Articles publicats en revistes (Medicina)

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Prothrombotic platelet phenotype in major depression: downregulation by antidepressant treatment
(Elsevier B.V., 2014-04) López Vilchez, Irene; Serra Millàs, Montserrat; Navarro, Valentín; Hernández, Maria Rosa; Villalta Blanch, Jaume; Diaz Ricart, M. Isabel; Gastó Ferrer, Cristóbal; Escolar Albaladejo, Ginés; Galán, Ana María
Background: Serotonergic mechanisms have been suggested as a link between major depression and cardiovascular risk. We investigated the existence of a prothrombotic condition in depressed patients and its possible modulation during treatment with a selective serotonin-reuptake inhibitor (SSRI). Methods: Modifications in a series of biomarkers of platelet and coagulation activation were evaluated in blood from 19 patients with a major depression disorder (MDD) at the time of diagnosis, and at 8 and 24 weeks of treatment with escitalopram. Response of blood aliquots recirculated through a thrombogenic surface was assessed in a thrombosis model. Results were compared with those of 20 healthy-matched controls. Results: In comparison with controls, platelets from MDD patients showed elevated volumes (p<0.01), significantly enhanced aggregating response to arachidonic acid and augmented expression of GPIb, fibrinogen, factor V, and anionic phospholipids by flow cytometry (p<0.05). Clot firmness and procoagulant activity of platelet-associated tissue factor were also significantly elevated (p<0.05). Studies with circulating blood revealed increased fibrin formation in early diagnosed patients (71.1±9.5% vs. 45.8±5.3%; p<0.05 vs. controls). After 24 weeks of treatment with escitalopram, the majority of the alterations observed were normalized, except for a residual increased expression of GPIIbIIIa (p<0.05) and persistent alterations in thromboelatometic parameters. Limitations: Despite the reduced number of followed-up patients our findings were consistent reaching statistical significance. Conclusions: Our results reveal a prothrombotic phenotype in MDD patients. While continuous treatment with an SSRI downregulated the majority of the biomarkers analyzed, alterations in viscoelastic parameters of clot formation remained unaffected by the antidepressant treatment.
Association between symptomatic profile and remission following antidepressant treatment in unipolar major depression
(Elsevier B.V., 2013) Navarro, Valentín; González, Alejandro; Guarch, Joana; Penadés Rubio, Rafael; Torra, Mercè; Fañanás Saura, Lourdes; Arias Sampériz, Bárbara; Serra, Maria; Pintor Pérez, Luis; Gastó Ferrer, Cristóbal
Background: To evaluate, in patients affected by an acute major depressive episode, what predictive value certain baseline psychopathological characteristics have with regard to expected therapeutic remission following biological antidepressant treatment (pharmacological/electroconvulsive; non-psychological). Methods: Six predefined psychopathological characteristics in acute major depressive episode were evaluated using a logistic regression model through a protocolised antidepressant treatment to assess their predictive value with regard to expected remission rate. Results: The final study sample consisted of 129 subjects affected by an acute major depressive episode. From the baseline evaluation of the anguish/restlessness, reduced emotional reactivity, reduced attention, reduced motor response, feeling of worthlessness, and mood characteristics items, it was possible to correctly classify 88.1% of the sample as remitter/non-remitter with sensitivity of 0.77 and specificity of 0.96. Addition of the 17-item HRSD baseline variable to the regression model increased the capacity for correct classification of the baseline sample by only 0.09%. Limitations: Protocolised antidepressant treatment was used. The results of this study may not be generalisable to pharmacological treatments not included in this protocol. Conclusions: The results of this study suggest that certain baseline psychopathological characteristics (and perhaps other clinical variables too) of the acute major depressive episode may be of great use in establishing patient subgroups according to expected clinical remission to the administration of biological antidepressant treatment. This could have considerable consequences for individualised therapeutic decision-making and for future researches (clinical trials included).
