Hospital General Universitario De Valencia

Objectives: The objective of this study was to investigate choroidal structural alterations and evaluate the outcomes of switching to faricimab in patients with neovascular age-related macular degeneration (nAMD) previously treated with other anti-vascular endothelial growth factor (anti-VEGF) therapies after 12 months of follow-up. Methods: We performed a retrospective study of 30 eyes from 30 patients with nAMD who were switched to faricimab. The choroidal vascularity index (CVI), best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (CST), and the presence of subretinal fluid, intraretinal fluid, and wet macula were assessed at baseline and after 6 and 12 months. Results: CVI remained stable during follow-up (p > 0.05). BCVA improved significantly after 6 months (p = 0.041), but not at 12 months (p = 0.075). A significant reduction in CMT was observed (p < 0.05). Additionally, wet macula improved after 12 months (p < 0.05). Moreover, treatment intervals increased from 7.53 ± 2.39 to 12.47 ± 4.51 weeks. Conclusions: Switching to faricimab in patients with nAMD previously treated with other anti-VEGF therapies was associated with anatomical improvement, extended treatment intervals, and short-term visual gains, while choroidal vascular structure was maintained. Nonetheless, additional studies are warranted to more comprehensively evaluate the effectiveness of switching to faricimab, as well as the associated changes in choroidal vascular structure.

Abstract: PURPOSE: The purpose of this study was to investigate the association of different cardiometabolic factors with the asymmetry index (AI) of quantitative parameters measured with swept-source-optical coherence tomography angiography (OCTA). MATERIALS AND METHODS: We performed a retrospective study. The study enrolled 200 eyes of 100 patients. Demographic and clinical characteristics were obtained. AI of OCTA quantitative parameters (vessel density [VD] and foveal avascular zone [FAZ] area of superficial capillary plexus [SCP], deep capillary plexus [DCP], total capillary plexus (TCP), and choriocapillaris) in 4.5 mm × 4.5 mm cube were recorded in each patient. RESULTS: Dyslipidemia (DL) was associated with AI of SCP VD ( P = 0.016). Moreover, males and nondiabetic patients had a higher AI of SCP VD ( P = 0.010 and P &lt; 0.001). Regarding to AI of FAZ area, diabetes mellitus (DM) was associated with AI of FAZ area of SCP and DCP ( P &lt; 0.042 and P = 0.022), and smoking status was associated with AI of TCP FAZ area ( P = 0.012). In addition, correlation analysis revealed a weak negative correlation between systolic and diastolic blood pressure (dBP) and AI of TCP VD ( P = 0.032 and 0.026) and between dBP and AI of DCP FAZ area and TCP FAZ area ( P = 0.034 and 0.013). Finally, a weak positive correlation was found between low-density lipoprotein and AI of SCP FAZ area ( P = 0.034). CONCLUSION: In an era without built-in normative data, we demonstrated that cardiometabolic conditions (DM, hypertension, and DL) are associated with interocular asymmetry of SCP perfusion and FAZ area of retinal capillary plexus.

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.

Background/Objectives: The treatment of dual disorders (DDs) must be comprehensive and multidisciplinary. Evidence supports the effectiveness of psychotherapy in treating DDs. The second part of this consensus synthesizes the available evidence on psychological treatment for specific DDs. Methods: Two consensus methods were sequentially implemented: the nominal group technique and the Delphi method. Results: This consensus review encompassed a compilation of recommendations for the psychological treatment of neurodevelopmental, anxiety, post-traumatic stress, somatic symptom, eating, and personality disorders. Finally, recommendations for the future research agenda on the psychological treatment of DD were included. Conclusions: (1) Psychological treatment, particularly integrated treatment, is effective. (2) In the case of dual autism, interventions for substance use disorders should be adapted to this population's characteristics. (3) More research is needed on dual social anxiety, panic, generalized anxiety, somatic symptom, and eating disorders, for which Cognitive Behavioral Therapy (CBT) is the most commonly used treatment. (4) For dual attention deficit hyperactivity disorder, multicomponent treatment is recommended (psychoeducation, CBT, and peer or family support). (5) For dual anxiety disorders, CBT is the first-line treatment. (6) For dual post-traumatic stress disorder, CBT (cognitive processing therapy and prolonged exposure therapy), acceptance and commitment therapy, stress inoculation training, and Eye Movement Desensitization and Reprocessing (EMDR) are effective. (7) For dual personality disorders, evidence is scarce. (8) For borderline personality disorder, dialectical behavior therapy, dynamic deconstructive psychotherapy, and dual-focus schema therapy show promise. (9) For antisocial personality disorder, CBT, contingency management, and counseling on impulsive lifestyles may be useful. (10) Much more evidence is needed from studies that overcome the methodological limitations of existing ones.

Objetivo: Evaluar el valor de la procalcitonina (PCT) y la proteína C reactiva (PCR) al tercer día postoperatorio como marcadores precoces de dehiscencia anastomótica en cirugía oncológica colorrectal.Materiales y Método: Estudio clínico observacional retrospectivo sobre pacientes intervenidos de neoplasia colorrectal entre octubre de 2021 y abril de 2024. Se recogieron datos referentes a los pacientes, tipo de intervención, y complicaciones postoperatorias. Se estudió la relación entre las complicaciones y el valor de la PCR y la PCT al tercer día del postoperatorio.En el análisis estadístico se emplearon el test de X2 de Pearson y de U de Mann-Whitney, el test de Wilcoxon, la curva ROC y el índice de Youden.Resultados: Se estudiaron 211 pacientes de los cuales 27 (12,7%) presentaron alguna complicación mayor. En 23 pacientes (10,9%) se diagnosticó dehiscencia de sutura, 10 se manejaron de forma conservadora y 13 (6,2%) se reintervinieron. Los valores de la PCT y de la PCR al tercer día se correlacionaron de forma significativa con la dehiscencia (p=0,000). Se obtuvo como punto de corte un valor de 0,995 ng/ml para la PCT y de 17 mg/dl para la PCR.Discusión: Aunque diversos estudios avalan la utilidad de la PCT y la PCR para el diagnóstico de dehiscencia de sutura, está por determinar el tiempo de determinación y el valor considerado patológico.Conclusión: La PCT y PCR determinadas al tercer día resultaron útiles considerándose patológicos a partir de 1 ng/ml de PCT y 17 mg/dl de PCR.

