchez, M Sánchez Marteles, V Garcés Horna, Z Albines Fiestas, I Giménez López, J Rubio Gracia","doi":"10.1016/j.rceng.2025.502332","DOIUrl":"10.1016/j.rceng.2025.502332","url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 1year (OR 2.52, 95% CI 1.02-6.26, p=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 (p<0.001).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502332"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","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":"Relationship between TyG trajectories and Alzheimer's disease: data from the Framingham Heart Study.","authors":"C K Guan, Z B Gu, J Y Sun, W G Zhu, M Ye","doi":"10.1016/j.rceng.2025.502331","DOIUrl":"10.1016/j.rceng.2025.502331","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502331"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","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":"The contribution of PET/MRI in benign/malignant nodule separation in thyroid incidentalomas detected in FDG PET/CT imaging.","authors":"A Nazari, S Sager, S Schenke, L Uslu Beşli, C Samancı, T Öztürk, H B Sayman","doi":"10.1016/j.rceng.2025.502333","DOIUrl":"10.1016/j.rceng.2025.502333","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Incidentalomas of the thyroid gland are frequently observed in oncological patients undergoing FDG PET/CT imaging for staging or treatment response assessment. This study aims to investigate the utility of SUVmax and ADC values measured by PET/MRI in distinguishing between benign and malignant thyroid nodules.</p><p><strong>Materials and methods: </strong>We selected 108 patients (72 females, 36 males; mean age 54 ± 12 years) who underwent routine oncological FDG PET/CT scans for staging or treatment response assessment, with nodule sizes greater than 1 cm. A one-bed neck PET/MRI scan followed the whole-body PET/CT. SUVmax values were measured, and ADC maps were created using DWI with b factors of 50 and 1000 s/mm². SUVmax and ADC values were correlated with FNAC results.</p><p><strong>Results: </strong>FNAC results revealed 76 (70.4%) benign and 32 (29.6%) malignant nodules among the 108 patients. The mean SUVmax of malignant nodules was significantly higher than that of benign nodules (10.6 ± 8.3 vs. 5.94 ± 5.2, p < 0.001). Similarly, the mean ADC value was lower in malignant nodules compared to benign ones (1.4 ± 0.6 × 10^-3 mm²/s vs. 1.8 ± 0.4 × 10^-3 mm²/s; p < 0.001). A significant but weak correlation was found between FNAC results and mean SUVmax (r = 0.335), as well as a significant weak negative correlation with mean ADC values (r = -0.355). Using a cut-off value of 6 for SUVmax and 1.56 × 10^-3 mm²/s for ADC, the sensitivity, specificity, and accuracy for SUVmax were 68.7%, 73.6%, and 72.1%, respectively, while for ADC, they were 71.8%, 69.7%, and 70.4%, respectively. The PET/MRI system demonstrated a relative sensitivity, specificity, accuracy, PPV, and NPV of 90.62%, 51.32%, 62.96%, 43.94%, and 92.86%.</p><p><strong>Conclusion: </strong>This study is one of the first in the literature to explore the use of FDG PET/MRI, a single-stop device, in distinguishing between benign and malignant thyroid nodules with high sensitivity and NPV.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502333"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295597","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":"On the difficulty of clinical diagnosis of acute heart failure in the emergency department","authors":"Ò. Miró ,&nbsp;N. Ivars ,&nbsp;P. Llorens","doi":"10.1016/j.rceng.2025.502301","DOIUrl":"10.1016/j.rceng.2025.502301","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502301"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030521","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":"Comparison of real and standardized patients in Degree in Medicine: a randomized controlled intervention study","authors":"N. Díez ,&nbsp;B. Franchez ,&nbsp;M.C. Rodríguez-Díez ,&nbsp;M. Vidaurreta ,&nbsp;M.T. Betés ,&nbsp;S. Fernández ,&nbsp;P. Palacio ,&nbsp;F.J. Pueyo ,&nbsp;N. Martín-Calvo","doi":"10.1016/j.rceng.2025.502306","DOIUrl":"10.1016/j.rceng.2025.502306","url":null,"abstract":"<div><h3>Introduction</h3><div>Simulated clinical scenarios allow students to learn in a safe environment. Although it is recommended that standardized patients (SP) participate in these scenarios, few studies compare the impact of SP and real patients (RP) on medical education.