Changes in plasma and platelet BDNF levels induced by S-citalopram in major depression
(Elsevier B.V., 2011) Serra-Millàs, Montserrat; López Vilchez, Irene; Navarro, Valentín; Galán, Ana María; Escolar, G.; Penadés Rubio, Rafael; Catalán Campos, Rosa; Fañanás Saura, Lourdes; Arias Sampériz, Bárbara; Gastó Ferrer, Cristóbal
OBJECTIVES: Compare BDNF levels in depressed patients and healthy controls in platelet poor plasma and in washed platelets. Observe the effects of 8 and 24 week treatment with S-citalopram on these levels. METHODS: We assessed the levels of BDNF in platelet poor plasma and in washed platelets from 18 major depression patients, and compared them with 14 healthy controls. Blood samples were obtained from patients before and during treatment (8 and 24 weeks) with a selective serotonin reuptake inhibitor, S-citalopram. RESULTS: A significant decrease in severity of depressive symptoms was observed from the first month of treatment with S-citalopram, and symptoms continued decreasing until the 6th month. Plasma BDNF levels in untreated patients appeared significantly increased (p<0.01), but reached values similar to those of controls at the 24th week. In contrast, levels of platelet BDNF appeared significantly decreased (p<0.05), but treatment also normalized levels so that values obtained were equivalent to those of controls. CONCLUSIONS: Untreated depressed patients showed increased plasma BDNF levels and decreased platelet BDNF levels, as compared with control subjects, and tend to normalize during treatment with S-citalopram for 24 weeks, with BDNF reaching levels similar to those in healthy controls at the 24th week in both samples. We observed that improvement in depressive symptoms was accompanied by normalization of plasma and platelet BDNF levels.
Managing Enterococcus faecium bloodstream infection: a Delphi document on clinical recommendations and research agenda
(Elsevier, 2026-05-02) Rinaldi, Matteo; Bartoletti, Michele; Cojutti, Piergiorgio; Escolà Vergé, Laura; Fernández Hidalgo, Nuria; Hornuss, Daniel; Gatti, Milo; Gudiol González, Carlota; Gutiérrez-Gutiérrez, Belén; López Cortés, Luis E.; Kern, Winfried V.; Los-Arcos, Ibai; Muñoz, Patricia; Oliva, Alessandra; Papadimitriou-Olivgeris, Matthaios; Pai, Manjunath; Pea, Federico; Pericàs, Juan M.; Rieg, Siegbert; Russo, Alessandro; Soriano Viladomiu, Alex; Thursky, Karin; Udy, Andrew; Venditti, Mario; Yahav, Dafna; Mo, Yin; Viale, Pierluigi; Giannella, Maddalena
Background: Management of E faecium bloodstream infections (BSIs) remains debated, particularly the clinical impact of vancomycin resistance, the role of follow-up cultures, and optimal therapeutic regimens. This study aimed to reach expert consensus on these unresolved clinical domains and identify priorities for future research. Methods: We first conducted a systematic review and meta-analysis in January 20, 204 focusing on four predefined areas: mortality in E faecium BSIs compared with other BSIs, mortality in vancomycin-resistant enterococci (VRE)-BSIs compared with vancomycin-susceptible enterococci-BSIs, management of catheter-related E faecium BSIs, and 4) optimal antibiotic therapy for VRE-BSIs. These results informed a three-round Delphi process involving a panel of experts. An iterative approach was adopted: 16 initial questions developed from the systematic review (6-point Likert scale) were refined across rounds based on expert feedback. Consensus was defined as at least 80% agreement or disagreement. Findings: 13 statements were generated across three broader domains. Regarding clinical outcomes and diagnostics, experts agreed that mortality is heavily influenced by comorbidities; thus, therapeutic assessment should rely on clinical trends and inflammatory markers, with follow-up blood cultures used to confirm eradication. Catheter-related BSI should be managed with device removal and short-course (<7 days) antibiotics in selected uncomplicated cases. For therapeutic management, teicoplanin is preferred for vanB VRE-BSI. For vanA VRE-BSI, both linezolid and high-dose daptomycin (>9 mg/kg per day) are effective, reserving daptomycin-based combinations for challenging cases (deep-seated infections and/or high Minimum Inhibitory Concentrations). Finally, future trials evaluating the impact of antimicrobial therapy should use Desirability-of-Outcome-Ranking analysis; the in-vitro potential of oritavancin justifies targeted randomized trials to define its clinical efficacy in VRE-BSI. Interpretation: This paper delineates current evidence and expert consensus on management of E faecium BSI while identifying crucial knowledge gaps to guide future clinical research.
