Sara Vela-Bernal

Background/Objectives: Patients with solid or hematological malignancies face a high risk of fragility fractures (FF) due to cancer treatment-induced bone loss (CTIBL) and the disease itself. However, these patients were largely excluded from pivotal clinical trials for romosozumab. This study aimed to evaluate the effectiveness and safety of romosozumab in a real-world multicenter cohort of onco-hematological patients.Methods: This was a retrospective observational study involving 64 patients (81.25% female; mean age 74.1 years) across five Spanish hospitals. Participants had severe osteoporosis and history or active diagnosis of malignancy. Effectiveness was assessed via bone mineral density (BMD) T-score changes at 12 months. Safety, adherence, and sequential therapy outcomes were monitored over a mean follow-up of 20.4 months. Results: Significant BMD improvements were observed at 12 months: the mean lumbar spine T-score increased from −2.7 to −1.79 (p<0.001) and the total hip T-score improved from −2.9 ± 0.96 to −2.57 ± 0.87 (p<0.01)The incident fracture rate during follow-up was 3.1%. Sequential therapy was initiated in 85.7% of cases (predominantly denosumab). All-cause mortality was 6.25%, with all deaths attributed to malignancy progression and none to the anabolic treatment. No serious cardiovascular events or unexpected safety signals were reported. Conclusions: Romosozumab is a potent and safe therapeutic option for onco-hematological patients with severe osteoporosis. The "anabolic-to-antiresorptive" sequence is effective in this population, providing clinical reassurance regarding sclerostin inhibition in oncological settings.

Strongyloidiasis is traditionally regarded as a tropical disease; however, in the Valencian Community (Spain), it has historically been linked to localized endemic foci considered of declining relevance. This was a multicenter regional case series study across three hospitals including patients ≥16 years with strongyloidiasis defined by positive serology and/or parasitological confirmation diagnosed from 2015 to 2024. A total of 301 patients were included (median age 53 years (quartile 1–quartile 3, 40–72); 135 (44.9%) female). Most cases were autochthonous (176/299, 58.9%), while 123/299 (41.1%) occurred in migrants, predominantly from Latin America. Symptoms were present in 165/296 (55.7%), most frequently cutaneous (68/296, 23.0%) and gastrointestinal (62/296, 20.9%). Eosinophilia (>500 cells/µL) was observed in 144/298 (48.3%) and severe infection (hyperinfection syndrome) in 7/294 (2.4%). Annual diagnoses increased over time, with a significant temporal trend by case origin (p < 0.001), reflecting an increasing contribution of imported infections, whereas trends by sex (p = 0.068) and immune status (p = 0.926) were not significant. Stool-based methods demonstrated a low diagnostic yield (microscopy 7/157, 4.5%; culture 21/136, 15.4%; rtPCR 2/27, 7.4%). These findings document the sustained detection of cases classified as autochthonous beyond historically recognized foci and an increasing proportion of imported diagnoses in a temperate European setting.

Background: Clostridioides difficile infection (CDI) is the leading cause of nosocomial diarrhea. Current diagnostic tools have difficulty distinguishing between colonization and active infection. This study evaluated the utility of fecal metabolomics in diagnosing CDI in hospitalized patients with acute diarrhea. Methods: We conducted a prospective observational study involving hospitalized adults with new-onset diarrhea during admission. Participants were stratified into groups based on clinical and microbiological findings: controls, C. difficile colonized and C. difficile infected. Fecal samples were analyzed using UPLC-MS/MS and GC-MS to quantify selected short-chain fatty acids, amino acids, and bile acids. Multivariate and univariate statistical analyses included PLS-DA, sPLSDA, and tests with FDR correction. Results: Infected patients exhibited significantly higher concentrations of SCFAs and notable alterations in bile acid profiles. Key discriminative metabolites included isovalerate, propionate, isobutyrate and alpha-aminobutyric acid. ROC curve analyses showed strong diagnostic performance for these markers, with AUC values exceeding 0.85. Conclusions: Fecal metabolomic profiling could effectively differentiate between colonization and infection in CDI among hospitalized patients with diarrhea. These results highlight the potential of metabolomic signatures to enhance the diagnostic precision for CDI.

Clostridioides difficile infection (CDI) is the leading cause of nosocomial diarrhea. Current diagnostic tools have difficulty distinguishing between colonization and active infection. This study evaluated the utility of fecal metabolomics in diagnosing CDI in hospitalized patients with acute diarrhea. We conducted a prospective observational study involving hospitalized adults with new-onset diarrhea during admission. Participants were strati-fied into groups based on clinical and microbiological findings: controls, C. difficile col-onized and C. difficile infected. Fecal samples were analyzed using UPLC-MS/MS and GC-MS to quantify selected short-chain fatty acids, amino acids, and bile acids. Multi-variate and univariate statistical analyses included PLS-DA, sPLSDA, and tests with FDR correction. Infected patients exhibited significantly higher concentrations of SCFAs and notable alterations in bile acid profiles. Key discriminative metabolites included isova-lerate, propionate, isobutyrate and alpha-aminobutyric acid. ROC curve analyses showed strong diagnostic performance for these markers, with AUC values exceeding 0.85. Fecal metabolomic profiling could effectively differentiate between colonization and infection in CDI among hospitalized patients with diarrhea. These results highlight the potential of metabolomic signatures to enhance the diagnostic precision for CDI.