Subcutaneous (SC) infliximab biosimilar CT-P13 has shown comparable efficacy and safety to the intravenous (IV) formulation in inflammatory bowel disease (IBD). However, long-term real-world data remain limited. This study assessed the three-year effectiveness, safety, and pharmacokinetics profile of SC CT-P13 in IBD patients switched from IV infliximab. Prospective, observational, multicenter study conducted in eight hospitals (Valencian Community, Spain). Adult patients with ulcerative colitis (UC) or Crohn's disease (CD) receiving IV infliximab were switched to SC CT-P13 and followed for up to 3 years. Clinical activity, inflammatory biomarkers, adverse events, treatment persistence, and infliximab trough levels were assessed, including analyses according to immunomodulatory therapy (IM) use and dosing intensities. Seventy-four patients were included (43% UC, 57% CD). Mean SC CT-P13 trough levels increased significantly from baseline to 3 years (8.15 ± 5.93 to 15.89 ± 7.99 µg/mL, p<0.001), with consistent results across disease type, intensified dosing, and perianal CD subgroups. Inflammatory markers (CRP, calprotectin) remained stable throughout follow-up. Concomitant IM use decreased from 51% at baseline to 26.3% at study end, without changes in pharmacokinetics, clinical outcomes, or biomarkers. Treatment persistence at 3 years was 80% overall and 88% when considering only discontinuations due to loss of efficacy or adverse events. Fourteen patients (19%) experienced adverse events, predominantly mild. Switching from intravenous to subcutaneous infliximab biosimilar CT-P13 was associated with sustained treatment persistence, stable disease control, favorable pharmacokinetics, and good tolerability over 3 years. These real-world findings support SC CT-P13 as a convenient long-term maintenance option in routine clinical practice.

El presente estudio tiene como objetivo describir las características de las personas con adicción admitidas en una Unidad de Conductas Adictivas (UCA), con especial atención a los pacientes con comorbilidad con otro trastorno mental (patología dual). Se llevó a cabo un estudio observacional y retrospectivo en la UCA de Paterna-La Coma (València), analizando datos de 2.086 pacientes admitidos entre 2012 y 2023. El 78,3% de las personas en tratamiento fueron hombres, con una media de edad de 20 años en jóvenes y 40 años en adultos. El 35,2% de las y los pacientes refieren un tratamiento previo. El 36,7% presenta un trastorno por uso de alcohol, seguido de cocaína (27,2%), cannabis (20,3%) y heroína (12,8%). El 42,5% presenta criterios de policonsumo. Además, el 58,9% de las personas en tratamiento tiene comorbilidad con otro trastorno mental y/o trastorno de personalidad y de éstos, el 11,0% presenta dos enfermedades mentales de manera concomitante asociadas al trastorno por uso de sustancias. Son las mujeres las que presentan un mayor porcentaje de trastornos mentales. Estos hallazgos refuerzan la necesidad de abordar el trastorno por uso de sustancias como un proceso crónico, subrayando la importancia de la intervención precoz y del tratamiento a largo plazo para mejorar los resultados en salud mental y reducir la comorbilidad.

BackgroundBictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) is a single-tablet regimen recommended as first-line HIV treatment in international guidelines. This analysis aimed to assess the effectiveness and safety of B/F/TAF in real-world Spanish clinical practice.MethodsThis was an analysis of the Spanish subset from the BICSTaR study in treatment-naïve (TN) and treatment-experienced (TE) people with HIV who started treatment between November 2019 and July 2021 (European study registration: EUPAS22185). The primary endpoint was virologic suppression (HIV-1 RNA <50 copies/mL); additional endpoints included CD4 cell count changes, treatment persistence, adverse events, weight changes, and the 36-Item Short Form Survey mental and physical component summary (MCS/PCS) scores at 12 months.ResultsIn total, 249 people with HIV initiated B/F/TAF treatment (62 TN, 187 TE). At 12 months, virologic suppression was achieved by 86% of TN and 98% of TE participants, with 91% of those TE participants with baseline HIV-1 RNA ≥50 copies/µL achieving suppression. Median CD4 count increased by 296 cells/µL in TN (p<0.001) and 12 cells/µL in TE (p=0.302) participants. Persistence at 12 months was high in all participants, with 95% still on treatment. Overall, none of TN and less than 3% of TE participants discontinued B/F/TAF due to drug-related adverse events, all of which were mild or moderate. Median weight increase was 2.9 kg in TN (p<0.001) and 1.0 kg in TE (p<0.001) participants. Median MCS scores improved in the TN group (8.4-point increase, p<0.001) but not in the TE group (0.4-point increase, p=0.767), while PCS scores remained stable both among TN and TE.ConclusionThese real-world findings strongly support B/F/TAF use in TN and TE people with HIV in Spain, demonstrating high 12-month persistence and effectiveness, and mental health benefits in TN participants, with minimal adverse events.