Inequities in Waiting Times for Major Elective Surgery Before and After the COVID-19 Pandemic: Socioeconomic and Sex Differences in the Southern Barcelona Metropolitan Area
(MDPI, 2026-03-01) Pericas Escale, Carles; Vilaplana Carnerero, Carles; Poltorak, Violeta; Redondo, Ana; Masuet Aumatell, Cristina; Tor Roca, Alba; Pagès Fernández, Constança; Grau, María
Background: Waiting times for elective surgery are widely used as indicators of health system performance, particularly following the disruption caused by COVID-19. The objective of this study is to compare the waiting times for major elective surgeries in the Southern Barcelona Metropolitan Area before (2018–2019) and after (2022–2023) the pandemic, examining differences according to sociodemographic characteristics. Methods: A retrospective comparative study was conducted using data from the Southern Barcelona Metropolitan Area between 2018 and 2023. Adults registered on the waiting list for major elective surgical procedures were included. All analyses were stratified by sex. A stratified pre–post pandemic analysis was conducted to examine differences in waiting times by Socioeconomic Index. Waiting times were modelled using generalized linear models with a Gamma distribution and log link, adjusting for age and Socioeconomic Index quartiles. Interaction between period and Socioeconomic Index was tested. Results: The analysis included 73,055 individuals (50.5% women). Median waiting time decreased after the COVID-19 pandemic for both sexes (women: 128 to 121 days; men: 99 to 94 days). This reduction showed an inverse socioeconomic gradient. Adjusted analyses showed longer waits in the lowest versus highest Socioeconomic Index quartile after the pandemic (women: RR = 1.23; men: RR = 1.30). Conclusions: Waiting times for major elective surgery decreased after COVID-19. An exclusive focus on waiting time indicators may conceal structural barriers to access and contribute to inequalities. Equity-sensitive monitoring of elective care is essential to ensure a fair recovery of surgical services.
Cecal volvulus secondary to iatrogenic postoperative intestinal obstruction
(Elsevier, 2021-11-01) Domínguez Garijo, Paula; Guzmán, Yoelimar
A 61-year-old woman with medical records of endometrioid carcinoma that required open cytoreductive surgery in 2018 and recent laparoscopic right partial nephrectomy consulted in the emergency room in the seventh postoperative day due to abdominal pain, distension, and constipation. Upon evaluation of the physical examination, the patient presented abdominal distension, with pain on palpation of the left hemiabdomen, without signs of peritoneal irritation
Incidence of Hepatocellular Carcinoma in Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review, Meta-analysis, and Meta-regression
(Elsevier, 2022-02-01) Orci, Lorenzo A.; Sanduzzi Zamparelli, Marco; Caballol, Berta; Sapena, Víctor; Colucci, Nicola; Torres, Ferran; Bruix, J.; Reig, María; Toso, Christian
Background & Aims Nonalcoholic fatty liver disease (NAFLD) may be a risk factor for hepatocellular carcinoma (HCC), but the extent of this association still needs to be addressed. Pooled incidence rates of HCC across the disease spectrum of NAFLD have never been estimated by meta-analysis. Methods In this systematic review, we searched Web of Science, Embase, PubMed, and the Cochrane Library from January 1, 1950 through July 30, 2020. We included studies reporting on HCC incidence in patients with NAFLD. The main outcomes were pooled HCC incidences in patients with NAFLD at distinct severity stages. Summary estimates were calculated with random-effects models. Sensitivity analyses and meta-regression analyses were carried out to address heterogeneity. Results We included 18 studies involving 470,404 patients. In patients with NAFLD at a stage earlier than cirrhosis, the incidence rate of HCC was 0.03 per 100 person-years (95% confidence interval [CI], 0.01–0.07; I2 = 98%). In patients with cirrhosis, the incidence rate was 3.78 per 100 person-years (95% CI, 2.47–5.78; I2 = 93%). Patients with cirrhosis undergoing regular screening for HCC had an incidence rate of 4.62 per 100 person-years (95% CI, 2.77–7.72; I2 = 77%).
Factors associated with late presentation to the emergency department in patients complaining of chest pain.
(Elsevier, 2021-06-29) Miró i Andreu, Òscar; Troester, Valentina; García Martínez, Ana; Martínez Nadal, Gemma; Coll-Vinent i Puig, Blanca; Lopez-Ayala, Pedro; Gil Espinosa, Victor; Aguiló, Sira; Galicia, Miguel; Jiménez, Sònia; López Barbeito, Beatriz; Moll, Conxi; Sánchez Marcos, Carolina; Cardozo, Carol; López Sobrino, Teresa; Strebel, Ivo; Boeddinghaus, Jasper; Nestelberger, Thomas; Bragulat Baur, Ernesto; Sánchez Sánchez, Miguel; Müller, Christian
Objective We investigated which factors predict late presentation (LP) to the emergency department (ED) in patients with non-traumatic chest pain (CP). Methods All CP cases attended at a single ED (2008–2017) were included. LP was considered if time from CP onset to ED arrival was>6 h. We analyzed associations between 42 patient/CP-related characteristics and LP in the whole cohort and in patients with CP due to acute coronary syndrome (ACS). Results The cohort included 25,693 cases (LP=50.6%; ACS=19.0%). Twenty factors were associated with LP, and 8 were also found in patients with ACS: CP of short-duration, aggravated by exertion or breathing/movement, undulating or recurrent CP increased the risk of LP, whereas CP accompanied by diaphoresis, irradiated to the throat, and chronic treatment with nitrates decreased the risk of LP. Exertional and recurrent CP were associated with both, LP and ACS.
