Higher Postoperative Mortality and Inferior Survival After Right-Sided Liver Resection for Perihilar Cholangiocarcinoma: Left-Sided Resection is Preferred When Possible

Postoperative mortality; Liver resection; Perihilar cholangiocarcinomaMortalidad posoperatoria; Resección hepática; Colangiocarcinoma perihiliarMortalitat postoperatòria; Resecció hepàtica; Colangiocarcinoma perihilarBackground A right- or left-sided liver resection can be considered in about half of patients with perihilar cholangiocarcinoma (pCCA), depending on tumor location and vascular involvement. This study compared postoperative mortality and long-term survival of right- versus left-sided liver resections for pCCA. Methods Patients who underwent major liver resection for pCCA at 25 Western centers were stratified according to the type of hepatectomy—left, extended left, right, and extended right. The primary outcomes were 90-day mortality and overall survival (OS). Results Between 2000 and 2022, 1701 patients underwent major liver resection for pCCA. The 90-day mortality was 9% after left-sided and 18% after right-sided liver resection (p < 0.001). The 90-day mortality rates were 8% (44/540) after left, 11% (29/276) after extended left, 17% (51/309) after right, and 19% (108/576) after extended right hepatectomy (p < 0.001). Median OS was 30 months (95% confidence interval [CI] 27–34) after left and 23 months (95% CI 20–25) after right liver resection (p < 0.001), and 33 months (95% CI 28–38), 27 months (95% CI 23–32), 25 months (95% CI 21–30), and 21 months (95% CI 18–24) after left, extended left, right, and extended right hepatectomy, respectively (p < 0.001). A left-sided resection was an independent favorable prognostic factor for both 90-day mortality and OS compared with right-sided resection, with similar results after excluding 90-day fatalities. Conclusions A left or extended left hepatectomy is associated with a lower 90-day mortality and superior OS compared with an (extended) right hepatectomy for pCCA. When both a left and right liver resection are feasible, a left-sided liver resection is preferred

Falls in hospitalized older adults and the use of fall risk-increasing drugs and anticholinergic medications in Colombia: a case‒control study

Cholinergic antagonists; Elderly aged; FallsAntagonistes colinèrgics; Gent gran; CaigudesAntagonistas colinérgicos; Ancianos; CaídasIntroduction: In-hospital falls are multicausal in older hospitalized patients. Drugs with anticholinergic load and psychotropic effects can increase the risk of falling. Objective: This study aimed to determine the associations between fall risk-increasing drugs (FRIDs) and the anticholinergic risk score (ARS) with falls in hospitalized older hospitalized patients. Methods: This was a case‒control study of patients ≥65 years of age of either sex treated in four clinics in Colombia between 2018 and 2020. Each patient who suffered a fall during hospitalization was matched with four hospitalized patients who did not. Sociodemographic, clinical, and pharmacologic variables and the use of the ARS and FRIDs were evaluated. The risk associated with FRIDs was estimated using conditional logistic regression. Results: There were 250 patients and 1,000 controls (ratio of 1:4), with a mean age of 77.4 ± 7.4 years and a predominance of men (n = 800, 64.0%). The majority of falls occurred during hospitalization (n = 192 patients, 76.8%). Polypharmacy, calcium channel blockers, antiepileptics, antipsychotics, sodium-glucose cotransporter type 2 inhibitors, and nonsteroidal anti-inflammatory drugs were associated with falls during hospitalization. With an ARS score of 3, the probability of falling during the hospital stay increased (aOR: 2.34; 95% CI: 1.64-3.32). Conclusion: There is an association between suffering a fall and the use of drugs with anticholinergic load or FRIDs in hospitalized adults more than 65 years of age in Colombia.The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. MM-D has a doctoral scholarship provided by Colfuturo

