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Outcomes and effect of somatic mutations after erythropoiesis stimulating agents in patients with lower-risk myelodysplastic syndromes.
No full text20.500.12530/87887Erythropoiesis stimulating agents (ESAs) are the first-line therapy in patients with lower-risk myelodysplastic syndromes (LR-MDS). Some predictive factors for ESAs response have been identified. Type and number of somatic mutations have been associated with prognosis and response to therapies in MDS patients. The objective was to evaluate the outcomes after ESAs in patients with LR-MDS and to address the potential predictive value of somatic mutations in ESAs-treated patients. Multi-center retrospective study of a cohort of 722 patients with LR-MDS included in the SPRESAS (Spanish Registry of Erythropoietic Stimulating Agents Study) study. Retrospective analysis of 65 patients with next generation sequencing (NGS) data from diagnosis. ESAs' efficacy and safety were evaluated in patients receiving ESAs and best supportive care (BSC). To assess the potential prognostic value of somatic mutations in erythroid response (ER) rate and outcome, NGS was performed in responders and non-responders. ER rate for ESAs-treated patients was 65%. Serum erythropoietin (EPO) level This large study confirms the beneficial effect of ESAs and the adverse effect of somatic mutations in patients with LR-MDS
Role and potential of 18F-fluorodeoxyglucose-positron emission tomography-computed tomography in large-vessel vasculitis: a comprehensive review.
No full text20.500.12530/87885Large-vessel vasculitis (LVV) is a group of diseases characterized by inflammation of the aorta and its main branches, which includes giant cell arteritis (GCA), polymyalgia rheumatica (PMR), and Takayasu's arteritis (TAK). These conditions pose significant diagnostic and management challenges due to their diverse clinical presentations and potential for serious complications. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG-PET-CT) has emerged as a valuable imaging modality for the diagnosis and monitoring of LVV, offering insights into disease activity, extent, and response to treatment. 18F-FDG-PET-CT plays a crucial role in the diagnosis and management of LVV by allowing to visualize vessel involvement, assess disease activity, and guide treatment decisions. Studies have demonstrated the utility of 18F-FDG-PET-CT in distinguishing between LVV subtypes, evaluating disease distribution, and detecting extracranial involvement in patients with cranial GCA or PMR phenotypes. Additionally, 18F-FDG-PET-CT has shown promising utility in predicting clinical outcomes and assessing treatment response, based on the correlation between reductions in FDG uptake and improved disease control. Future research should focus on further refining PET-CT techniques, exploring their utility in monitoring treatment response, and investigating novel imaging modalities such as PET-MRI for enhanced diagnostic accuracy in LVV. Overall, 18F-FDG-PET-CT represents a valuable tool in the multidisciplinary management of LVV, facilitating timely diagnosis and personalized treatment strategies to improve patient outcomes
C-reactive Protein and Risk of Right Ventricular Dysfunction and Mortality in Patients With Acute Symptomatic Pulmonary Embolism.
No full text20.500.12530/87854Right ventricle (RV) dysfunction increases the risk of death from pulmonary embolism (PE). C-reactive protein (CRP) might identify RV inflammation and dysfunction in patients with PE. This cohort study enrolled consecutive stable patients with acute PE between 2017 and 2023. We stratified patients by quartiles of CRP. We evaluated the association between CRP quartiles and the presence of RV dysfunction, and used multivariable models to assess for an association between CRP and the outcomes of all-cause and PE-specific mortality during the 30 days of follow-up after PE diagnosis. The study included 633 stable patients with PE. Patients without RV dysfunction had significantly lower median (IQR) CRP levels compared with patients with RV dysfunction (n=509, 31.7 [10.0-76.4]mg/L vs n=124, 45.4 [16.0-111.4]mg/L; P=0.018). CRP showed a statistically significant positive association with the presence of RV dysfunction (P As an indicator of RV dysfunction, CRP may improve risk stratification algorithms for hemodynamically stable patients with acute symptomatic PE
Validation and Psychometric Properties of the Spanish Version of King's Parkinson's Disease Pain Scale
No full text20.500.12530/87893Objective: To assess the psychometric properties of the Spanish King's Parkinson's Disease Pain Scale (KPPS).Design: A descriptive transversal study at a Spanish hospital.Methods: Fifty-three Parkinson's disease (PD) patients suffering from otherwise explained pain (34 females, age = 63.42 +/- 10.52 years, time with disease = 7.25 +/- 4.65 years) were evaluated by the KPPS, Brief Pain Inventory (BPI), two Pain Pressure Thresholds (PPTs), Widespread Mechanical Hyperalgesia (WMH), and Conditioned Pain Modulation (CPM). A retest of the KPPS was performed 7-15 days later. Internal consistency, test-retest reliability (intraclass correlation coefficient (ICC)), measurement error, factor structure, and criterion/convergent validity were assessed.Results: Internal consistency of the Spanish KPPS was acceptable (Cronbach's alpha = 0.77). The mean test and retest total KPPS scores were similar (test = 34.83 +/- 23.50 points, retest = 35.87 +/- 26.23 points), and test-retest reliability was good (ICC = 0.85, 95% CI = 0.75-0.91). Standard error of measurement (SEM) was 9.1 points and smallest detectable change (SDC) was 25.22 points. The sampling adequacy was not sufficient to perform factor analysis. The total KPPS score was not correlated to the BPI intensity subscale (r = 0.18, p=0.19), but it was moderately and positively correlated to the interference subscale (r = 0.43, p=0.001). The total KPPS was moderately and negatively correlated to both the remote PPT (r = -0.4, p=0.003) and WMH (r = -0.38, p=0.005). No statistical correlations were found with local PPT or CPM.Conclusion: The present study provides evidence that the Spanish KPPS effectively measures pain in individuals with PD, with its total score demonstrating good reliability, minimal measurement error, and adequate criterion and convergent validity
Immigrant Health and Early-Onset Colorectal Cancer Disparities: Results From the Spanish Early-Onset Colorectal Cancer Consortium.
