El síndrome de QT largo es causa de muerte súbita por arritmias ventriculares y puede ser de origen congénito o adquirido. Entre las causas adquiridas, las más frecuentes son los trastornos iónicos y los fármacos. En esta presentación se describe el caso de una paciente con síndrome de QT largo secundario a hipocalcemia por hipoparatiroidismo primario. Es indispensable la detección de posibles causas secundarias y reversibles de síndrome de QT largo, que son más frecuentes que el origen genético, dado que tienen tratamiento etiológico eficaz y se evitan medidas diagnósticas y terapéuticas innecesarias.
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.
BACKGROUND:Home dialysis therapies could offer benefits to individuals undergoing dialysis. This study examines trends of home dialysis, including home haemodialysis (HHD) and peritoneal dialysis (PD) across European countries from 2012 to 2021, and evaluates transitions between home dialysis and other kidney replacement therapies (KRT). METHODS:Data from adult patients undergoing KRT in 13 European countries were obtained from the European Renal Association Registry. Trends in home dialysis initiation, the number of patients receiving home dialysis by 31 December of each year, and transitions before and after home dialysis were analysed. RESULTS:Between 2012 and 2021, 65 246 adults initiated PD and 7878 HHD. Over the last decade, HHD initiation rates and prevalence increased, while those for PD declined, resulting in a stable overall home dialysis initiation rate and prevalence. Home dialysis accounted for 5.8% of the total KRT prevalence. Most HHD patients transitioned from in-centre HD (ICHD, 76.6%), whereas 86.9% of PD patients had no prior KRT. Two years after initiation, 53.2% of HHD patients remained on HHD, 20.9% received a kidney transplant (KT), 16.6% transitioned to ICHD, 8.1% died while on HHD and 0.6% switched to PD. Among PD patients, 39.6% remained on PD, 22.6% transitioned to ICHD, 18.3% received a KT, 17.4% died while on PD and 0.3% switched to HHD. CONCLUSIONS:While the use of HHD over the past decade increased in some European countries, the use of PD has declined. The prevalence of both HHD and PD remains low, with limited transitions from other KRT options to home dialysis and between home dialysis modalities. These findings highlight the need for more effective, region-specific strategies to improve access to these modalities for patients who may benefit from it.
PURPOSE:Angiogenesis plays an essential role in neuroendocrine tumors (NETs). This study evaluates efficacy and safety of axitinib in extrapancreatic (ep)-NETs. PATIENTS AND METHODS:AXINET was an international, randomized, double-blind, placebo-controlled, phase II/III trial including patients age 18 years and older, with unresectable/metastatic G1-2 epNETs and up to two previous treatment lines. Patients were randomly assigned (1:1) to axitinib 5 mg or placebo, both orally twice a day, in combination with intramuscular octreotide long-acting release 30 mg once every 28 days until disease progression or unacceptable toxicity. Randomization was stratified by primary tumor site, Ki-67 index (≤5% or >5%), and time from diagnosis (> or ≤12 months). The primary end point was investigator-assessed progression-free survival (PFS). Efficacy was also assessed by a blinded independent central review (BICR). RESULTS:From October 2011 to May 2019, 256 patients were assigned to axitinib (n = 126) or placebo (n = 130). Investigator-assessed median PFS was 17.2 months (95% CI, 13.6 to 24.7) versus 13.1 months (95% CI, 10.9 to 18.6) in the axitinib and placebo groups, respectively (hazard ratio [HR], 0.86 [95% CI, 0.65 to 1.15]). The median BICR PFS was 16.6 months (95% CI, 13.5 to 24.2) versus 9.9 months (95% CI, 8.2 to 13.9) in the axitinib and placebo groups, respectively (HR, 0.71 [95% CI, 0.54 to 0.94], P = .017). Objective response rate (ORR) was significantly greater for axitinib per investigator assessment (17.5% v 4.6%; P = .001) and BICR (12.8% v 3.2%; P = .005). Most common grade ≥3 toxicities were hypertension (24.0% v 9.2%) and diarrhea (13.6% v 1.5%). CONCLUSION:Axitinib significantly increased PFS per BICR assessment and ORR both per investigator and BICR assessment compared with placebo, although the primary study end point was not met. Toxicity profile was manageable with no new safety concerns.
INTRODUCTION:The Active Gains in Brain Using Exercise During Aging (AGUEDA) trial examined the effects of a 24 week resistance exercise (RE) intervention on executive function (EF) and other cognitive domains in cognitively normal older adults. METHODS:Ninety participants (mean age, 71.8 years; 57.8% female) were randomized to an RE or control group. At baseline and 24 weeks, EF and other cognitive domains were assessed. RESULTS:The RE group showed significant improvements in overall EF (standardized mean difference [SMD] = 0.39, 95% confidence interval = 0.14, 0.65), with no significant between-group difference (SMD = 0.13, p = 0.37). The RE group showed a significant improvement in attentional/inhibitory control (SMD = 0.43, p < 0.001) compared to the control group, while no effects were observed in other domains (all p > 0.12). Moderation by age, education, and subjective cognitive decline was observed. DISCUSSION:Although no overall EF benefit was observed, RE improved attentional/inhibitory control in cognitively normal older adults. RE may yield greater benefits in vulnerable subgroups. CLINICAL TRIAL REGISTRATION:The trial was registered on ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT05186090). HIGHLIGHTS:Cognitive effects of resistance exercise (RE) may vary across different cognitive domains in cognitively healthy older adults. Twenty-four week RE produced selective improvements in attention/inhibitory control. RE did not improve executive function (EF), or other cognitive domains (episodic memory, processing speed, visuospatial processing, and working memory). RE improved muscular strength, which were associated with gains in EF, episodic memory and working memory. There is value in personalized exercise interventions tailored to individual risk populations, such as those with higher subjective cognitive decline.
