Revista clinica espanola最新文献

{"title":"Notification of suspected adverse drug reactions by nurses to a hospital pharmacovigilance program. Retrospective descriptive study","authors":"P. Ordóñez-Rufat,&nbsp;D. Rodríguez-Cumplido,&nbsp;R. Llop-Rius,&nbsp;A. Tarres-Martínez,&nbsp;P. Hereu-Boher","doi":"10.1016/j.rceng.2026.502577","DOIUrl":"10.1016/j.rceng.2026.502577","url":null,"abstract":"<div><h3>Introduction</h3><div>Adverse drug reactions (ADR) are a common cause of illness. The Spontaneous reporting of adverse drug reactions is essential to characterize drug toxicity. Nurses, due to their proximity to patients, can contribute to detect them. The purpose is to describe the number of notifications of adverse drug reactions from nurses after a set of actions aimed at promoting reporting.</div></div><div><h3>Material and method</h3><div>Single-center observational, retrospective, and descriptive study on the characteristics and number of spontaneous ADR reports made by nurses following the implementation of informational/training actions in different health care areas of a tertiary hospital.</div></div><div><h3>Results</h3><div>Of the total 806 of suspected adverse drug reactions, nurses reported 124 (38.51%). There was a predominance of women 77 (62,1%), with a mean age of 54 years; 22.6% were over 65 years of age and 61.3% were polymedicated (five or more drugs prescribed). The most frequently reported reactions were skin disorders, and 71% of them resolved within 24 h. Intravenous contrast agents for diagnostic testing were the most reported drugs. In 116 (93.5%) of cases, the reactions were considered definitively or probably related to the drug.</div></div><div><h3>Conclusions</h3><div>It is essential to promote the role of nurses in increasing adverse drug reactions reporting in order to sustainably strengthen pharmacovigilance systems.</div><div>Continuous training that is adapted and maintained over time, as well as intuitive and accessible notification circuits, can contribute to improving participation.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 7","pages":"Article 502577"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059341","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":"Blood pressure variability: a still underestimated topic","authors":"P. Stiefel,&nbsp;J. Muñoz-García,&nbsp;R. Pino-Mejías","doi":"10.1016/j.rceng.2026.502580","DOIUrl":"10.1016/j.rceng.2026.502580","url":null,"abstract":"<div><div>The importance of blood pressure variability has grown exponentially over the past two to three years. In this review, we aim to discuss the reasons underlying this increasing interest. First, we describe the different methods used to assess blood pressure variability, including very short-term (beat-to-beat), short-term (24-h ambulatory blood pressure monitoring), mid-term (home self-measurements), and long-term (visit-to-visit measurements), as well as the mathematical indices used to quantify it.</div><div>We then address the clinical relevance of blood pressure variability. First, increased variability is more prevalent in several health conditions not necessarily related to vascular disease, such as mental illness, severity of COVID-19 infection, bone fractures, and various forms of cognitive impairment. Second, blood pressure variability appears to be involved in the progression from prehypertensive states to established hypertension and, once hypertension is present, in the development of target organ damage. It has also been associated with an increased risk of gestational hypertension, preeclampsia, and adverse neonatal outcomes. Furthermore, blood pressure variability, even independently of mean arterial blood pressure, influences the development, prognosis, and complications of coronary and cerebrovascular disease. Finally, we discuss evidence suggesting that blood pressure variability is associated with both vascular and all-cause mortality.