No full text20.500.12530/87858To better understand immigration disparities among a Spanish Early-Onset Colorectal Cancer (SECOC) subset, according to the country of origin. We selected 250 consecutive participants from the SECOC consortium. Data on baseline patient and tumor characteristics, family history of colorectal cancer (CRC), and follow-up were collected. The presence of mismatch repair deficiency was also assessed. Special data regarding country of origin, time of stay in Spain in case of other different country, and a 10-year cutoff that specifies the obtaining of Spanish nationality defined the variables of interest for comparison. Seventy-five percent of patients with early-onset CRC (EOCRC) (188) were born in Spain, whereas the other 25% were born outside of Spain. The mean time of living in Spain until the EOCRC diagnosis was 16.5 years. Comparatively, most of the analyzed features showed equivalent proportions between cohorts. Only Spanish patients appeared to have more familial cancer component in first degree in general (32.3%; P = .01), compared with non-Spaniards, which showed a predominant sporadic component (56.4%; P Although there were few differences between Spanish and non-Spanish EOCRC, the most remarkable difference was that linked with the situation of those immigrants who have recently arrived in Spain, in relation to their lower health coverage, which could be associated with the delay in the diagnosis and their subsequent worse prognosis
Development and validation of a prediction model for consistency of pituitary adenoma: the PiTCon score.
No full textPituitary adenomas (PAs) usually have a soft consistency, facilitating gross total resection. However, 5-13% of PAs with fibrous consistency are challenging to remove entirely and are accompanied by greater morbimortality. This study aims to identify the clinical and radiological characteristics that correlate with PA fibrous consistency preoperatively. A simple scoring system has been proposed to predict incidence of fibrous PAs. Consecutive interventions (226) were analyzed, all performed through an endoscopic endonasal transsphenoidal approach. Univariable and multivariable logistic regression analysis was performed. Hosmer-Lemeshow test and receiver operating characteristic (ROC) curves were assessed to evaluate the model. A point scoring system (PiTCon) was derived based on the multivariable regression model. Our study aimed to identify the clinical and radiological characteristics that correlate with fibrous tumor consistency preoperatively. The best diagnostic accuracy for predicting PA consistency consisted of five predictive factors: age, compressive symptoms, panhypopituitarism, craniocaudal extension of the PA in mm, and prior surgery. The multivariable model achieved good discrimination with an area under the curve (AUC) of the ROC curve being 0.82 and the 95% CI 0.76 to 0.88. Internal validation yielded an optimism-adjusted C-statistic of 0.80 (95% CI 0.74 to 0.86). A point scoring system (PiTCon score) was designed using the best predictive model. PA consistency can be estimated preoperatively regarding clinical and radiological characteristics. We propose a point-based scoring system (PiTCon score) that can better guide neurosurgeons in clinical decision-making and surgical risk assessment and help establish and describe patient prognosis
Role of compliance in Helicobacter pylori eradication treatment: Results of the European Registry on H. pylori management.
No full text20.500.12530/87885Adherence to Helicobacter pylori (H. pylori) eradication treatment is a cornerstone for achieving adequate treatment efficacy. To determine which factors influence compliance with treatment. A systematic prospective non-interventional registry (Hp-EuReg) of the clinical practice of European gastroenterologists. Compliance was considered adequate if ≥90% drug intake. Data were collected until September 2021 using the AEG-REDCap e-CRF and were subjected to quality control. Modified intention-to-treat analyses were performed. Multivariate analysis carried out the factors associated with the effectiveness of treatment and compliance. Compliance was inadequate in 646 (1.7%) of 38,698 patients. The non-compliance rate was higher in patients prescribed longer regimens (10-, 14-days) and rescue treatments, patients with uninvestigated dyspepsia/functional dyspepsia, and patients reporting adverse effects. Prevalence of non-adherence was lower for first-line treatment than for rescue treatment (1.5% vs. 2.2%; p Compliance with Helicobacter pylori eradication treatment is very good. Factors associated with poor compliance include uninvestigated/functional dyspepsia, rescue-treatment, prolonged treatment regimens, the presence of adverse events, and the use of non-bismuth sequential and concomitant treatment. Adequate treatment compliance was the variable most closely associated with successful eradication
Design of an international, phase IV, open-label study of simoctocog alfa in women/girls with hemophilia A undergoing surgery (NuDIMENSION).
