Medicina

Venetoclax as a possible chemopreventive agent in adenomatous polyposis: A case report

2026-04-15T18:06:45Z

Venetoclax as a possible chemopreventive agent in adenomatous polyposis: A case report; Venetoclax como posible agente quimiopreventivo en la poliposis adenomatosa: a propósito de un caso Maimouni, Cautar el; Daca Alvarez, Maria de los Angeles; Delgado, Julio (Delgado González); Pellisé Urquiza, Maria; Balaguer Prunés, Francesc Familial adenomatous polyposis (FAP) is a hereditary colorectal cancer (CRC) syndrome caused by a germline pathogenic variant in the Adenomatous Polyposis Coli (APC) gene. However, a pathogenic mutation in this gene is not identified in 20% of patients.

From peri-implant mucositis to peri-implantitis: Incidence and risk indicators in a university dental hospital sample with up to 10 years of follow-up

2026-04-15T10:53:14Z

From peri-implant mucositis to peri-implantitis: Incidence and risk indicators in a university dental hospital sample with up to 10 years of follow-up Alahmari, Ahmad; Arsalan Askarizadeh, Amir; Barbosa de Figueiredo, Rui Pedro; García-García, Marta; Costa-Berenguer, Xavier; Sales Collado, Miquel; Valmaseda Castellón, Eduardo; Sánchez Torres, Alba Objectives: To determine the proportion of patients with peri‑implant mucositis who develop peri‑implantitis over a 1- to 10-year follow-up period, and to identify the variables associated with this progression. Materials and Methods: A retrospective cohort study was conducted including 97 patients with 204 dental implants diagnosed with peri‑implant mucositis. Clinical and radiographic examinations were performed, and compliance with supportive peri‑implant care (SPIC) was recorded. A multilevel multinomial logistic regression model was developed to identify the predictors of disease progression. Results: After a mean follow-up of 49.8 months, 23.7% of patients initially diagnosed with peri‑implant mucositis became healthy, 57.7% showed no change and remained with peri‑implant mucositis, while 18.5% progressed to peri‑implantitis. A history of periodontitis significantly increased the odds of presenting peri‑implant disease at the last follow-up appointment (p < 0.001). Conversely, regular compliance with SPIC, prostheses with an adequate design, and single-unit restorations significantly reduced the risk of progression (p < 0.001). Conclusions: Almost one fifth of patients with dental implants with peri‑implant mucositis are likely to develop peri‑implantitis after a mean follow-up of 4 years. A history of periodontitis, irregular supportive peri‑implant care and inadequate prosthetic design increase the likelihood of bone loss and progression to peri‑implantitis. Clinical Significance: This study emphasizes the importance of regular supportive peri‑implant care and appropriate prosthetic design to prevent progression from peri‑implant mucositis to peri‑implantitis, especially in patients with a history of periodontitis

Neurological Symptoms and Cause of Death Among Young Children in Low- and Middle-Income Countries

2026-04-14T12:05:54Z

Neurological Symptoms and Cause of Death Among Young Children in Low- and Middle-Income Countries Ajanovic, Sara; Mandomando, Inácio; Varo, Rosauro; Bassat Orellana, Quique; Child Health and Mortality Prevention Surveillance (CHAMPS) Consortium IMPORTANCE The emergence of acute neurological symptoms in children necessitates immediate intervention. Although low- and middle-income countries (LMICs) bear the highest burden of neurological diseases, there is a scarcity of diagnostic and therapeutic resources. Therefore, current understanding of the etiology of neurological emergencies in LMICs relies mainly on clinical diagnoses and verbal autopsies. OBJECTIVE To characterize the association of premortem neurological symptoms and their management with postmortem-confirmed cause of death among children aged younger than 5 years in LMICs and to identify current gaps and improve strategies to enhance child survival. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted between December 3, 2016, and July 22, 2022, at the 7 participating sites in the Child Health and Mortality Prevention Surveillance (CHAMPS) network (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa). Minimally invasive tissue sampling was performed at the CHAMPS sites with specimens from deceased children aged younger than 5 years. This study included deceased children who underwent a premortem neurological evaluation and had a postmortem-confirmed cause of death. Data analysis was performed between July 22, 2022, and January 15, 2023. MAIN OUTCOMES AND MEASURES Descriptive analysis was performed using neurological evaluations from premortem clinical records and from postmortem determination of cause of death (based on histopathology, microbiological testing, clinical records, and verbal autopsies). RESULTS Of the 2127 deaths of children codified during the study period, 1330 (62.5%) had neurological evaluations recorded and were included in this analysis. The 1330 children had a median age of 11 (IQR, 2-324) days; 745 (56.0%) were male and 727 (54.7%) presented with neurological symptoms during illness before death. The most common postmortem-confirmed neurological diagnoses related to death were hypoxic events (308 [23.2%]), meningoencephalitis (135 [10.2%]), and cerebral malaria (68 [5.1%]). There were 12 neonates with overlapping hypoxic events and meningoencephalitis, but there were no patients with overlapping meningoencephalitis and cerebral malaria. Neurological symptoms were similar among diagnoses, and no combination of symptoms was accurate in differentiating them without complementary tools. However, only 25 children (18.5%) with meningitis had a lumbar puncture performed before death. Nearly 90% of deaths (442 of 511 [86.5%]) with neurological diagnoses in the chain of events leading to deathwere considered preventable.