Profilaxi postexposició al virus de la immunodeficiència humana

Profilaxi; Virus de la immunodeficiència humana (VIH); PrevencióProfilaxis; Virus de la inmunodeficiencia humana (VIH); PrevenciónProphylaxis; Human immunodeficiency virus (HIV); Prevention.La infecció pel virus de la immunodeficiència humana (VIH) continua sent un problema important de salut, tant per la prevalença (a Catalunya s’estima que hi ha 33.000 persones que viuen amb el VIH) com per les repercussions sobre la qualitat de vida i la supervivència de les persones que n’estan infectades. A l’actualitat no hi ha cap tractament curatiu enfront d’aquesta infecció, això obliga a prendre una medicació de per vida amb els seus possibles efectes indesitjables.La infección por el virus de la inmunodeficiencia humana (VIH) sigue siendo un problema importante de salud, tanto por la prevalencia (en Cataluña se estima que hay 33.000 personas que viven con el VIH) como por las repercusiones sobre la calidad de vida y la supervivencia de las personas que están infectadas. En la actualidad no existe ningún tratamiento curativo frente a esta infección, esto obliga a tomar una medicación de por vida con sus posibles efectos indeseables.Infection with the human immunodeficiency virus (HIV) continues to be an important health problem, both because of its prevalence (in Catalonia it is estimated that there are 33,000 people living with HIV) and because of the repercussions on the quality of life and the survival of people who are infected. At present there is no curative treatment for this infection, which forces you to take medication for life with its possible undesirable effects

Código Medicamento

Medicament; Prevenció; Atenció sanitàriaMedicamento; Prevención; Atención sanitariaMedicine; Prevention; Health careL’envelliment progressiu de la població en les societats occidentals està comportant un augment de les necessitats d’atenció sanitària associat a l’augment de multimorbiditat, fragilitat i dependència. Això implica una major demanda assistencial, especialment als serveis d’urgències hospitalàries, i entre les persones més vulnerables amb malalties cròniques, multimorbiditat, polifarmàcia, dependència i altres condicions a llarg termini, incloses les consultes per problemes de salut relacionats amb els medicaments.El progresivo envejecimiento de la población en las sociedades occidentales está comportando un aumento de las necesidades de atención sanitaria asociado al aumento de multimorbilidad, fragilidad y dependencia. Esto implica una mayor demanda asistencial, especialmente en los servicios de urgencias hospitalarias, y entre las personas más vulnerables con enfermedades crónicas, multimorbilidad, polifarmacia, dependencia y otras condiciones a largo plazo, incluidas las consultas por problemas de salud relacionados con los medicamentos.The progressive aging of the population in Western societies is leading to an increase in health care needs associated with the increase in multimorbidity, frailty and dependency. This implies a greater demand for care, especially in hospital emergency services, and among the most vulnerable people with chronic diseases, multimorbidity, polypharmacy, dependency and other long-term conditions, including consultations for health problems related to medicines

Extended Safety and Tolerability of Darolutamide for Nonmetastatic Castration-Resistant Prostate Cancer and Adverse Event Time Course in ARAMIS

Androgen receptor inhibitor; Nonmetastatic castration-resistant prostate cancer; TolerabilityInhibidor del receptor de andrógenos; Cáncer de próstata no metastásico resistente a la castración; TolerabilidadInhibidor del receptor d'andrògens; Càncer de pròstata no metastàtic resistent a la castració; TolerabilitatBackground Patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) are usually asymptomatic and seek treatments that improve survival but have a low risk of adverse events. Darolutamide, a structurally distinct androgen receptor inhibitor (ARi), significantly reduced the risk of metastasis and death versus placebo in ARAMIS. We assessed the extended safety and tolerability of darolutamide and the time-course profile of treatment-emergent adverse events (TEAEs) related to ARis and androgen-suppressive treatment. Patients and Methods Patients with nmCRPC were randomized 2:1 to darolutamide (n = 955) or placebo (n = 554). After trial unblinding, patients could receive open-label darolutamide. Tolerability and TEAEs were assessed every 16 weeks. Time interval–specific new and cumulative event rates were determined during the first 24 months of the double-blind period. Results Darolutamide remained well tolerated during the double-blind and open-label periods, with 98.8% of patients receiving the full planned dose. The incidence of TEAEs of interest in the darolutamide group was low and ≤2% different from that in the placebo group, except for fatigue. When incidences were adjusted for exposure time, there were minimal differences between the darolutamide double-blind and double-blind plus open-label periods. The rate of initial onset and cumulative incidence of grade 3/4 TEAEs and serious TEAEs were similar for darolutamide and placebo groups over 24 months. Conclusion Extended treatment with darolutamide was well tolerated and no new safety signals were observed. Most ARi-associated and androgen-suppressive treatment–related TEAEs occurred at low incidences with darolutamide, were similar to placebo, and showed minimal increase over time with continued treatment. Trial number ClinicalTrials.gov identifier NCT02200614.This work was supported by Bayer AG and Orion Pharma

