Carlos Sanchez-Piedra

FUNDAMENTOS // El análisis de la impedancia bioeléctrica (BIA) es una técnica no invasiva que permite estimar diferentes compartimentos corporales, como la masa grasa, la masa libre de grasa y el agua corporal total, y podría complementar la información proporcionada por las medidas antropométricas tradicionales. El objetivo de esta revisión sistemática fue sintetizar la evidencia disponible sobre la validez del BIA para la evaluación de la composición corporal en niños, niñas y adolescentes, así como identificar los factores que condicionan su rendimiento. MÉTODOS // Se realizó una revisión sistemática de métodos diagnósticos siguiendo las recomendaciones Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA). En febrero de 2025 se realizaron búsquedas en PubMed, EMBASE y Cochrane Library de estudios publicados entre 2010 y 2024. Se incluyeron estudios de validación en participantes menores de dieciocho años que compararan el BIA con métodos de referencia, como absorciometría dual de rayos X (DXA), dilución isotópica, pletismografía por desplazamiento de aire o modelos multicompartimentales. Dos revisores realizaron de forma independiente el cribado de los estudios y la extracción de la información relevante. El riesgo de sesgo se evaluó mediante QUADAS-2 y los resultados se sintetizaron de forma narrativa. RESULTADOS // Se incluyeron cincuenta y seis estudios; en cincuenta y tres con tamaño muestral cuantificable participaron aproximadamente 11.100 sujetos. Se observaron correlaciones muy variables (r=0,03–0,98), más altas cuando se emplearon ecuaciones derivadas en poblaciones similares y más bajas en obesidad, deportistas, lactantes o grupos clínicos, especialmente con ecuaciones genéricas. Los análisis de acuerdo mostraron discrepancias relevantes a nivel individual. En sobrepeso/obesidad, el BIA tendió a subestimar porcentaje de grasa/masa grasa y a sobreestimar masa libre de grasa. La fiabilidad fue alta (ICC: aproximadamente 0,93–0,98). CONCLUSIONES // La evidencia disponible respalda que el BIA es una herramienta no invasiva, reproducible y fiable, útil para la estimación grupal, la vigilancia y, especialmente, el seguimiento longitudinal de la composición corporal en población pediátrica. No sustituye al índice de masa corporal ni a los métodos de referencia, y su desempeño depende de forma crítica del dispositivo, la ecuación empleada y el contexto clínico, por lo que en extremos de composición corporal se recomienda cautela y el uso de ecuaciones específicas. Aun así, por su factibilidad y capacidad para monitorizar cambios, el BIA puede aportar información complementaria sobre la composición corporal y contribuir a un abordaje más centrado en la salud y el riesgo cardiometabólico en la obesidad en la población infantil, siempre que los resultados se interpreten y comuniquen adecuadamente. REGISTRO // PROSPERO CRD420261305127 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420261305127).

Background/Objectives: Artificial intelligence tools have emerged as promising methodological support for systematic reviews and health technology assessment (HTA). Smart infusion pump interoperability represents a relevant case study due to its implications for medication safety, nursing workflow, and hospital quality improvement. The aim was to evaluate the performance of artificial intelligence as a methodological support tool across a systematic review, using the evidence synthesis on smart infusion pump–electronic health record interoperability as a case study. Methods: A systematic review following PRISMA 2020 guidelines was conducted. Searches were performed in MEDLINE, Embase, and Cochrane Library databases. AI-assisted tools (ChatGPT GPT-4 and Open Science Reviewer) were incorporated into data extraction, reporting appraisal based on STROBE criteria, and exploratory identification of methodological limitations under strict human supervision. Concordance between AI-assisted and manual extraction was evaluated descriptively. Results: Overall concordance between AI-assisted and manual data extraction was 82.5% (99/120) across assessed variables. Agreement was highest for structured variables, including study design (10/10; 100.0%), study identification variables (19/20; 95.0%), and participant characteristics (36/40; 90.0%). Agreement was lower for study content variables (18/30; 60.0%) and methodological appraisal (16/20; 80.0%). Among the 21 discrepancies, misclassification errors were most common (13/21; 61.9%), followed by omissions (3/21; 14.3%), incomplete data (3/21; 14.3%), and hallucinations (2/21; 9.5%). AI-assisted identification of methodological limitations showed substantial descriptive agreement with human assessments but demonstrated limited capacity for judgmental interpretations. Conclusions: Artificial intelligence demonstrated utility for structured review tasks such as data extraction and reporting appraisal, but showed limitations in tasks requiring interpretative and methodological judgement. Human oversight therefore remains essential throughout the review process. These findings derive from a single case study and should not be generalised beyond the evaluated context and AI tools.