Kidney Transplantation in Monoclonal Immunoglobulin Deposition Disease: A Report of 6 Cases
(Elsevier, 2021-05-04) Molina Andújar, Alícia; Tovar Gomis, Natalia; Cuadrado Payán, Elena; Castrejón de Anta, Natalia; Revuelta, Ignacio; Cucchiari, David; Cofán Pujol, Federico; Esforzado Armengol, Núria; Cibeira López, Maria Teresa; Rosiñol Dachs, Laura; Bladé, J. (Joan); Diekmann, Fritz; Fernández de Larrea, Carlos José; Quintana Porras, Luis F.
Monoclonal immunoglobulin deposition disease (MIDD) usually leads to kidney failure. Treatment of patients with a bortezomib-based regimen followed by autologous stem cell transplantation (SCT) has been increasingly used, with improvements in the response rates and allograft outcomes in kidney transplant recipients. The objective of this report was to analyze the outcomes of 6 patients who underwent kidney transplantation in our institution after treatment of MIDD between 2010 and 2019. Monoclonal immunoglobulin deposition disease was initially treated with bortezomib-based therapy followed by high-dose melphalan and autologous SCT with complete hematologic response, although all patients remained on dialysis. During a median follow-up of 20.5 months from kidney transplant (54 months from SCT), 1 patient experienced hematologic relapse and 2 had hematologic progression (one of them with MIDD relapse in the allograft) requiring treatment. The patient with organ relapse received daratumumab monotherapy, achieving complete hematologic response but with graft failure. The other 5 patients had functional grafts with median serum creatinine 1.68 mg/dL. These results support that, in patients with MIDD and sustained complete hematologic response, a kidney transplant can be considered. The optimal approach to treatment of hematologic relapse or recurrence of MIDD after kidney transplant remains to be determined.
Long-term outcomes of cardiac defibrillator implantation in survivors of out-of-hospital cardiac arrest
(Elsevier España, 2021) Izquierdo, Marc; Cepas Guillén, Pedro; Fernández Valledor, Andrea; Diego Soler, Oriol de; Tolosana, José M. (José María); Andrea, Rut
Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Survival after OHCA is poor, although it has improved in the last decade because of the availability of public access to defibrillators. European guidelines recommend an implantable cardioverter defibrillator (ICD) in patients with OHCA and a documented ventricular fibrillation in the absence of reversible causes such as acute coronary syndrome (ACS). However, there is limited data available on the use of an ICD in this group of patients.
Clinical Utility and Evolution of Donor Serum Lactate During Normothermic Regional Perfusion in Uncontrolled Donation After Circulatory Death
(Elsevier B.V., 2021-11-01) Rodríguez, Camino; Paredes, David; Roque, Rebeca; Reinoso, Johanna; Sánchez-Etayo, Gerard
Kidney transplantation from uncontrolled donor after circulatory death (uDCD) showed a higher incidence of delayed graft function and primary failure. The aim of this study was to study basal and kinetic evolution of lactate values in uDCD preserved on normothermic regional perfusion (NRP) as a predictive factor of kidney suitability exposed to prolong ischemic conditions.
