BACKGROUND:Hepatitis C virus (HCV) has significantly impacted people with human immunodeficiency virus (HIV). Harm reduction programs, changing transmission patterns, and direct-acting antivirals (DAAs) have profoundly altered HIV/HCV coinfection trends. This study evaluates HCV prevalence among people with HIV in Spain over 2 decades. METHODS:We conducted 9 cross-sectional studies (2002-2023) in 39-43 centers. Sampled individuals were randomly sampled from people with HIV actively followed up at these centers, with proportional allocation. Main outcomes included the prevalence of anti-HCV antibody and active HCV infection (HCV RNA--positive result). RESULTS:The reference population ranged from 31 800 to 47 006, with sample sizes of 1260-1867. HIV transmission patterns shifted from 2002 to 2023, with injection drug use decreasing from 55% to 21% and the proportion of men who have sex with men increasing from 17% to 46%. HCV seroprevalence fell from 60.8% to 27.4%, and active infection from 46.3% to 0.9%. In the DAA era (2015-2023), active HCV infection dropped by 100% in heterosexuals, 94% in people who inject drugs, and 71% in men who have sex with men. Treatment uptake increased from 23% in 2002 to 99% by 2023 with all-oral DAAs. The prevalence of cirrhosis among active HCV cases peaked at 23.1% in 2015 but fell to 0% by 2021. Among those achieving sustained virologic response, cirrhosis prevalence was 20.4% in 2023. CONCLUSIONS:HIV/HCV coinfection has drastically declined in Spain, with active HCV infection prevalence <1% since 2021. DAAs were pivotal in this achievement. However, cirrhosis remains a concern among those with sustained virologic response. Ongoing surveillance and prevention efforts are essential to sustain these gains and address residual risks.
Artificial intelligence (AI) is reshaping modern medicine, and gastroenterology and hepatology are among the specialties where its impact is becoming increasingly evident. AI has demonstrated the ability to process and analyze large amounts of clinical, radiological, endoscopic, and multi-omics data, offering unprecedented opportunities to enhance diagnostic accuracy, optimize therapeutic decision-making, and reduce variability in clinical practice. In endoscopy, computer-aided detection and diagnosis systems have shown consistent improvements in adenoma detection rates and real-time polyp characterization, while in hepatology, machine learning models outperform traditional scores for non-invasive assessment of liver fibrosis. Furthermore, multimodal approaches integrating genomics, microbiome, and imaging data are paving the way for precision medicine in inflammatory bowel disease and other complex digestive conditions. Despite these promising advances, significant barriers remain. The quality and heterogeneity of training data, the lack of rigorous external validation, and the opaque “black box” nature of many algorithms limit their clinical reliability. Ethical challenges, including accountability in case of diagnostic errors, protection of patient privacy, cost, and equitable access, also need to be addressed. This narrative review summarizes the current applications of AI in gastroenterology and hepatology, critically examines methodological and ethical challenges, and outlines future perspectives. Responsible, transparent, and equitable implementation will be essential for AI to transition from an emerging promise to a consolidated tool that improves outcomes and advances personalized digestive care.
In a large multicenter real-world cohort, we aimed to evaluate outcomes of FLAG-Ida salvage therapy for relapsed/refractory (R/R) acute myeloid leukemia (AML) and validated the SALFLAGE prognostic score. We analyzed 1079 adults with R/R AML treated across 112 PETHEMA institutions over 26 years (1998-2024), including patients with primary refractory disease (36.9%) and first relapse episode (63.1%), with a median age of 52 years. Complete remission composite (CRc) was achieved 56.8%, including complete remission (CR) in 51.0%, CR with incomplete recovery in 4.0%, and morphological-free-state in 1.8%, enabling 35.2% of patients and 62% of responders to proceed to allogeneic transplantation without morphological disease. With median follow-up of 50.9 months, median overall survival (OS) was 10.2 months, with 5-year OS rate of 21.6%. Prior allogeneic transplantation (HR 0.54; p < 0.001) and relapse-free interval ≥ 1 year (HR 0.75; p = 0.024) independently predicted improved OS, whereas modified high-risk cytogenetics including t(8; 21) (HR 3.58; p < 0.001), FLT3-ITD mutation at primary diagnosis (HR 1.61; p < 0.001), and age ≥ 60 (HR 1.43; p < 0.001) conferred inferior OS. Validation of the SALFLAGE score demonstrated moderate discrimination (C-index 0.67), with 5-year survival of 38.4%, 27.2%, and 12.7% across risk categories (p < 0.001). Outcomes improved over periods (1998-2005 vs. 2006-2016 vs. 2017-2024): 30-day mortality was 6.9% vs. 9.3% vs. 5.0%, respectively (p = 0.030), and median OS was 7.8 versus 9.4 versus 11.1 months, respectively (p = 0.16). We confirm FLAG-Ida as a reference salvage regimen in fit R/R AML and validate the SALFLAGE score in this setting.
INTRODUCTION:Seizure emergencies pose significant clinical and healthcare challenges in Spain, impacting morbidity, mortality, and resource utilization. Comprehensive data on epidemiology, clinical outcomes, and economic impact remain limited. METHODS:A systematic review was conducted following the Centre for Reviews and Dissemination (CRD), Cochrane, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Embase, PubMed, and CINAHL were searched (January 2010-April 2025) for observational studies on epileptic seizure emergencies in Spain. Study selection, data extraction, and risk of bias assessment (ROBINS-I) were performed independently by two reviewers. Given reporting heterogeneity, a descriptive narrative synthesis was undertaken. RESULTS:Forty-seven observational studies identified 16 population groups. The analysis focuses on two groups with the most comprehensive data: status epilepticus (SE), epileptic seizures at the emergency department; and in pediatric populations. SE patients experienced extended seizure duration (8-51 h), in-hospital mortality averaging 24.3%, intensive care unit (ICU) admissions between 17% and 48%, and hospital stays up to 24 days, indicating substantial resource utilization. Patients with epileptic seizures at the emergency department exhibited hospitalization rates between 6-32% and medical complications between 19.4% and 52.1%. Pre-hospital benzodiazepines use was between 11 and 38%. Pediatric likely underrepresented populations had lower mortality but frequent emergency visits. No studies assessed quality of life or indirect costs; one reported direct cost in SE. CONCLUSION:Reporting of seizure emergencies in Spain is heterogeneous and biased toward severe cases, likely overestimating per-patient burden while underestimating population impact. Broader data capture and improved early management could inform planning and reduce overall burden.
La calidad asistencial en Psicología Clínica carece de estándares e indicadores propios dentro del sistema público, dificultando la planificación y mejora de los servicios. Se realizó un estudio descriptivo transversal mediante una encuesta online y anónima dirigida a los Psicólogos Especialistas en Psicología Clínica (PEPC) del Servicio de Salud de Castilla-La Mancha (SESCAM). Participaron 66 de los 138 profesionales convocados (47,8%). Se evidencian déficits estructurales como la escasez de profesionales, tiempos de espera elevados, duración insuficiente de las consultas y limitadas condiciones materiales y organizativas. Los profesionales expresan una alta insatisfacción con aspectos clave de la práctica clínica y una limitada participación en funciones de gestión y toma de decisiones. Los resultados reflejan una sobrecarga estructural que afecta tanto a la calidad de la atención como al bienestar profesional. Se plantea la necesidad de incrementar la ratio de PEPC, incorporar la especialidad en Atención Primaria, mejorar las condiciones laborales y establecer indicadores propios de calidad asistencial. Estas medidas permitirían una atención psicológica más accesible, equitativa y eficaz.