This study evaluates ASReview, an open-source machine learning application for study selection in systematic literature reviews, using data from a review of whether screening for sexually transmitted infections reduces the incidence of pelvic inflammatory disease. A systematic literature review was conducted in accordance with the PRISMA guidelines, and manual screening produced a fully labeled dataset that served as the reference standard. ASReview was configured with four machine learning classifiers (Naïve Bayes, Random Forest, Support Vector Machines, and Logistic Regression) and two feature extraction methods (TF-IDF and Doc2Vec). Simulation experiments assessed screening efficiency under sampling-based and heuristic stopping rules. The systematic review suggested that annual screening for sexually transmitted infections may reduce the incidence of pelvic inflammatory disease by up to 40% compared with routine practice, although the evidence base was limited. In the simulation experiments, Naïve Bayes with TF-IDF achieved the highest recall and screening efficiency, particularly in datasets with a low prevalence of relevant records. Conservative stopping rules increased the likelihood of complete retrieval but required greater screening effort. Overall, these findings highlight the limited and heterogeneous evidence on sexually transmitted infection screening for pelvic inflammatory disease prevention and show that ASReview may improve the efficiency of study selection when evaluated within a real systematic review workflow.

Objective: To identify key clinical and therapeutic predictors of malignancy in a well‐characterized, multicenter Spanish cohort of patients with Sjögren's disease (SjD). Methods: A retrospective, cross‐sectional study was conducted using data from the SjögrenSER‐TRANS registry, a national cohort of 437 SjD patients from 33 Spanish hospitals who fulfilled the 2002 AECG classification criteria. Clinical, serological, and treatment‐related variables were systematically collected. Descriptive statistics were used to summarize demographic and clinical characteristics. Bivariate analysis (chi‐squared for categorical variables and t ‐tests for continuous variables) was performed to identify associations with malignancy ( p < 0.05), followed by multivariate logistic regression to determine independent predictors. Results: Malignancy was identified in 30 patients (6.86%), with gynecological cancers (30%) and lymphomas (23.3%) being the most common types. Independent predictors of malignancy included older age (OR 1.042, 95% CI 1.007–1.079), glandular inflammation (OR 2.888, 95% CI 1.281–6.512), and rituximab use (OR 3.959, 95% CI 1.461–10.730). Conclusion: This study underscores the role of older age, glandular inflammation, and rituximab use as key risk factors for malignancy in SjD. However, the association with rituximab should be interpreted with caution, as indication bias cannot be ruled out. These findings emphasize the need for improved risk stratification and targeted surveillance strategies to facilitate early detection and enhance malignancy management in clinical practice. Prospective studies are warranted to refine monitoring protocols and optimize patient outcomes.

Background: Patient satisfaction is a key indicator of healthcare system performance and legitimacy. Understanding its determinants provides valuable insights for policy design. To identify healthcare-related and socioeconomic determinants at both the individual and contextual levels (including regional indicators such as healthcare expenditure, physician density, life expectancy, and poverty rate) associated with satisfaction with the Spanish public healthcare system, and to assess changes in satisfaction levels before and after the COVID-19 pandemic. Methods: We conducted a cross-sectional analysis using nationally representative data from the Spanish Healthcare Barometer for the years 2018, 2019, 2022, and 2023. Individual-level data were linked with regional-level indicators, aggregated at the level of Spain’s autonomous communities, including public healthcare expenditure, physician density, life expectancy, and poverty rate. Descriptive statistics were used to examine temporal trends. For descriptive purposes, overall satisfaction was analyzed using the original 1–10 scale. For multivariate analysis, satisfaction was operationalized as a three-category ordinal outcome (low, moderate, and high satisfaction). Additional models included interaction terms with the pandemic period, defined as surveys conducted from March 2020 onwards, to assess changes in determinants over time. Results: The final sample included 29,146 adult respondents. Based on the original 1–10 scale, overall satisfaction declined significantly following the pandemic (from 6.66 to 6.26; p < 0.001), indicating a negative shift in public perception after COVID-19. Higher satisfaction was associated with better self-rated health, lower frequency of healthcare visits, and recent utilization of public healthcare services, including hospital, specialist, and emergency care. Sociodemographic factors such as being female, younger, and born outside of Spain were also positively associated with satisfaction. Lower satisfaction was observed among individuals with chronic conditions, lower socioeconomic status, or limited educational attainment. Contextual variables showed weaker associations, with only life expectancy exhibiting a significant positive relationship. Conclusions: Satisfaction with the Spanish healthcare system is primarily shaped by individual characteristics and experiences, with only limited evidence of associations with broader contextual indicators. The post-pandemic decline in satisfaction highlights the need for targeted policies that improve responsiveness, equity, and user confidence in public healthcare services.