</div></div><div><h3>Methods</h3><div>Forty medical students per course (4th, 5th, and 6th) were selected and randomly assigned (1:1) to two groups: a scenario with RP or SP. The students and the external observer were unaware of the type of patient participating in the scenario. The students completed questionnaires on perceptions and knowledge, and the responsible professors and external observer completed questionnaires on perceptions. Qualitative information was collected through focus groups with the students.</div></div><div><h3>Results</h3><div>No significant differences were found between both groups in perceptions and acquired knowledge, but there was a significant difference in the probability of correctly identifying the type of patient (p &lt; 0.001): most students in the scenario with SP identified it as RP. No differences were found between groups in the professor and external observer questionnaires. Students were more prepared and involved if they believed they were facing a RP and considered the patient's feedback enriching, regardless of the type of patient.</div></div><div><h3>Conclusions</h3><div>Medical students do not differentiate SP from RP in scenarios and evaluate them similarly. Given the difficulty of having PR with diverse pathologies and severity levels, SP is a good alternative for training medical students.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502306"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056537","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":"In reply to the article of Ivars N, et al. “Clinical features, management in the emergency department and mortality of acute heart failure episodes in patients with chronic obstructive pulmonary disease”","authors":"A. Gil-Rodrigo ,&nbsp;M.-J. Luque-Hernández ,&nbsp;L. Cuesta-García ,&nbsp;C. Martínez-Buendía","doi":"10.1016/j.rceng.2025.502298","DOIUrl":"10.1016/j.rceng.2025.502298","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502298"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065537","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":"Aging with HIV: a cross-sectional look at comorbidities","authors":"M.C. Montes ,&nbsp;J.A. Rueda-Camino ,&nbsp;N. Rallón ,&nbsp;S. Nistal-Juncos ,&nbsp;R. Barba Martín","doi":"10.1016/j.rceng.2025.502310","DOIUrl":"10.1016/j.rceng.2025.502310","url":null,"abstract":"<div><h3>Background</h3><div>People living with HIV (PLHIV) are at increased risk of multimorbidity compared to the general population. The goal of this study is to evaluate the prevalence of non-infectious comorbidities and geriatric syndromes in PLHIV ≥ 50 years old.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis was conducted on a cohort of PLHIV regularly followed at an outpatient clinic in a University Hospital in Spain, focusing on PLHIV aged 50 and above. Participants were categorized by age into ten-year intervals. Crude and standardized prevalence of each comorbidity and its trend across age groups were estimated. The prevalence of multimorbidity (≥2 diseases) was also evaluated. All prevalence were estimated with the exact method.</div></div><div><h3>Results</h3><div>We evaluated 122 PLHIV, of which 25.4% were women and 13% resided in nursing homes. The median time between HIV diagnosis and the last documented visit was 19 (9–29) years. Overall prevalence of multimorbidity was 37% (95% CI 28.4 %–45.6 %), being the most prevalent comorbidities cardiovascular risk factors dyslipidemia (37.7%; 95% CI 29.6 %–46.6 %), hypertension (26.2%; 95% CI: 19.2 %–34.7 %), diabetes mellitus (14.8%; 95% CI: 9.5 %–22.1 %) and non-AIDS defining cancers (15.6%; 95% CI: 10.2 %–23.0 %). The most common geriatric syndromes were fractures/osteoporosis (9.8%; 95% CI: 5.7 %–16.4 %), dementia (8.2%; 95% CI: 4.5–14.4 %) and frailty (8.2%; 95% CI: 4.5–14.4 %). The prevalence of most comorbidities and multimorbidity showed a significantly increasing trend across age groups.</div></div><div><h3>Conclusions</h3><div>PLHIV who are over 50 years of age have a high prevalence of non-infectious comorbidities and geriatric syndromes. Multimorbidity increases with age in this population group.