Pembrolizumab and Paclitaxel in Patients with HR+/HER2− Breast Cancer with HER2-Enriched or Basal-like Subtypes
(American Association for Cancer Research, 2026-04-01) Conte, Benedetta; Brasó-Maristany, Fara; Pascual, Tomás; Hernando, Cristina; Vázquez, Silvia; Blanch, Salvador; Oliveira, Mafalda; Virizuela, Juan Antonio; Muñoz, Montserrat; Seguí, Elia; Rodriguez Hernandez, Adela; Vidal Losada, Maria; Galván, Patricia; Castillo, Oleguer; Blasco, Paula; Alva, Manuel; Chic Ruché, Núria ; Sanfeliu Torres, Esther; Cano Crespo, Sara; Salvador, Fernando; Villacampa, Guillermo; Villanueva, Lorea; Ferrero Cafiero, Juan Manuel; Vivancos, Ana; Prat Aparicio, Aleix; Ciruelos, Eva
Purpose: Hormone receptor-positive (HR+), HER2-negative (HER2-) metastatic breast cancer (mBC) is biologically distinct from early-stage disease, with a higher prevalence of genomically defined nonluminal subtypes, particularly the HER2-enriched (HER2-E) and basal-like subtypes. These tumors are highly proliferative, less dependent on hormone signaling, and associated with poor outcomes and early resistance to endocrine therapy and CDK4/6 inhibition (CDK4/6i). This biological shift highlights the need for biomarker-driven strategies in the CDK4/6i-resistant setting. Patients and methods: The SOLTI-1716 TATEN trial (NCT04251169) is a phase II, single-arm study evaluating the combination of pembrolizumab and paclitaxel in patients with HR+/HER2- mBC classified as HER2-E or basal-like by PAM50 following progression on CDK4/6i. A total of 126 patients were screened using the PAM50 genomic assay; 20 with HER2-E or basal-like subtypes were enrolled and received pembrolizumab (200 mg every 3 weeks) and paclitaxel (80 mg/m2 weekly). Results: The primary endpoint, overall response rate (ORR), was 61.1% [95% confidence interval (CI), 35.7-82.7], and the clinical benefit rate was 94.4% (95% CI, 72.7-99.9). The median progression-free survival was 8.1 months (95% CI, 5.9-10.4), and the median overall survival was 26 months [95% CI, 18-not reached (NR)]. Three patients achieved durable responses lasting ≥24 months. Gene expression analyses revealed that high expression of proliferation- and immune-related genes predicted improved ORR and survival, whereas luminal-related gene expression was associated with lower clinical benefit. Conclusions: These results suggest that chemo-immunotherapy may be an effective strategy in genomically defined nonluminal subtypes of HR+/HER2- mBC following CDK4/6i resistance and highlight the value of molecular subtyping to guide post-endocrine treatment decisions.
Sciatic nerve movement in the deep gluteal space during hip rotations maneuvers
(Wiley, 2021-12-15) Balius, Ramón; Pujol Rojo, Miquel; Pérez Cuenca, Dolores; Morros, Carles; Susín, Antonio; Corominas, Héctor; Sala Blanch, Xavier
We hypothesize that the sciatic nerve in the subgluteal space has a specific behavior during internal and external coxofemoral rotation and during isometric contraction of the internal and external rotator muscles of the hip. In 58 healthy volunteers, sciatic nerve behavior was studied by ultrasound during passive internal and external hip rotation movements and during isometric contraction of internal and external rotators. Using MATLAB software, changes in nerve curvature at the beginning and end of each exercise were evaluated for longitudinal catches and axial movement for transverse catches. In the long axis, it was observed that during the passive internal rotation and during the isometric contraction of external rotators, the shape of the curve increased significantly while during the passive external rotation and the isometric contraction of the internal rotators the curvature flattened out. During passive movements in internal rotation, on the short axis, the nerve tended to move laterally and forward, while during external rotation the tendency of the nerve was to move toward a medial and backward position. During the isometric exercises, this displacement was less in the passive movements. Passive movements of hip rotation and isometric contraction of the muscles affect the sciatic nerve in the subgluteal space. Retrotrochanteric pain may be related to both the shear effect of the subgluteus muscles and the endoneural and mechanosensitive aggression to which the sciatic nerve is subjected.
Combined heart and other organ transplants in Spain: Current review of clinical outcomes. COMBI Study
(Elsevier, 2026-05-01) López-Vilella, Raquel; González Costello, José; González-Vílchez, Francisco; Gómez Bueno, Manuel; Grille, Zulaika; Caravaca Pérez, Pedro; Cobo Belaustegui, Manuel; González-Martín, Javier; Díaz-Molina, Beatriz; López, Laura; Rangel-Sousa, Diego; Blasco Peiró, Maria Teresa ; Ortiz Bautista, Carlos; Crespín, Manuel; Garrido Bravo, Iris; Almenar Bonet, Luis
Background: Combined heart transplantation (HTx) with other organs is an established intervention when both organs fail simultaneously or when a noncardiac organ fails after HTx. This study aimed to describe the Spanish experience with this transplant modality and to analyze survival outcomes. Methods: This is a retrospective study based on the Spanish Heart Transplant Registry (1998-2024). Pediatric HTx and patients with previous transplants of other organs were excluded. Patients were classified into isolated HTx (n = 6663), simultaneous combined HTx (n = 147; kidney:60; lung:71; liver:16), and delayed combined HTx (n = 110; kidney:72; hematopoietic stem cells [HSC]:27; liver:10; lung:1). Combined HTx accounted for 3.9% of the total. Results: For simultaneous combined procedures, 30-day survival rates were: HTx+kidney: 84%; HTx+liver: 88%; HTx+lung: 73% (p = 0.034); 5-year survival rates were: 64%, 74%, and 41%, respectively (p = 0.0001). In delayed combined HTx, early mortality was low across all types. Five-year survival rates were: HTx+kidney: 73%; HTx+liver: 67%; HTx+HSC: 59% (p = 0.39). An elective isolated HTx showed better results at 10-year survival than combined HTx, both simultaneous and delayed (p = 0.004). Conclusions: Combined HTx accounts for around 4% of total HTx. Simultaneous heart-liver transplantation provides the best outcomes, while heart-lung transplantation carries the highest risk. Delayed combined HTx shows good early survival.
