El mieloma múltiple en recaída y refractario continúa siendo un reto terapéutico, especialmente en pacientes expuestos a múltiples líneas previas. Los anticuerpos biespecíficos dirigidos frente a BCMA, como teclistamab, han supuesto un avance al redirigir linfocitos T contra células plasmáticas tumorales, con disponibilidad inmediata frente a terapias celulares. Este trabajo describe la experiencia en vida real en dos pacientes con mieloma múltiple altamente pretratadas, con citogenética de alto riesgo y comorbilidad relevante. Ambas recibieron teclistamab según pauta estándar. La paciente 1 presentó respuesta metabólica significativa en PET-TC, con reducción de lesiones óseas y extramedulares, desarrollando síndrome de liberación de citocinas grado 1 e infecciones respiratorias manejadas con soporte y ajustes temporales del tratamiento. La paciente 2 mantuvo estabilidad clínica prolongada, presentando neutropenia e infección digestiva como principales complicaciones. Ambas desarrollaron hipogammaglobulinemia que requirió inmunoglobulinas intravenosas. El seguimiento desde Farmacia Hospitalaria permitió optimizar la seguridad y continuidad terapéutica mediante monitorización estrecha y manejo precoz de toxicidades, confirmando la eficacia y manejabilidad de teclistamab en práctica clínica real.
La leucoplasia oral vellosa es un trastorno benigno caracterizado por la hipertrofia de las papilas filiformes de la lengua, junto con una coloración pardo-negruzca. La prevalencia varía según el área geográfica y otros factores de riesgo como el tabaco. En este artículo se describe, a través de un caso clínico, el diagnóstico de esta patología, así como la evolución del cuadro. Palabras clave: leucoplasia vellosa, lengua, papilas gustativas.
INTRODUCTION:Migrants living with HIV often face high mobility, vulnerability and limited baseline information on HIV-1 genotype or treatment history. We aimed to assess the effectiveness and persistence of long-acting injectable cabotegravir and rilpivirine (LAI CAB+RPV) among migrants in Spain. METHODS:This multicentre cohort study across 58 Spanish hospitals included virologically suppressed adults switching to CAB+RPV LAI before January 2025. Data collection started in June 2023. Baseline characteristics and outcomes were compared by migrant status, and multivariate Cox proportional hazards regression models were fitted to assess factors associated with virological failure (VF) and discontinuation. Propensity score matching (PSM) by gender, age, known genotype and prior VF was employed to control for confounding. RESULTS:Of 3135 participants, 951 (30.3%) were migrants, predominantly from Latin America. Median follow-up was 13.8 months (interquartile range 8.91-19.1). VF occurred in 0.9% of migrants versus 0.5% of Spanish-born individuals (odds ratio 1.89, 95% confidence interval [CI] 0.69-5.03; p = 0.22). In adjusted models, migrant status showed a non-significant trend towards higher VF (adjusted hazard ratio [aHR] 2.16, 95% CI 0.89-5.22; p = 0.079). At 12 months, 95.8% of migrants (461/481) persisted on LAI CAB+RPV treatment versus 98.3% of Spanish-born individuals (1348/1372) (p = 0.005). Discontinuation due to any adverse event was more frequent in migrants (3.3% vs. 1.8%). Migrant status was significantly associated with discontinuation due to both local (aHR 2.63, 95% CI 1.33-5.26; p = 0.005) and systemic adverse events (aHR 3.33, 95% CI 1.45-7.69, p = 0.005). In the PSM cohort (n = 932 per group), migrant status was independently associated with increased risk of VF (aHR 3.51, 95% CI 0.95-12.98, p = 0.045) and discontinuation due to systemic adverse events (aHR 2.88, 95% CI 1.01-8.17, p = 0.047). CONCLUSIONS:Nearly one-third of participants switching to LAI CAB+RPV were migrants. While VF was rare overall, migrants had a significantly higher risk of treatment discontinuation, partly driven by adverse events. These findings highlight the need for closer monitoring and tailored strategies to optimize persistence with LAI regimens in migrant populations.
Background: Childhood obesity and overweight have increased considerably in recent years, representing a major global public health problem. This was a comparative study between a group of overweight or obese children and a group of normal-weight children, within an observational setting, performed in a previously studied cohort in which, in the present work, the objective was specifically to evaluate lipoprotein subclasses, particle size, particle number and lipid composition. Methods: We studied the different lipoprotein particles using the Liposcale test. The number of particles of each lipoprotein subclass was quantified by 1H-NMR. This method measures the signals emitted by the protons of the terminal methyl group of the four types of lipids present in the lipoprotein particles. Results: It was found that the concentrations of VLDL-C, VLDL-TG, IDL-TG, and HDL-TG, as well as the number of VLDL-Ps and all their subclasses, were statistically higher in the overweight/obese children group. REM-C was also higher in overweight/obese children, and they had a smaller mean LDL-Z. Conclusions: These results support the presence, already in prepubertal childhood, of early metabolic alterations, associated with excess weight, and show that advanced lipoprotein profiling may provide additional information beyond the conventional lipid profile.
La pupila tónica de Adie es una condición neurológica rara caracterizada por una dilatación pupilar con pobre respuesta a la luz y acomodación. Se diagnostica por exclusión y pruebas con pilocarpina diluida. Aunque suele ser idiopática, debe descartarse una causa subyacente. Se presenta un caso sobre esta patología.