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502310"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055685","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":"SGLT2 inhibitors after acute heart failure: great benefit, low prescription rates","authors":"R. Quirós-López","doi":"10.1016/j.rceng.2025.502299","DOIUrl":"10.1016/j.rceng.2025.502299","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502299"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056609","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":"Is home hospitalization of acute patients who are admitted due to infection safe and effective?","authors":"L. Moreno Núñez ,&nbsp;C. Garmendia Fernández ,&nbsp;M. Ruiz Muñoz ,&nbsp;J. Collado Álvarez ,&nbsp;C. Jimeno Griño ,&nbsp;Á. Prieto Callejero ,&nbsp;E. Pérez Fernández ,&nbsp;I. González Anglada","doi":"10.1016/j.rceng.2025.502308","DOIUrl":"10.1016/j.rceng.2025.502308","url":null,"abstract":"<div><h3>Introduction</h3><div>Home hospitalization (HH) is a safe, effective and more efficient modality of care than conventional hospitalization (CH). There is little scientific evidence comparing these two models of hospitalization in patients admitted from the Emergency Department (ED) for infection.</div></div><div><h3>Material and methods</h3><div>Retrospective cohort study between October 1 and December 15, 2023 of patients admitted from the ED for infection. Two cohorts were analyzed, the first one, patients admitted to CH in Internal Medicine, Geriatrics or Infectious Diseases units and the second one, patients admitted to HH. Patients with hemodynamic instability, those who died in the first 48 hours of admission, Staphylococcus aureus bacteremia, catheter-associated bacteremia, osteoarticular infection, meningitis, diverticulitis, fever without focus, and infections with undrained focus were excluded.</div></div><div><h3>Results</h3><div>257 patients were analyzed, 151 in CH and 106 in HH. The median duration of antibiotherapy was 9 days in HC vs 7 in HH (p &lt; 0.001), the mean length of stay was longer in CH vs HH (6 vs 4; p = 0.007). More laboratory tests were performed in CH vs HH (3 vs 1, p &lt; 0.001), radiographs (11% vs 0%), ultrasound (12% vs 2%) and computed axial tomography (13% vs 3%, p &lt; 0.001). Patients admitted to CH had more confusional syndrome than those admitted to HH (15% vs 2%; p &lt; 0.001). There were no differences in mortality or readmissions. In the multivariate linear regression analysis, patients admitted to HH shortened their hospital stay by 1 day (95% CI: -2.2- -0.185) compared to those admitted to CH.</div></div><div><h3>Conclusion</h3><div>Patients admitted for infection in HH from the ED have a shorter hospital stay than patients admitted to CH.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502308"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133403","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":"Use of SCORE2 in the assessment and control of cardiovascular risk in an apparently healthy individuals’ cohort","authors":"J. Campos ,&nbsp;A. Figueiredo ,&nbsp;J. Silva ,&nbsp;L. Azevedo ,&nbsp;I. Ribeiro ,&nbsp;M. Miranda ,&nbsp;H. Gomes","doi":"10.1016/j.rceng.2025.502302","DOIUrl":"10.1016/j.rceng.2025.502302","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Cardiovascular risk estimation is an essential step in reducing the onset of adverse cardiovascular events. It helps to identify healthy patients who will benefit most from treatment for atherosclerotic risk factors. The authors pretend to assess the Cardiovascular risk in an apparently healthy Portuguese population and evaluate the degree of control of LDL-cholesterol.</div></div><div><h3>Materials and methods</h3><div>This cross-sectional study assessed the cardiovascular risk level in a Portuguese population aged 40 to 69 years, using the Systematic Coronary Risk Evaluation 2 algorithm. This research received no specific funding.</div></div><div><h3>Results</h3><div>12076 apparently healthy patients were included, median age of 53.8<!--> <!-->±<!--> <!-->8.03 (min. 40; max. 69), 58.7% women and 41.3% men. Based on the Systematic Coronary Risk Evaluation 2 calculation, 59.5% of patients belonged to the low moderate risk, 35.1% to the high risk group, and 5.4% to the very high risk group.</div><div>Based on cardiovascular risk stratification, 64.6%, 94.1%, and 98.5% of the patients with low-moderate, high, and very high cardiovascular risk were above the LDL-cholesterol target, respectively. Of those with high and very high cardiovascular risk, 94.7% were above LDL-cholesterol goal in spite that 35.9% were under statin treatment.</div></div><div><h3>Conclusion</h3><div>In this real-life setting study, over a third of the population had high and very high cardiovascular risk, of which 94.7% were above the LDL-cholesterol goal. The study highlights that a large part of apparently healthy patients could benefit from a therapeutic intervention to reduce the risk of the onset of adverse cardiovascular events.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"225 6","pages":"Article 502302"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051865","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}