Humoral Immunogenicity of SARS-CoV-2 mRNA Primary Vaccination Among People with HIV
(MDPI, 2026-04-16) Suanzes, Paula; García Gasalla, Mercedes; Homar, Francisco; Mothe, Beatriz; Casabona, J.; Reyes-Urueña, J.; Buzón, Maria José; Miró Meda, José M. (José María), 1956-; Nomah, D.K.; Robles, Alba G.; Bruguera, Andreu; Tiraboschi, Juan Manuel; Benet, Susana; García-Pérez, Javier; Jimenez, Paloma; Vilaró, I.; Navarro Brugal, Gemma; Sánchez Palomino, Sonsoles
People with HIV (PWH) may exhibit altered immune responses to SARS-CoV-2 vaccination due to persistent immune dysregulation despite antiretroviral therapy. We evaluated humoral immunogenicity following mRNA SARS-CoV-2 vaccination in PWH according to CD4 T-cell count and compared responses with HIV-negative controls. The study included 57 PWH stratified by CD4 count (<200 and ≥200 cells/µL), alongside 12 HIV-negative controls. Neutralizing antibody titers (NT50) against SARS-CoV-2 pseudoviruses expressing the D614G and Omicron BA.5 spike variants were measured using a luciferase-based neutralization assay one month (M1) and six months (M6) after primary vaccination with BNT162b2 or mRNA-1273. PWH with CD4 counts ≥ 200 cells/µL demonstrated higher neutralizing titers against D614G at M1 and M6, with significant differences observed between CD4 groups (M1: p = 0.03; M6: p = 0.02). Neutralization of BA.5 was lower overall; while no overall group differences were observed at M1, higher titers were detected among individuals with CD4 ≥ 200 cells/µL at six months (p = 0.04). Neutralizing titers correlated positively with CD4 counts among PWH. Responses were broadly comparable between PWH and HIV-negative controls and did not differ substantially by vaccine type. These findings indicate that immune status, reflected by CD4 T-cell count, is a key determinant of SARS-CoV-2 vaccine-induced humoral responses in PWH and support prioritizing vaccination strategies for individuals with advanced immunosuppression.
Rituximab and IVIG added to plasma exchange improves the outcome of severe CNS demyelinating attacks: a retrospective study
(SAGE Publications, 2026-05-07) Cuello, Juan Pablo; Palacios, Michael; Gifreu Fraixinó, Ariadna; Martínez-Gins, María Luisa; Álvarez Bravo, Gary; Meca-Lallana, José E.; Costa-Frossard, Lucienne; Blanco, Yolanda; Cabrera Maqueda, Jose Maria; Saiz Hinarejos, Albert; Albertí, Blanca; Llufriu Duran, Sara; Cid Vidal, Joan; Lozano Molero, Miquel; Charry, Paola; Rodríguez-Jorge, Fernando; Sainz-Amo, Raquel; Sainz de la Maza, Susana; Monreal Laguillo, Enric; Villar, Luisa Maria; Masjuan, Jaime; Chico García, Juan Luis; Morales de la Prida, Moisés; Boix Lago, Almudena; García-Domínguez, José Manuel; Sepúlveda, María; Martínez-Hernández, Eugenia; Guasp, Mar; Fonseca, Elianet; Calvi, Alberto; Alba-Isasi, María Teresa; Valero-López, Gabriel; Millán-Pascual, Jorge
Background: Plasma exchange (PE) is a therapeutic option for CNS demyelinating attacks unresponsive to corticosteroids, but the potential benefit of adding rituximab and IV immunoglobulins to PE (RTX-IVIG-PE), which has shown its efficacy and safety in other immune-mediated conditions, has not been investigated. Objective: We aimed to determine the overall effectiveness of PE in severe demyelinating attacks, identify predictors of response, and compare outcomes between standard PE and RTX-IVIG-PE protocols. Design: Retrospective analysis of patients with CNS demyelinating attacks treated with PE between 2012 and 2023 across five Spanish hospitals. Methods: Clinical response was measured as an improvement or a complete recovery at discharge and 6 months. Uni- and multivariable logistic regression models were developed to identify predictors of PE response. A logistic regression analysis, after inverse probability of treatment weighting (IPTW), was performed to compare the outcome of attacks treated with standard PE and RTX-IVIG-PE. Results: A total of 162 attacks in 150 patients (81 multiple sclerosis; 37 others acquired demyelinating syndromes; 27 neuromyelitis optica spectrum disorder; 5 myelin oligodendrocyte glycoprotein antibody-associated disease; 73% female; median age 43 years (interquartile range 33-52.75)) were analyzed. At discharge, 60% of all attacks showed clinical improvement, and 15% achieved complete recovery. At 6 months, these rates increased to 77% and 31%, respectively. Younger age, lower preattack Expanded Disability Status Scale, and treatment with RTX-IVIG-PE were independent predictors of complete recovery at 6 months. IPTW analysis showed that attacks treated with RTX-IVIG-PE (33) were associated with improvement (adjusted odds ratio (aOR) 5.4, p < 0.001) and complete recovery (aOR 4.55, p < 0.001) at 6 months compared to those treated with standard PE (129), without significant differences in the adverse event profile between the two protocols. Conclusion: PE improves the outcome of steroid-refractory CNS demyelinating attacks, and the addition of rituximab and IVIG to PE may increase the likelihood of long-term recovery.
