The Hospital General Universitario Gregorio Marañón is a public general hospital located at the neighborhood of Ibiza in Madrid, Spain, part of the hospital network of the Servicio Madrileño de Salud (SERMAS).It is one of the healthcare institutions associated to the Complutense University of Madrid (UCM) for the purpose of clinical internship.
Gene fusions involving neurotrophic tyrosine receptor kinase (NTRK) genes represent uncommon genetic alterations that may occur across a wide spectrum of tumor types. NTRK-rearranged sarcomas are most frequently identified in pediatric mesenchymal neoplasms, although they have also been described, less commonly, in adult mesenchymal tumors. We present the case of a 28-year-old woman with a large pelvic mass arising in relation to the psoas muscle. It was histologically composed of a dual cell population consisting of small hyperchromatic irregular cells intermixed with markedly pleomorphic "monster cells". Immunohistochemistry showed diffuse p16, Factor XIIIa, and CD163 positivity, while S100 protein, CD34, CD68 and other lineage-specific markers were negative. Pan-TRK immunostaining was negative. Targeted next-generation sequencing (NGS) was performed due to the non-specific findings of the tumor in a young adult patient, and a STRN::NTRK3 gene fusion involving exon 3 and exon 14, respectively, was identified, establishing this tumor as part of the emerging group of NTRK-rearranged neoplasms. Entrectinib was administered, and an excellent response was observed. This case emphasizes the relevance of performing NGS in cases with unusual clinicopathological findings to identify potential treatment options. Importantly, the morphology deviated from the classic fibrosarcoma-like appearance described in most adult NTRK3-fused neoplasms and broadens the morphological spectrum in which these neoplasms should be considered.
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.
Hyperprolactinemia is classically linked to reproductive dysfunction, but emerging evidence suggests an association with metabolic and cardiovascular (CV) risk. This study evaluated sex differences in CV risk factors (CVRFs) and cardiovascular disease (CVD) in patients with hyperprolactinemia. A multicenter, retrospective cross-sectional study was conducted in 449 adult patients (199 men, 250 women) with confirmed hyperprolactinemia from 19 tertiary referral centers in Spain. Clinical, biochemical, and hormonal data were collected and analyzed. The prevalence of CVRFs and CVD was compared between sexes. Associations between serum prolactin levels and CVRFs/CVD were assessed using nonparametric tests, correlation analyses, and multivariable logistic regression. Men had significantly higher serum prolactin levels than women (median 796 [IQR 250–1499] vs. 114 [74.5–224] ng/mL; p < 0.001) and a greater crude prevalence of all major CVRFs (p < 0.001 for all). After adjustment for age, male sex remained independently associated with smoking (OR 2.16; p = 0.007) and hyperlipidemia (OR 1.97; p = 0.031). Serum prolactin levels positively correlated with age, BMI, systolic blood pressure, glucose, total cholesterol, and triglycerides (all p < 0.001). In sex-stratified analyses, prolactin was associated with BMI and lipid profile in men, and with hypertension and hyperlipidemia in women. Prolactin levels were significantly elevated in patients with any form of CVD (p = 0.007), particularly arrhythmias (p = 0.013), while a trend was noted for ischemic heart disease (p = 0.050). Men with hyperprolactinemia exhibit a more adverse cardiometabolic profile, characterized by higher serum prolactin levels and a greater burden of classical CVRFs and CVD. Prolactin concentrations are positively associated with multiple metabolic and CV parameters, with sex-specific patterns suggesting distinct mechanisms of susceptibility and regulation. These findings underscore the importance of incorporating sex and hormonal context into CV risk assessment in patients with hyperprolactinemia.
Acute kidney injury (AKI) is a clinically significant complication after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Although multiple renal protective strategies have been proposed, the role of intraoperative urine output during the hyperthermic phase remains unclear. This study aimed to identify risk factors for postoperative AKI in a large CRS-HIPEC cohort and evaluate the impact of urine output during heated perfusion. A retrospective cohort study analyzed 512 patients who underwent CRS-HIPEC between January 2011 and September 2022. Patient characteristics and perioperative variables including intra-HIPEC urine output, chemotherapy regimens, and postoperative complications were collected. The study defined AKI using Kidney Disease Improving Global Outcomes (KDIGO) criteria. Multivariate logistic regression identified independent predictors of postoperative AKI, and receiver operating characteristic (ROC) analysis determined optimal urine output thresholds. The overall incidence of AKI was 14