Novel prognostic scoring systems for severe CRS and ICANS after anti-CD19 CAR T cells in large B-cell lymphoma

Cytokine release syndrome; Anti-CD19 CAR T cells; Large B-cell lymphomaSíndrome de liberación de citocinas; Células T CAR anti-CD19; Linfoma de células B grandesSíndrome d'alliberament de citocines; Cèl·lules T CAR anti-CD19; Limfoma de cèl·lules B gransAutologous anti-CD19 chimeric antigen receptor (CAR) T cells are now used in routine practice for relapsed/refractory (R/R) large B-cell lymphoma (LBCL). Severe (grade ≥ 3) cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity (ICANS) are still the most concerning acute toxicities leading to frequent intensive care unit (ICU) admission, prolonging hospitalization, and adding significant cost to treatment. We report on the incidence of CRS and ICANS and the outcomes in a large cohort of 925 patients with LBCL treated with axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel) in France based on patient data captured through the DESCAR-T registry. CRS of any grade occurred in 778 patients (84.1%), with 74 patients (8.0%) with grade 3 CRS or higher, while ICANS of any grade occurred in 375 patients (40.5%), with 112 patients (12.1%) with grade ≥ 3 ICANS. Based on the parameters selected by multivariable analyses, two independent prognostic scoring systems (PSS) were derived, one for grade ≥ 3 CRS and one for grade ≥ 3 ICANS. CRS-PSS included bulky disease, a platelet count  30 mg/L and no bridging therapy or stable or progressive disease (SD/PD) after bridging. Patients with a CRS-PSS score > 2 had significantly higher risk to develop grade ≥ 3 CRS. ICANS-PSS included female sex, low level of platelets ( 2 had significantly higher risk to develop grade ≥ 3 ICANS. Both scores were externally validated in international cohorts of patients treated with tisa-cel or axi-cel

Towards a tailored approach for patients with acute diverticulitis and abscess formation. The DivAbsc2023 multicentre case–control study

Conservative treatment; Diverticular abscess; Percutaneous drainageTractament conservador; Abscés diverticular; Drenatge percutaniTratamiento conservador; Absceso diverticular; Drenaje percutáneoBackground This multicentre case–control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses. Methods This study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed. Results Failure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P  5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI − 0.66;3.70, P = 0.23). Conclusions Non-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups.Open access funding provided by Università degli Studi di Cagliari within the CRUI-CARE Agreement. This research has not received any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Long-term safety of OnabotulinumtoxinA treatment in chronic migraine patients: a five-year retrospective study