PrEP program experience in a hospital HIV unit. Description of baseline user profile and identification of opportunities for improvement Experiencia de un programa de profilaxis preexposición en una unidad de virus de la inmunodeficiencia humana hospitalaria. Descripción del perfil basal del usuario e identificación de oportunidades de mejora
(Elsevier, 2023-01-01) Laguno Centeno, Montserrat; Ugarte, A.; Martínez Rebollar, María; Sobrino, Yeray; Font, Guillermo; De Lazzari, Elisa; Mora, Lorena de la ; Torres, Berta; Chivite, Ivan; Riera, Jordi; Ambrosioni, Juan; Inciarte, Alexy; González Cordón, Ana; Rojas, Jhon; Cordón, Encarna; Blanco, José L.; Martínez Chamorro, Esteban José; Mallolas Masferrer, Josep
Se incluyeron 190 individuos, 177 hombres y 12 mujeres transexuales con una edad media de 35 años (8 DE). El 70% tenía estudios superiores y la mitad nacionalidad española. Informaron de tener 10 parejas de media al trimestre y el 60% de practicar sexo anal desprotegido. El 31% presentó al menos una PCR positiva para ITS, siendo la N. gonorrhoeae el germen más prevalente (51%) y la muestra rectal la más afectada (21%). El 63% reportó el uso de chemsex, el 19% policonsumo y el 8% slamming. La mitad expresó su preocupación por el consumo y/o prácticas sexuales y un 25% la necesidad de ayuda.
A sustainable development goal framework to guide multisectoral action on NAFLD through a societal approach
(John Wiley & Sons, 2021-12-05) Lazarus, Jeffrey V.; Mark, Henry E.; Colombo, Massimo; Demaio, Sandro; Dillon, John F.; George, Jacob; Hagström, Hannes; Hocking, Samantha; Lee, Nancy; Nieuwenhuijsen, Mark J.; Rinella, Mary E.; Schattenberg, Jörn M.; Romero-Gomez, Manuel; Soriano, Joan B.; Tacke, Frank; Tsochatzis, Emmanuel A.; Valenti, Luca; Zelber-Sagi, Shira; Dirac, M. Ashworth; Huang, Terry T-K.
Background: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent condition that requires a comprehensive and coordinated response across sectors and disciplines. Aims: In the absence of a multisectoral framework to tackle this condition, we developed one using the sustainable development goals (SDGs) as the basis for converging thinking about the design and delivery of public health responses. Methods: A multidisciplinary group identified the SDG targets and indicators for inclusion in the new framework through a two-stage process. Firstly, a core team of three researchers independently reviewed the 169 targets and 231 indicators of the SDGs to select a shortlist. Over two Delphi rounds, a multidisciplinary group of 12 experts selected which of the shortlisted targets and indicators to include. Respondents also provided written feedback on their selection. Targets and indicators with 75% or greater agreement were included in the final framework. Results: The final framework comprises 16 targets—representing 9% of all targets and 62% (16/26) of the shortlisted targets—and seven indicators, accounting for 50% (7/14) of the shortlisted indicators and 3% of all indicators. The selected targets and indicators cover a broad range of factors, from health, food and nutrition to education, the economy, and the built environment. Conclusions: Addressing the challenge of NAFLD will require a re-envisioning of the liver health landscape, with greater focus on joined-up systems thinking and action. This new framework can help guide this process, including by outlining the stakeholders with whom the liver health community needs to engage.