Prospective validation of the EASL management algorithm for acute kidney injury in cirrhosis

2026-04-14T09:34:21Z

Prospective validation of the EASL management algorithm for acute kidney injury in cirrhosis Ma, Ann T.; Solé, Cristina; Juanola, Adrià; Escudé, Laia; Napoleone, Laura; Avitabile, Emma; Pérez-Guasch, Martina; Carol, Marta; Pompili, Enrico; Gratacós Ginès, Jordi; Soria, Anna; Rubio, Ana Belén; Cervera Carbonell, Marta; Moreta, Maria José; Morales Ruiz, Manuel; Solà, Elsa; Poch, Esteban; Fabrellas i Padrès, Núria; Graupera, Isabel; Pose Méndez, Elisa; Ginès i Gibert, Pere Background & Aims The management of acute kidney injury (AKI) in cirrhosis is challenging. The EASL guidelines proposed an algorithm for the management of AKI, but this has never been validated. We aimed to prospectively evaluate this algorithm in clinical practice. Methods We performed a prospective cohort study in consecutive hospitalized patients with cirrhosis and AKI. The EASL management algorithm includes identification/treatment of precipitating factors, 2-day albumin infusion in patients with AKI ≥stage 1B, and treatment with terlipressin in patients with hepatorenal syndrome (HRS-AKI). The primary outcome was treatment response, which included both full and partial response. Secondary outcomes were survival and adverse events associated with terlipressin therapy. Results A total of 202 AKI episodes in 139 patients were included. Overall treatment response was 80%, while renal replacement therapy was required in only 8%. Response to albumin infusion was achieved in one-third of episodes. Of patients not responding to albumin, most (74%) did not meet the diagnostic criteria of HRS-AKI, with acute tubular necrosis (ATN) being the most common phenotype. The response rate in patients not meeting the criteria for HRS-AKI was 70%. Only 30 patients met the diagnostic criteria for HRS-AKI, and their response rate to terlipressin was 61%. Median time from AKI diagnosis to terlipressin initiation was only 2.5 days. While uNGAL (urinary neutrophil gelatinase-associated lipocalin) could differentiate ATN from other phenotypes (AUROC 0.78), it did not predict response to therapy in HRS-AKI. Ninety-day transplant-free survival was negatively associated with MELD-Na, ATN and HRS-AKI as well as uNGAL. Three patients treated with terlipressin developed pulmonary edema. Conclusions The application of the EASL AKI algorithm is associated with very good response rates and does not significantly delay initiation of terlipressin therapy. Impact and implications The occurrence of acute kidney injury (AKI) in patients with cirrhosis is associated with poor short-term mortality. Improving its rapid identification and prompt management was the focus of the recently proposed EASL AKI algorithm. This is the first prospective study demonstrating that high AKI response rates are achieved with the use of this algorithm, which includes identification of AKI, treatment of precipitating factors, a 2-day albumin challenge in patients with AKI ≥1B, and supportive therapy in patients with persistent AKI not meeting HRS-AKI criteria or terlipressin with albumin in those with HRS-AKI. These findings support the use of this algorithm in clinical practice.