Complejo Hospitalario de Pontevedra

Parkinson's disease is a progressive neurodegenerative disorder characterized by motor and non-motor impairments that substantially affect functional capacity and quality of life. Although pharmacological treatment remains the cornerstone of therapeutic management, exercise-based interventions have gained prominence as effective complementary strategies. Among these, Nordic walking has emerged as a potentially beneficial modality to enhance motor performance and increase overall muscular engagement during locomotion. This overview of systematic reviews aims to synthesize the available evidence on the effects of Nordic walking in individuals diagnosed with Parkinson's disease, with a particular focus on its impact on functional capacity. The methodological assessment conducted using the AMSTAR-2 tool (A MeaSurement Tool to Assess Reviews-2) revealed confidence ratings ranging from moderate to critically low, which limits the overall robustness of the conclusions. The findings suggest that Nordic walking may be associated with improvements in clinically relevant domains such as quality of life, gait speed, step length, aerobic capacity, and balance. However, given the substantial methodological limitations of several included reviews, these conclusions should be interpreted with caution.

Peptide receptor radionuclide therapy (PRRT) is an established treatment for patients with well-differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs) expressing somatostatin receptors (SSTR). Despite robust trial and real-world data, heterogeneity persists regarding patient selection, therapeutic sequencing, and follow-up strategies. A Delphi consensus was conducted by the Galician Multidisciplinary Group on Neuroendocrine and Endocrine Tumors (GGNET). Ten experts in oncology, endocrinology, nuclear medicine, and radiology participated. 29 clinical statements were developed after a systematic review and rated using a 4-point Likert scale. Consensus was defined as ≥ 70% agreement. Consensus (defined a priori as ≥ 70% agreement) was achieved for all statements although the level of agreement varied across domains. PRRT was endorsed for patients with unresectable or metastatic, progressive, well-differentiated GEP-NETs (grades 1-3, Ki-67 ≤ 55%) with confirmed SSTR expression. SSTR-targeted imaging (PET or scintigraphy) was considered mandatory for eligibility, with PET identified as the preferred modality. [18F]-FDG-PET was recommended selectively as a complementary prognostic tool in higher-grade tumors, rapid progression, or discordant imaging. Multidisciplinary tumor board review was universally supported. Guidance was provided on treatment administration, including standard dosing, renal protection, hematologic monitoring, and individualized risk assessment. Routine interim imaging was not recommended. Structured follow-up with CT/MRI was endorsed, with indication-driven use of SSTR or FDG-PET and limited routine value of non-specific biomarkers. Functional biomarkers, such as 5-HIAA and peptide hormones, retained utility in functioning tumors. This Delphi consensus provides pragmatic, multidisciplinary, and evidence-informed guidance to harmonize routine clinical practice in the use of PRRT for well-differentiated, SSTR-positive NETs. The proposed statements and the algorithm aim to harmonize practice across centers, reduce variability in care, enhance safety, and ultimately improve patient outcomes.

Chronic nonspecific low back pain (CNLBP) is a widely recognized condition worldwide. Its clinical management must be based on the best current evidence to achieve optimal outcomes, yet there is still a lack of consensus on its clinical approach. To evaluate the effectiveness of manual therapy (MT) on pain intensity, frequency, disability, and quality of life in adults with chronic nonspecific low back pain (CNLBP). A comprehensive search was conducted in 8 databases, covering January 2014 to October 2024. Inclusion criteria included adults with CNLBP, MT interventions provided by healthcare professionals, and systematic reviews (SRs) of randomized controlled trials (RCT). Data on pain intensity, pain frequency, disability, and quality of life measured using validated scales were extracted. The results were shown according to the type of intervention and the period evaluated (short, medium, or long term). About 21 SRs with 35,711 participants were included. MT included spinal manipulation, soft-tissue techniques, myofascial techniques, massage, and neuromeningeal techniques. MT outperforms other interventions regarding pain (MD -10.52; 95% CI -13.71 to -7.33) and disability (SMD -0.60; 95% CI-0.80 to -0.40) in the short term, and this effect diminishes over time. MT offers significant short-term benefits in reducing pain and disability in individuals with CNLBP. Like most interventions for CNLBP, the effects of MT tend to diminish over time. Nevertheless, MT may serve as a valuable treatment option for short-term pain relief and functional improvement. Limitations in the methodological quality and long-term follow-up of included studies constrain the conclusions that can be drawn about long-term efficacy. PROSPERO, CRD42023382825.