No full text20.500.12530/87913Although hemophilia A mainly affects males, carriers (defined as females with hemophilia A, as well as symptomatic or asymptomatic hemophilia A carriers) are at risk of excessive bleeding, particularly during trauma or during surgical procedures. Clinical trials have focused on male patients with severe disease, and data for females are limited. Improved, evidence-based treatment guidelines for management of hemophilia A carriers are required. The NuDIMENSION study is a phase IV, prospective, open-label, single-arm study that will evaluate the perioperative efficacy and safety of simoctocog alfa (Nuwiq®), a recombinant factor VIII (FVIII), in women/girls with hemophilia A undergoing major surgery. The study will be conducted at approximately 15 centers worldwide. Women/girls aged ⩾12 years, with mild or moderate hemophilia A (residual FVIII activity (FVIII:C) ⩾1% to The primary endpoint is overall perioperative hemostatic efficacy ("success" or "failure") of simoctocog alfa. Hemostatic efficacy will be assessed at the end of surgery and at the end of the postoperative period (i.e., completion of wound healing), with overall adjudication by an Independent Data Monitoring Committee. Safety endpoints will include the incidences of thrombotic events and FVIII inhibitor development. The aim is to recruit 28 patients to achieve 26 evaluable surgeries. Ethical approval will be received from institutional review boards/independent ethics committees, and the study will be conducted in compliance with the Declaration of Helsinki. Data from NuDIMENSION will generate much-needed evidence on surgical management of women/girls with hemophilia A, which will help to enable the development of treatment guidelines specific for such patients. CT EU 2022-502061-17-00; NCT05936580
Influence of surgical timing on the visual prognosis of patients suffering from a pituitary apoplexy with visual impairment.
No full text20.500.12530/87857Pituitary apoplexy is a clinical syndrome that can cause vision loss and oculomotor (OM) deficits. Neurosurgical decompression is still considered the treatment of choice for those with visual impairment. We aim to explore the influence of timing of neurosurgical decompression on visual outcome. Multicentre retrospective study of patients presenting with pituitary adenoma and pituitary apoplexy who were operated in three Spanish tertiary hospitals between 2008 and 2022. We identified 49 patients with pituitary apoplexy with visual symptoms and were operated. Among the visual symptoms, 35 patients (73%) had visual acuity (VA) impairment and 33 (67%) had an OM nerve paresis. Twenty-three of the 35 patients improved their VA, and 24 of the 33 improved their OM nerve paresis after surgery. The median time between apoplexy to surgery was 10 days (range 0-164). Regarding visual acuity, 50% (3 out of 6) of those operated within 3 days of apoplexy showed improvement, compared to 69% (20 out of 29) of those operated beyond (p = 0.37).Regarding OM paresis, 62.5% (5 out of 8) of those operated within 3 days of apoplexy improved, compared to 76% (19 out of 25) of those operated beyond (p = 0.56).Mean apoplexy to surgery time was 18 ± 19 days in those whose VA improved (vs. 32 ± 51; p = 0.46); and mean apoplexy to surgery time for those whose OM symptoms improved was 21+/- 35 days (vs. 24 +/- 37; p = 0.86). Our results suggest that timing of neurosurgical decompression does not affect the visual outcome of patients with pituitary apoplexy
Sperm recovery from urine in men with retrograde ejaculation.
No full text20.500.12530/87857Retrograde ejaculation (RE) consists of the reflux backwards, towards the bladder, of the ejaculate, during the emission phase of ejaculation, causing a total or partial absence of sperm emission, with the consequent diversion of semen into the bladder during the emission phase of ejaculation. Evaluating the ejaculate may not be sufficient for identifying RE in some patients. Hence, the management of infertility may involve the use of invasive methods such as epididymal fluid retrieval or testicular biopsy. This paper defines RE and methods for its diagnosis. A description is also provided of the techniques used for the detection of sperm in post-ejaculatory urine (PEU), the preparation and retrieval of sperm from urine and their subsequent use in assisted reproductive techniques. The diagnosis of RE is based on the detection of spermatozoa in PEU in patients with aspermia or oligozoospermia and low or normal seminal volume. Although the presence of sperm in PEU could be sufficient for a diagnosis of RE, there is a lack of consensus regarding the diagnostic criteria for PEU, and the literature available is very limited. A correct diagnosis of RE allows the use of PEU for recovering sperm and its subsequent use in assisted human reproduction techniques, thus avoiding invasive techniques. A significant number of patients with RE may remain undiagnosed. Therefore, it is essential to conduct an RE study in patients with suspicion, through the analysis of PEU, and to properly interpret the results for accurate diagnosis