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 7","pages":"Article 502580"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147985005","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 National Early Warning Score 2 (NEWS-2) in the emergency care of patients over 80 years old with infection: an observational study","authors":"M. Perea Gainza,&nbsp;M.A. Arce Marañón,&nbsp;N. Miota Hernández,&nbsp;D. Sempertegui Gutiérrez,&nbsp;M. Carbó Díez,&nbsp;G. Osorio Quispe,&nbsp;L. Artajona García,&nbsp;C. Piñol Bel,&nbsp;M.J. Castaño Suero,&nbsp;C. Rangel Falcón,&nbsp;G. Benedetti,&nbsp;M.M. Ortega Romero","doi":"10.1016/j.rceng.2026.502574","DOIUrl":"10.1016/j.rceng.2026.502574","url":null,"abstract":"<div><h3>Introduction</h3><div>Prognostic stratification of very elderly patients with infection presenting to the emergency department remains challenging. The <em>National Early Warning Score 2</em> (NEWS-2) is widely used to identify the risk of clinical deterioration; however, its prognostic performance in patients aged 80 years or older has been insufficiently evaluated.</div></div><div><h3>Objective</h3><div>To assess the prognostic value of NEWS-2 for in-hospital mortality in patients aged ≥80 years presenting to the emergency department with infection who receive antibiotic therapy and require hospital admission.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study in an emergency department during 2022. Patients aged ≥80 years with infection, initiation of antibiotic therapy in the emergency department, and subsequent hospital admission were included. Collected variables comprised comorbidity (Charlson Comorbidity Index), functional status (Barthel Index), frailty (Clinical Frailty Scale), and NEWS-2 at admission. The primary outcome was in-hospital mortality. Multivariate logistic regression analysis and assessment of discriminatory performance were performed.</div></div><div><h3>Results</h3><div>A total of 987 patients were included (mean age 87 years; 53% women). In-hospital mortality was 13%. NEWS-2 was independently associated with mortality (OR 1.30; 95% CI 1.22–1.37). The area under the receiver operating characteristic curve was 0.748 (95% CI 0.698–0.797). A NEWS-2 cut-off value of ≥8 showed a sensitivity of 54% and a specificity of 85%, with adequate model calibration.</div></div><div><h3>Conclusions</h3><div>NEWS-2 demonstrates moderate prognostic accuracy for in-hospital mortality in patients aged ≥80 years with infection attended in the emergency department who require hospital admission, and may provide complementary information to support clinical decision-making in this population.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 7","pages":"Article 502574"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059291","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":"Features, treatment and 1-year prognosis of patients with heart failure and chronic kidney disease stages 4 or 5","authors":"M. Anguita-Gámez,&nbsp;J.L. Bonilla-Palomas,&nbsp;A. Esteban-Fernández,&nbsp;A. Recio-Mayoral,&nbsp;J. Muñiz,&nbsp;R. González-Manzanares,&nbsp;M. Ruiz-Ortiz,&nbsp;M. Anguita-Sánchez,&nbsp;D. Mesa-Rubio","doi":"10.1016/j.rceng.2026.502578","DOIUrl":"10.1016/j.rceng.2026.502578","url":null,"abstract":"<div><h3>Aims</h3><div>To analyze, in a contemporary registry of patients with heart failure (HF), the differences in characteristics, treatment, and 1-year prognosis between patients with chronic kidney disease (CKD) stages 4−5 versus CKD 1−3.</div></div><div><h3>Methods</h3><div>We analyzed the SEC-Excelente-HF registry of the Spanish Society of Cardiology, that included 2245 patients between 2018 and 2023 by 68 HF units. Characteristics, treatment, mortality, and hospitalization rates for HF at 1 year were compared between patients with an estimated glomerular filtration rate (eGFR) &lt; 30 ml/min/m² and those with an eGFR ≥ 30 ml/min/m².</div></div><div><h3>Results</h3><div>Of the 2245 patients, 9.9% had CKD 4–5 and 90.1% had an eGFR ≥ 30 ml/min/m². Ejection fraction was similar (42.8 ± 15.4 vs. 40.3 ± 15.3%). The CKD 4–5 group was older (76.9 ± 9.6 vs. 70.5 ± 12.4 years; <em>p</em> &lt; 0.001) and showed a higher prevalence of ischemic heart disease, diabetes mellitus, anemia, and iron deficiency. These patients received in a lower proportion all drugs for HF (<em>p</em> &lt; 0.001), except diuretics and potassium binders. Mortality rate (36.1 vs. 14.6/100 person-years; <em>p</em> &lt; 0.001) and the rate of HF hospitalizations at one year (67.3 vs. 30.9/100 person-years; <em>p</em> &lt; 0.001) were higher in patients with CKD stages 4−5.</div></div><div><h3>Conclusions</h3><div>In a contemporary cohort of patients with HF, patients with CKD stages 4−5 had different clinical characteristics, received in a lesser proportion adequate treatment, and had higher 1-year mortality and HF hospitalization rates.