OnabotulinumtoxinA; Chronic migraine; ProphylaxisOnabotulinumtoxinA; Migraña crónica; ProfilaxisOnabotulinumtoxinA; Migranya crònica; ProfilaxiBackground: Real-world studies have shown the sustained therapeutic effect and favourable safety profile of OnabotulinumtoxinA (BoNTA) in the long term and up to 4 years of treatment in chronic migraine (CM). This study aims to assess the safety profile and efficacy of BoNTA in CM after 5 years of treatment in a real-life setting. Methods: We performed a retrospective chart review of patients with CM in relation to BoNTA treatment for more than 5 years in 19 Spanish headache clinics. We excluded patients who discontinued treatment due to lack of efficacy or poor tolerability. Results: 489 patients were included [mean age 49, 82.8% women]. The mean age of onset of migraine was 21.8 years; patients had CM with a mean of 6.4 years (20.8% fulfilled the aura criteria). At baseline, patients reported a mean of 24.7 monthly headache days (MHDs) and 15.7 monthly migraine days (MMDs). In relation to effectiveness, the responder rate was 59.1% and the mean reduction in MMDs was 9.4 days (15.7 to 6.3 days; p < 0.001). The MHDs were also reduced by 14.9 days (24.7 to 9.8 days; p < 0.001). Regarding the side effects, 17.5% experienced neck pain, 17.3% headache, 8.5% eyelid ptosis, 7.5% temporal muscle atrophy and 3.2% trapezius muscle atrophy. Furthermore, after longer-term exposure exceeding 5 years, there were no serious adverse events (AE) or treatment discontinuation because of safety or tolerability issues. Conclusion: Treatment with BoNTA led to sustained reductions in migraine frequency, even after long-term exposure exceeding 5 years, with no evidence of new safety concerns

Grape Seed Proanthocyanidin Extract Attenuates Cafeteria-Diet-Induced Liver Metabolic Disturbances in Rats: Influence of Photoperiod

Cafeteria diet; Circannual rhythms; Liver lipidic metabolismDieta cafeteria; Ritmes circanuals; Metabolisme lipídic hepàticDieta cafetería; Ritmos circanuales; Metabolismo lipídico hepáticoThis study investigated the influence of photoperiod (day length) on the efficacy of grape seed proanthocyanidin extract (GSPE) in mitigating metabolic disorders in obese rats fed a cafeteria diet. Rats were exposed to standard (L12), long (L18), or short (L6) photoperiods and treated with GSPE or vehicle. In the standard photoperiod, GSPE reduced body weight gain (50.5%), total cholesterol (37%), and triglycerides (34.8%), while increasing the expression of hepatic metabolic genes. In the long photoperiod, GSPE tended to decrease body weight gain, increased testosterone levels (68.3%), decreased liver weight (12.4%), and decreased reverse serum amino acids. In the short photoperiod, GSPE reduced glycemia (~10%) and lowered triglyceride levels (38.5%), with effects modified by diet. The standard photoperiod showed the greatest efficacy against metabolic syndrome-associated diseases. The study showed how day length affects GSPE’s benefits and underscores considering biological rhythms in metabolic disease therapies.This project was funded by the Spanish Ministry of Science and Innovation MCIN/AEI/10.13039/501100011033/, by ERDF “A way of making Europe” (Grants numbers: PID2021-128813OB-I00 and PID2020-113739RB-I00). R.M.R. was the recipient of a predoctoral fellowship from Universitat Rovira i Virgili—Martí i Franquès, grant number 2018PMF-PIPF-11. M.C.P. was the recipient of a predoctoral fellowship from the Catalan Government, grant number 2021FI_B2 00150. E.C. and M.M. are Serra-Hunter fellows

Situació epidemiològica dels casos d’Mpox (verola del mico) a Catalunya – 2024/08

Verola del mico; Vigilància epidemiològica; Salut públicaViruela del mono; Vigilancia epidemiológica; Salud públicaMonkey pox; Epidemiological surveillance; Public healthEs descriu la situació epidemiològica del virus Mpox (verola del mico) a la Xarxa de Vigilància Epidemiològica de Catalunya (XVEC). S’analitzen les característiques dels casos i la malaltia, els aspectes clínics, els antecedents personals i les característiques de l’exposició, des de l’inici de la pandèmia a tots els territoris de Catalunya.The document described the epidemiological situation of the Mpox virus (monkey pox) in the Xarxa de Vigilància Epidemiològica de Catalunya (XVEC). It analyze the characteristics of the cases and the disease, the clinical aspects, the personal antecedents and the characteristics of the exposure, since the beginning of the pandemic.Se describe la situación epidemiológica del virus Mpox (viruela del mono) en la Xarxa de Vigilància Epidemiològica de Catalunya (XVEC). Se analizan las características de los casos y la enfermedad, los aspectos clínicos, los antecedentes personales y las características de la exposición, desde el inicio de la pandemia