<h3>Background and Importance</h3> Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents, such as aflibercept and ranibizumab, are widely used. Although generally safe, they carry a risk of endophthalmitis, a rare but severe adverse event. Understanding its incidence is essential to enhance patient safety. <h3>Aim and Objectives</h3> To determine the incidence of endophthalmitis as an adverse reaction following intravitreal injection of prefilled syringe formulations of aflibercept and ranibizumab. <h3>Material and Methods</h3> A retrospective descriptive study was conducted including patients treated with aflibercept or ranibizumab between January 2021 and August 2025. They were identified using the hospital pharmacy dispensing software, filtered by indications: age-related macular degeneration (AMD), diabetic macular oedema (DMO), choroidal neovascularisation (CNV), retinal vein occlusion (RVO) and other eye diseases. Suspected cases of endophthalmitis were identified by searching for compounded ceftazidime and vancomycin eye drops or intravitreal syringes, both used in initial endophthalmitis management. Electronic medical records were reviewed to confirm the diagnosis and clinical courses. <h3>Results</h3> We identified 2019 patients treated with aflibercept and 1689 with ranibizumab. Among 101 patients who received compounded ceftazidime and vancomycin, 12 had previously been treated with anti-VEGF agents (2 aflibercept only, 4 ranibizumab only and 6 with both). 6 confirmed cases of post-injection endophthalmitis were detected (4 women, 2 men), with a median age of 82.5 (55-94) years. Details of cases (case number, indication, anti-VEGF agent, onset of symptoms in days, previous injections of aflibercept/ranibizumab): CNV, aflibercept, 3, 9/2 DMO, aflibercept, 5, 9/1 RVO, ranibizumab, 7, 0/13 AMD, aflibercept, 28, 10/6 AMD, ranibizumab, 7, 0/6 AMD, aflibercept, 7, 14/6 <h3>Conclusion and Relevance</h3> Endophthalmitis represents a low-incidence adverse event associated with intravitreal anti-VEGF injections for AMD, DMO, CNV and RVO. No apparent differences were observed between aflibercept and ranibizumab regarding endophthalmitis occurrence. Ongoing pharmacovigilance and aseptic technique remain essential to ensure safe clinical practice. <h3>Conflict of Interest</h3> No conflict of interest

BackgroundNon-small cell lung cancer (NSCLC) with mutations in epidermal growth factor receptor exon 20 (EGFR Ex20Ins) is rare and resistant to conventional tyrosine kinase inhibitors (TKIs), limiting treatment options. This retrospective study in Galicia (Spain) evaluated the clinical characteristics, treatment response, and survival of patients with NSCLC and EGFR Ex20Ins.MethodsData from patients diagnosed between 2013 and 2023, confirmed by next-generation sequencing (NGS) or polymerase chain reaction (PCR), were included. Overall survival (OS), progression-free survival (PFS), and the incidence of serious adverse events were assessed.ResultsOf the 43 patients in the present study, 39 had metastatic disease and were considered for survival analysis. Among patients with metastatic disease, the median OS was 14.6 months (95% CI: 7–20 months), and the median PFS was 7.4 months (95% CI: 3–12 months) with first-line therapy (1L). Patients treated with platinum-based chemotherapy in the 1L achieved a median PFS of 9.8 months (95% CI: 3–27 months), whereas those receiving TKIs achieved a median PFS of 3.4 months (95% CI: 1–12 months). No significant differences in treatment response were found according to age or sex.ConclusionsThe results show the limited effectiveness of TKIs in patients with EGFR Ex20Ins and highlight the need for specific therapies. Platinum-based chemotherapy performed better in preventing disease relapse.

Aortitis associated with giant cell arteritis (GCA) is a severe manifestation, potentially leading to aneurysms and aortic dissection. Tocilizumab (TCZ) has demonstrated efficacy in the treatment of GCA, both intravenously or subcutaneously administered. However, pivotal studies did not specifically evaluate aortic involvement, and no comparison of intravenous (IV) versus subcutaneous (SC) TCZ has been performed in patients with GCA-related aortitis. The objective of this study was to compare the effectiveness of TCZ according to the administration route in patients with GCA-associated aortitis under clinical practice conditions. This was a multicenter observational study including 196 patients diagnosed with GCA-associated aortitis by imaging and treated with TCZ. Patients were grouped by administration route: IV or SC. GCA was diagnosed following the 1990 American College of Rheumatology criteria, temporal artery biopsy, and/or vascular imaging. Aortitis was identified using 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan. Main outcomes included EULAR remission, clinical and imaging remission, absence of systemic inflammation, and glucocorticoid-sparing effect. Of 196 patients (148 women; mean age 69.8 ± SD 9.4 years), 110 received IV TCZ and 86 SC TCZ. Baseline clinical characteristics and markers of inflammation were comparable between groups. The glucocorticoid-sparing effect was similar. At 24-month follow-up, EULAR-defined remission was significantly more frequent in the SC group (83.3% vs 80.6%; P < 0.05). However, rates of imaging remission and absence of systemic inflammation were comparable between treatment arms. In this real-world cohort of GCA-associated aortitis, SC TCZ showed slightly greater effectiveness than IV TCZ in achieving EULAR-defined remission, whereas no significant differences were observed between both routes regarding imaging remission.