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 7","pages":"Article 502578"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059275","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 consensus document on management of the transition of patients with inborn errors of intermediary metabolism","authors":"M.Á. Martínez Olmos ,&nbsp;C. Alcalde-Martín ,&nbsp;A. Bélanger-Quintana ,&nbsp;R. Burgos Peláez ,&nbsp;J. de las Heras ,&nbsp;M. del Toro ,&nbsp;M. Forga Visa ,&nbsp;A. Moráis-López ,&nbsp;M. Morales-Conejo ,&nbsp;E. Venegas-Moreno ,&nbsp;I. Vitoria Miñana","doi":"10.1016/j.rceng.2026.502548","DOIUrl":"10.1016/j.rceng.2026.502548","url":null,"abstract":"<div><div>Inborn errors of intermediary metabolism (IEiM) are rare genetic diseases with significant morbidity and mortality, requiring complex and continuous management throughout life. To ensure continuity of care and improve patient outcomes and quality of life, a transition from pediatric to adult care must be made. However, this transition is not standardised, and its current status in Spain is unknown. In this study, 11 experts in IEiM (Endocrinology and Nutrition, Pediatrics, Internal Medicine, pediatric Neurology) developed questions and statements to validate in a survey based on the Delphi method, where 25 experts participated. Data from current clinical practice in Spain were obtained regarding patients with IEiM and their transition, with 68% of participants reporting that up to 25% of patients who should be managed as adults receive care in Pediatrics. Subsequently, we proposed 24 recommendations to improve the transition of patients with IEiM.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502548"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793876","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":"Real-world impact of oral semaglutide on inflammatory markers in patients at high cardiovascular risk","authors":"S. Mariscal Vázquez ,&nbsp;C. Jiménez-Méndez ,&nbsp;A. Pérez Asensio ,&nbsp;Etelino Silva ,&nbsp;P. Rodríguez Delgado ,&nbsp;L. García Fernández ,&nbsp;M. del Rocio Bulo Concellón ,&nbsp;J.A. Panera de la Mano ,&nbsp;A. Garrido Vital ,&nbsp;G. Calle Pérez","doi":"10.1016/j.rceng.2026.502562","DOIUrl":"10.1016/j.rceng.2026.502562","url":null,"abstract":"<div><h3>Background and objective</h3><div>Inflammation plays a central role in the pathophysiology of atherosclerosis and contributes to residual cardiovascular risk (CVR). High-sensitivity C-reactive protein (hs-CRP) and fibrinogen are considered key biomarkers in this context. Although GLP-1 receptor agonists have demonstrated anti-inflammatory effects, real-world evidence on oral semaglutide is limited. The objective of this study was to evaluate the impact of oral semaglutide on inflammatory markers in patients with high cardiovascular risk (CVR) in routine clinical practice.</div></div><div><h3>Materials and methods</h3><div>This was an observational study that included adult patients receiving treatment with oral semaglutide. The primary endpoint was the change in hs-CRP and fibrinogen levels. Secondary objectives included evaluating modifications in glycated hemoglobin (HbA1c), safety, and predictors of sustained anti-inflammatory response, defined as hs-CRP ≤ 2 mg/L.</div></div><div><h3>Results</h3><div>A total of 164 patients were included (mean age 68 ± 9 years; 37.6% women). After a mean follow-up of 370 ± 42 days, hs-CRP decreased from 6.7 ± 9.1 mg/L to 2.9 ± 6.1 mg/L (<em>p</em> &lt; 0.001) and fibrinogen decreased from 428 ± 130 mg/dL to 370 ± 113 mg/dL (<em>p</em> &lt; 0.001). Sixty percent (60%) achieved hs-CRP ≤ 2 mg/L, with a favorable safety profile. In multivariate analysis, baseline hs-CRP and continuity of semaglutide treatment emerged as independent predictors of hs-CRP ≤ 2 mg/L.</div></div><div><h3>Conclusions</h3><div>Under real-world conditions, treatment with oral semaglutide significantly reduced hs-CRP and fibrinogen levels in patients with high CVR. This effect may help to explain the cardiovascular benefit observed in clinical trials.