Response to mepolizumab according to disease manifestations in patients with eosinophilic granulomatosis with polyangiitis
(Elsevier B.V., 2022) Ríos Garcés, Roberto; Prieto González, Sergio; Hernández-Rodríguez, José; Arismendi, Ebymar; Alobid, Isam; Penatti, Alessandra E.; Cid, María C.; Espígol Frigolé, Georgina
Among 56 patients with EGPA regularly controlled at our department, 11 patients were treated with mepolizumab because of corticodependence and unsatisfactory disease control. The mean time of treatment was 38 months (range: 3-66 months). Patients with persistent symptoms improved their asthma control, but 3 of them persisted with recurrent ENT symptoms in spite of treatment with mepolizumab. None of the patients developed vasculitic manifestations (cutaneous, neurological, gastrointestinal, renal) during treatment. All patients achieved a Birmingham Vasculitis Activity Score (BVAS) of 0 points at 12 months or earlier. In general, patients reduced the number of flares, which tended to be milder, and all related to asthma or ENT manifestations. The improvement in disease activity allowed notable glucocorticoid tapering.
Effect of invitation to colonoscopy versus faecal immunochemical test screening on colorectal cancer mortality (COLONPREV): a pragmatic, randomised, controlled, non-inferiority trial
(Elsevier B.V., 2025-03-27) Castells Garangou, Antoni; Quintero, Enrique; Bujanda, Luis; Castán-Cameo, Susana; Cubiella, Joaquin; Díaz-Tasende, José; Lanas, Angel; Ono, Akiko; Serra-Burriel, Miquel; Frías-Arrocha, Eladio; Hernández, Cristina; Jover, Rodrigo; Andreu, Montserrat; Carballo, Fernando; Morillas, Juan Diego; Salas, Dolores; Almazán, Raquel; Alonso-Abreu, Inmaculada; Banales, Jesús M.; Hernández, Vicent; Portillo, Isabel; Vanaclocha Espi, Mercedes; de la Vega, Mariola; COLONPREV study investigators.
Background: Colonoscopy and the faecal immunochemical test are accepted strategies for colorectal cancer screening in the average-risk population (ie, people aged ≥50 years without personal or family history of colorectal cancer). In this trial, we aimed to compare whether invitation to screening with faecal immunochemical test was non-inferior to colonoscopy in a screening programme. Methods: COLONPREV was a pragmatic, randomised, controlled, non-inferiority trial done at 15 tertiary hospitals across eight regions of Spain. Eligible participants were presumptively healthy and aged between 50 years and 69 years without a personal history of colorectal cancer, adenoma or inflammatory bowel disease, family history of hereditary or familial colorectal cancer (ie, two or more first-degree relatives with colorectal cancer or one diagnosed before age 60 years), severe comorbidities, or previous colectomy. Participants were randomly assigned (1:1) to one-time colonoscopy or biennial faecal immunochemical test before invitation to screening. The primary endpoint was colorectal cancer mortality at 10 years, assessed in the intention-to-screen population. An absolute difference of less than 0·16 percentage points was required to show non-inferiority. This trial was registered with ClinicalTrials.gov, NCT00906997. Findings: Between June 1, 2009, and Dec 31, 2021, 57 404 individuals were randomly assigned to receive an invitation for colonoscopy (n=28 708) or the faecal immunochemical test (n=28 696). The intention-to-screen population consisted of 26 332 individuals in the colonoscopy group and 26 719 in the faecal immunochemical test group. In the intention-to-screen population, participation in any form of screening was 31·8% in the colonoscopy group and 39·9% in the faecal immunochemical test group (risk ratio [RR] 0·79 [95% CI 0·77 to 0·82]). Faecal immunochemical testing was non-inferior to colonoscopy with regard to the risk of colorectal cancer mortality at 10 years: the risk was 0·22% (55 deaths) in the colonoscopy group and 0·24% (60 deaths) in the faecal immunochemical test group (risk difference -0·02 [95% CI -0·10 to 0·06; RR 0·92 [95% CI 0·64 to 1·32]; pnon-inferiority=0·0005). Interpretation: Participation in screening was higher among individuals invited to faecal immunochemical test screening than colonoscopy screening. On the basis of participation observed in this study, a faecal immunochemical test-based programme was non-inferior to a colonoscopy-based programme for colorectal cancer-related mortality. Funding: Fundación Científica de la Asociación Española contra el Cáncer and Instituto de Salud Carlos III.

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