Background: Teen pregnancy and psychoactive substance use represent some of the factors that can have a negative impact on children's development. Objetives: To explore the effect of the prevalence of drug, alcohol and tobacco use in the different federative entities in Mexico and children with adolescent mothers on the early childhood development (ECD). Methods: Observational study. ECD was evaluated with the Early Childhood Development Index (ECDI) using the 2015 National Survey of Boys, Girls and Women. The prevalence of psychoactive substance use was estimated using the 2016 National Survey of Drug, Alcohol and Tobacco use. Association of ECD with different characteristics of the environment where the children resided was explored using a multilevel logistic regression model. Results: The average age for an adolescent mother was 18 years and for an adult mother it was 28 years. The population is characterized by a higher percentage of children who attend early education, have support for learning, have three or more books and receive adequate care. The children with adolescent mothers (aOR = 1.54, 95% CI: 1.03–2.31) the prevalence of ilegal drug use use (aOR = 1.16, 95% CI: 1.02–1.32) and number of homicides (aOR = 1.18, 95% CI: 1.03–1.36) were factors associated with inadequate ECD. Finally, population density was negatively associated with inadequate ECD (aOR = 0.91, 95% CI: 0.88–0.95). Conclusion: In Mexico, children with adolescent mothers and children with inadequate ECD prevail in populations in a situation of vulnerability. These findings can be useful to design public policies that consider the individual and social context of children and their mothers.

This study aimed to evaluate the therapeutic adherence to antiretroviral therapy (ART) and the cost of care for people living with HIV (PLwHIV) in the Condesa Specialized Clinics (CSCs). A cross-sectional observational study was conducted using the Adherence Follow-Up Questionnaire developed by The AIDS Clinical Trials Group (ACTG) to measure adherence in 261 PLwHIV. An economic Markov model was developed to simulate clinical outcomes, health costs, and quality-adjusted life years (QALYs) over a 5-year horizon from the CSC perspective. The mean adherence index was 89.97, and 59% of the surveyed PLwHIV were non-adherent, but more than 95% of the population had an undetectable viral load, suggesting that ART remains effective in achieving clinical goals, even under suboptimal adherence conditions. More than half of the surveyed PLwHIV (60.54%) stated that they had stopped taking their ART at some point, and the three most frequent causes were forgetting (49.37%), being away from home (45.57%), and having a change in their daily routine (25.95%). The economic model showed a cumulative cost per PLwHIV of USD 8432 and 3.80 QALYs (USD 2218/QALYs), which is below the threshold of willingness to pay in Mexico (USD 13,790/QALY). These findings provide valuable information to guide public health decisions and resource allocation in HIV management in Mexico.

To assess the efficacy of electrical impedance tomography (EIT)-guided positive end-expiratory pressure (PEEP) titration in improving outcomes for patients with acute respiratory distress syndrome (ARDS). A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials and observational studies with a control group comparing EIT-guided PEEP titration to other strategies were included. Endpoints analysed included mortality, days of mechanical ventilation (MV), intensive care unit (ICU) length of stay (LOS), weaning success rate, barotrauma, driving pressure (∆P), mechanical power (MP), Sequential Organ Failure Assessment (SOFA) score and adverse events. Pooled results were presented as Risk Ratio (RR) for dichotomous outcomes and standardized difference in means (SMD) for continuous outcomes. A total of 4 studies were identified (3 randomized controlled trials and one observational study). All studies were single-center studies (N total = 271 patients). The main limitations were related to potential bias in selecting reported outcomes. EIT-guided PEEP titration was associated with a significant reduction in mortality among critically ill patients with ARDS (RR = 0.64, 95% CI: 0.45–0.91). No significant differences were found in other outcomes. Our findings suggest that EIT may be a valuable tool for PEEP titration in critically ill patients with ARDS. By optimizing lung mechanics, EIT-guided PEEP titration may potentially reduce mortality rates. While larger, multicenter studies are needed to definitively establish the clinical role of EIT in ARDS management, our results provide promising evidence for its potential clinical impact.