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502562"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825418","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":"Ketone elevation during SGLT2 inhibitor therapy is driven by acute illness rather than treatment indication","authors":"M. Constanti ,&nbsp;V. Liakopoulos ,&nbsp;K. Kotsa ,&nbsp;T. Koufakis","doi":"10.1016/j.rceng.2026.502565","DOIUrl":"10.1016/j.rceng.2026.502565","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502565"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848380","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":"Community-acquired pneumonia: assessment of therapeutic adequacy in patients admitted to a secondary-level hospital","authors":"A. Silva Asiain ,&nbsp;M. Arrondo Turrado ,&nbsp;M.A. Domínguez Sepúlveda ,&nbsp;P. Bermejo Acevedo ,&nbsp;R. Barba Martín ,&nbsp;J.A. Rueda Camino","doi":"10.1016/j.rceng.2026.502563","DOIUrl":"10.1016/j.rceng.2026.502563","url":null,"abstract":"<div><h3>Background</h3><div>there is limited evidence regarding the appropriateness of therapeutic management for community-acquired pneumonia (CAP) in Spain. This study assessed treatment adequacy according to the 2019 IDSA guidelines.</div></div><div><h3>Materials and methods</h3><div>retrospective cohort study involving adults hospitalized for CAP between January–December 2022, excluding nosocomial pneumonia and ICU admissions. Treatment was considered adequate if antibiotic type, duration, and dosage were appropriate. The primary outcome was the proportion of patients receiving adequate treatment. Secondary outcomes included length of stay and hospital costs.</div></div><div><h3>Results</h3><div>382 patients (50% male, mean age 74.24 ± 16.62 years) were included; 17.8% (95% CI: 14.1%–22.0%) received adequate treatment. Patients with adequate treatment exhibited a significantly shorter hospital stay (–1 day, 95% CI: –1.7 to –0.3) and significantly lower hospital costs (–545;, 95% CI: –1081; to –9;).</div></div><div><h3>Conclusion</h3><div>therapeutic adequacy among hospitalized patients with CAP is low.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502563"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848391","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":"Generalized ostraceous psoriasis","authors":"Julio C. Salas-Alanís ,&nbsp;Pablo Martínez-Fernández ,&nbsp;Gerardo Rivera-Silva","doi":"10.1016/j.rceng.2026.502570","DOIUrl":"10.1016/j.rceng.2026.502570","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502570"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793865","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 2026 consensus document. Planning the future of Internal Medicine: A position statement of the International Forum of Internal Medicine (FIMI)","authors":"P. Valdez ,&nbsp;L. Cámera ,&nbsp;H.L. Puello Galarcio ,&nbsp;D. Manfellotto ,&nbsp;A. Fadhil Hlaihel ,&nbsp;F. Benmediouni ,&nbsp;D. Johnson ,&nbsp;G. Dalekos ,&nbsp;E. Casariego-Vales ,&nbsp;en nombre del Grupo de trabajo Futuro de la Medicina Interna (FIMI)","doi":"10.1016/j.rceng.2026.502572","DOIUrl":"10.1016/j.rceng.2026.502572","url":null,"abstract":"<div><div>The International Forum of Internal Medicine (FIMI) presents a position paper that analyzes the current state and projects the future of Internal Medicine in a global context marked by population aging, multimorbidity, fragmentation of health systems, and rapid technological transformation. The document emerged from a collaborative process involving 52 scientific societies from 43 countries, with representation from all five continents. Drawing on Ibero-American research and the consensus of international leaders, it describes the central role of the internist in comprehensive, longitudinal, and person-centered care for adults, particularly those with complex conditions. Key strengths are identified, including integrative clinical reasoning and interdisciplinary coordination, alongside persistent weaknesses such as heterogeneity in training, adverse working conditions, and professional burnout. The challenges and opportunities posed by telemedicine, point-of-care ultrasound, and artificial intelligence are also examined. Finally, a structured Improvement Plan is proposed, encompassing clinical care, education, research, management, and professional well-being.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 6","pages":"Article 502572"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848422","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}