This retrospective cohort study aimed to assess clinical and epidemiological characteristics, treatment outcomes, and predictors of serological cure in patients with chronic Chagas disease in a non-endemic setting. All individuals aged ≥16 years with confirmed infection and evaluated at a tertiary hospital in Spain from 2008 to 2023 were included. Most of the 107 participants were women (78.5%) and Bolivian-born (99.1%). Digestive and cardiac involvement were identified in 32.7% and 17.8% of cases, respectively. Cardiac symptoms were significantly associated with the diagnostic findings of cardiac involvement (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.1–8.2), whereas digestive symptoms did not correlate with imaging abnormalities (OR 0.7, 95% CI 0.3–1.6). Antiparasitic treatment, usually benznidazole, was initiated in 69% of patients and led to adverse events in 66.2%, with treatment discontinuation in 25.7%. Only 8.1% of treated patients achieved serological cure after a median 26 months, with obesity emerging as the only independent predictor (adjusted OR 31.0, 95% CI 3.7–261.2). Cardiac progression occurred in 9.3% of patients despite treatment. Although 59.8% were lost to follow-up, the cohort maintained a median follow-up of 27 months. These findings underscore the need for improved treatment strategies and sustained clinical monitoring in non-endemic settings.

The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term “elderly” corresponds to different ages in the literature, but it is defined by considerable comorbidity and heterogeneity. Cancer incidence, specifically colorectal cancer, is increased in older patients with IE and impacts its outcome. Diagnosis of IE in elderly patients is challenging due to the atypical presentation of the disease and the lower performance of imaging studies. Enterococcal etiology is more frequent than in younger patients. Antibiotic treatment should prioritize diminishing adverse effects and drug interactions while maintaining the best efficacy, as surgical treatment is less commonly performed in this population due to the high surgical risk. The global assessment of elderly patients with IE, with particular attention to frailty and geriatric profiles, should be performed by multidisciplinary teams to improve disease management in this population.

Introduction: Early diagnosis and initiation of immunosuppression can prevent the necessity of surgical intervention in necrotizing scleritis with inflammation and lowers the risk of perforation and loss of vision. However, clinical signs for early diagnosis and methods for monitoring response to immunosuppressive therapy are missing. Methods: Here, we present a case of necrotizing scleritis with inflammation where avascular plaques precede scleral defects. We use slit lamp imaging and anterior segment optical coherence tomography to evaluate evolution lesions depth and impact on scleral structure. Results: The patient presented 5 months after detection of avascular plaques with a new scleral ulcer of the left eye. After 3-day-administration of i.v. corticosteroids anterior segment optical coherence tomography showed progressive scleral thickening. The patient was therefore spared surgical intervention and discharged resulting in complete remission under decreasing doses of oral corticosteroids. Conclusions: Avascular plaques can precede necrotizing scleritis with inflammation by several months and may therefore qualify as early clinical signs. Anterior segment optical coherence tomography enables objective evaluation of scleral structure for making rational decisions about surgical intervention.

Aims: This study assessed the impact of acute hemoglobin (Hb) falls in heart failure (HF) patients. Methods: HF patients with repeated Hb values over time were included. Falls in Hb greater than 30% were considered to represent an acute episode of anemia and the risk of hospitalization and all-cause mortality after the first episode was assessed. Results: In total, 45,437 HF patients (54.9% female, mean age 74.3 years) during a follow-up average of 2.9 years were analyzed. A total of 2892 (6.4%) patients had one episode of Hb falls, 139 (0.3%) had more than one episode, and 342 (0.8%) had concomitant acute kidney injury (AKI). Acute heart failure occurred in 4673 (10.3%) patients, representing 3.6/100 HF patients/year. The risk of hospitalization increased with one episode (Hazard Ratio = 1.30, 95% confidence interval (CI) 1.19–1.43), two or more episodes (HR = 1.59, 95% CI 1.14–2.23, and concurrent AKI (HR = 1.61, 95% CI 1.27–2.03). A total of 10,490 patients have died, representing 8.1/100 HF patients/year. The risk of mortality was HR = 2.20 (95% CI 2.06–2.35) for one episode, HR = 3.14 (95% CI 2.48–3.97) for two or more episodes, and HR = 3.20 (95% CI 2.73–3.75) with AKI. In the two or more episodes and AKI groups, Hb levels at the baseline were significantly lower (10.2–11.4 g/dL) than in the no episodes group (12.8 g/dL), and a higher and significant mortality in these subgroups was observed. Conclusions: Hb falls in heart failure patients identified those with a worse prognosis requiring a more careful evaluation and follow-up.