The venous excess ultrasound score (VExUS) is a promising method to assess venous congestion in adults, but evidence in children is scarce. This study aimed to evaluate the feasibility, reproducibility, and clinical usefulness of VExUS in pediatric patients. We also explored whether portal venous Doppler (PVD) alone could serve as a faster alternative and assessed the role of inferior vena cava (IVC) measurements. In this prospective single-center study, 35 pediatric patients were enrolled between 2022 and 2024. Associations between clinical variables and VExUS grades at admission (VExUS-0), 24 h (VExUS-24 h), and 48 h (VExUS-48 h), as well as PVD at corresponding time points, were analyzed. The relationship between IVC diameter and VExUS was also evaluated. VExUS demonstrated perfect reproducibility (κ coefficient and intraclass correlation coefficient = 1). Patients with VExUS-0 or VExUS-24 h grades 2–3 had longer aortic cross-clamp times (p = 0.03; 0.04) and higher vasoactive–inotropic scores (p = 0.01) than those graded 0–1. A higher incidence of acute kidney injury was observed in VExUS-24 h grades 2–3 (p = 0.04). Similar associations were found with PVD. Most patients with VExUS grades 2–3 had non-dilated IVCs according to pediatric reference values. Conclusion: VExUS is a feasible, reproducible, and clinically relevant bedside tool for detecting venous congestion in children. Its association with morbidity markers suggests prognostic potential, with optimal performance 24 h after PICU admission. PVD may provide comparable information in less time, while IVC diameter appears unreliable for this purpose.
BACKGROUND:Dual antiretroviral therapy (ART) with dolutegravir/lamivudine (DTG/3TC) is widely used in virologically suppressed individuals. However, data remain limited on potential differential effects of ART regimens on mid-term systemic inflammation and metabolic health. We evaluated whether switching from DTG/3TC to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) modifies systemic inflammation or metabolic parameters. METHODS:INSTINCT was a phase IV, multicenter, open-label, randomized trial enrolling adults with HIV-1 on stable DTG/3TC and sustained viral suppression. Participants were randomized (1:1) to continue DTG/3TC or switch to BIC/FTC/TAF and followed for 96 weeks. Plasma biomarkers (sCD14, IL-6, sCD163, hsCRP, D-dimer, and kynurenine/tryptophan ratio) were measured at baseline, week 48, and week 96. Secondary outcomes included CD4⁺ and CD4/CD8 ratio, virological suppression, weight, lipid profile, and renal function. Longitudinal changes were analyzed using linear mixed-effects models. RESULTS:A total of 141 participants were randomized. Over 96 weeks, no significant between-group differences were observed in inflammatory biomarkers. CD4⁺ T-cell counts and CD4/CD8 ratio remained stable and comparable across arms. Weight changes were modest and similar; the proportion with ≥5% weight gain did not differ. No relevant differences were found in lipids, glucose, or eGFR. Virological suppression was maintained in >95% of participants. Adverse events were mild and balanced between groups. CONCLUSIONS:In virologically suppressed individuals, maintaining DTG/3TC or switching to BIC/FTC/TAF demonstrated equivalent profiles with respect to systemic inflammation, metabolic outcomes, and immunologic markers over 96 weeks.
OBJECTIVES:The aim of this study was to describe the long-term effectiveness and treatment persistence of anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies (MAbs) in migraine and to identify baseline factors associated with 2-year treatment continuation. METHODS:A prospective observational multicenter registry-based study of anti-CGRP MAbs was conducted. We analyzed changes in monthly headache days (MHDs) at 24 months (M24) compared with baseline in those who reached M24 (ON-group). We analyzed patterns of response at 4 time points (6, 12, 18, and 24 months). We defined sustained response (SR) as a ≥50% reduction in MHDs at ≥3 of 4 time points. We compared baseline characteristics of the ON-group with those of the discontinuation group because of lack of effectiveness (OFF-group). RESULTS:A total of 1,340 individuals reached M24 (ON-group: median age 48.0 [41.0-55.0] years; 81.7% female). The median MHD at baseline was 20.0 (13.0-28.0) days. At M24, 60.4% of patients demonstrated ≥50% reduction in MHDs (809/1,340). The proportion of participants achieving SR at M24 was 53.8% (142/264). When compared with the ON-group (n = 1,340), the OFF-group (n = 1,057) showed statistically significant higher baseline MHDs (ON: 20.0 [13.0-28.0] vs OFF: 25.0 [16.0-28.0]) and a greater proportion of patients with aura (ON: 16.2% vs OFF: 22.9%), depression (ON: 22.8% vs OFF: 37.9%), and obesity (ON: 7.2% vs OFF: 19.1%) (p < 0.001). DISCUSSION:Sustained reductions in MHDs to anti-CGRP treatment at 2 years was observed. Delayed treatment onset, migraine with aura, depression, and obesity may negatively affect treatment persistence. CLASSIFICATION OF EVIDENCE:This study provides Class IV evidence that, in patients with migraine, treatment with anti-CGRP MAbs is associated with sustained reductions in MHDs over a 24-month period.
Infections are the most common adverse events associated with systemic treatment for psoriasis. Using data from the BIOBADADERM registry, we analyzed incidence rates of overall, serious, and special-interest infections associated with biologics and oral small molecules. Adjusted incidence rate ratios were calculated using propensity score analysis, with adalimumab as the comparator. The study included 4820 patients (8826 treatment cycles; 20,829 patient years of follow-up). The overall incidence of serious infections was low across all treatments (5.33%), with infliximab showing the highest incidence rate. The most frequent serious infections were pneumonia, followed by COVID-19 pneumonia and cellulitis. Among nonserious infections, respiratory tract infections were most common, followed by COVID-19 and urinary tract infections. Risankizumab and ustekinumab were associated with significantly lower risk of overall infections than adalimumab (P < .002). The risk of Candida infections was significantly higher with bimekizumab, brodalumab, secukinumab, and ixekizumab. Guselkumab, secukinumab, ixekizumab, and ustekinumab were linked to reduced incidence of respiratory infections. Ixekizumab was associated with a lower risk of COVID-19 infection, whereas dimethyl fumarate showed an increased risk compared with adalimumab. Overall, our findings support the favorable safety profile of biologics and small molecules in psoriasis, particularly regarding serious infections.
Chronic obstructive pulmonary disease (COPD) is a progressive lung condition associated with high morbidity and mortality. Single-inhaler triple therapy (SITT), such as budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF), is recommended for patients with COPD who are not adequately controlled by dual therapy (DT). Escalation from DT or switching from triple therapy (TT)—SITT or multiple-inhaler TT (MITT)—are key real-world treatment pathways. The observational, retrospective, multicenter ORESTES study included adults (≥ 40 years) with COPD initiating BGF in routine clinical practice. This secondary analysis focuses on the following treatment pathways: escalation from DT and switch from TT. Patients’ characteristics, exacerbations, additional COPD treatments, and healthcare resource utilization (HCRU) were assessed. A total of 295 patients escalated from DT and 356 switched from TT (SITT: 147; MITT: 209) to BGF. 66.8
