An approach to autologous stem cell mobilization: trying to define good mobilizers.

BACKGROUND AND OBJECTIVES: Stem cell mobilization is a well-known procedure to harvest hematopoietic stem cells for autologous stem cell transplantation in certain hematologic diseases. Numerous studies have been conducted to identify risk factors for poor mobilization but there are no studies that identify good mobilizers. In our hospital, we decided to explore good mobilizers, defining them as those with ≥40 CD34+ cells/µL on Day +4 in order to start early apheresis. MATERIAL AND METHODS: A descriptive retrospective study was performed at Hospital Universitari Son Espases. A total of 198 patients mobilized with doses of around 10 µg/kg of granulocyte colony-stimulating factor (G-CSF) every 12 h were analyzed for autologous collection between January 2015 and September 2022. Fifty patients who had ≥40 CD34+ cells/µL on Day +4 started early apheresis; the rest continued mobilization as planned. Success was defined as obtaining over 2.5 × 106 CD34+ cells/kg in a single apheresis. RESULTS: The necessary number of CD34+ cells/kg to perform an autologous stem cell transplantation was reached in a single apheresis session in 62 % of patients with ≥40 CD34+ cells/µL in peripheral blood. A cutoff of 102 CD34+ cells/µL on Day +4 was shown to have the best success rate (94 %). In an analysis of success, age, previously failed mobilization and having one or more adverse factors for bad mobilization were statistically significant. CONCLUSION: Patients considered as good mobilizers were matched with our factors of poor mobilization, revealing that most patients (79 %) had none or only one risk factor for poor mobilization. Apheresis on Day +4 in good mobilizers was shown to be an effective alternative to reduce mobilization duration and decrease the amount of granulocyte-colony stimulating factor administered.

Microalgae and phytase dietary supplementation improved growth and gut microbiota in juvenile European seabass (Dicentrarchus labrax).

Fishmeal and fish oil have been the main sources of protein and fatty acid for aquaculture fish. However, their increasing price and low sustainability have led the aquafeed industry to seek sustainable alternative feedstuffs to meet the nutritional requirements of fish and improve their health and performance. Plant proteins have been successfully used to replace fishery derivatives in aquafeeds, but the presence of anti-nutritional substances is a potential drawback of this approach. Thus, it has been reported that phytate breakdown can be caused by feed supplementation with exogenous phytase. The inclusion of microalgae has been proposed to improve gut functionality in fish fed diets with a high vegetable protein content. The aim of this study was to evaluate the effect on the growth and gut microbiota of European seabass (Dicentrarchus labrax) juveniles of a diet containing a blend of microalgae (Arthrospira platensis and Nannochloropsis gaditana) and different concentrations of phytase. An 83-day feeding trial was conducted, comprising four experimental diets with 2.5% microalgae and 500, 1,000, 2,000, or 10,000 phytase units (FTU)/kg feed and a microalgae- and phytase-free control diet. At the end of the trial, a significantly increased body weight was observed in fish fed the diet with the highest phytase concentration (10,000 FTU/kg) versus controls, although the gut bacterial composition did not differ from controls in alpha or beta diversity with either majority (Weighted UniFrac) or minority bacterial strains (Unweighted UniFrac). In comparison to the control group, the groups fed diets with 1,000 or 2,000 FTU/kg diets had a lower alpha diversity (Shannon's diversity index), while those fed diets with 500 FTU/kg or 1,000 FTU/kg showed distinct clusters in beta diversity (involving minority ASVs). According to these findings, the diet containing the 2.5% microalgae blend with 10,000 FTU/kg may be useful to increase the aquafeed quality and sustain the growth performance of juvenile European seabass.

Autonomic dysfunction as manifestation of ICANS: A case report.

RATIONALE: Anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy is a successful treatment for B-cell malignancies associated with cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Cardiovascular toxicities have also been reported in this setting. However, there is scarce data regarding development of autonomic disorders after CAR-T cell therapy. PATIENT CONCERNS: We report a case with a patient with non-Hodgkin B-cell lymphoma, refractory to 2 prior lines of immunochemotherapy, treated with CAR-T therapy. DIAGNOSES: Orthostatic hypotension secondary to autonomic dysfunction was diagnosed as manifestation of ICANS. INTERVENTIONS: The patient received metilprednisolone 1000 mg IV daily for 3 days and anakinra 100 mg IV every 6h. OUTCOMES: The vast majority of autonomic symptoms ceased and 4 months after CAR-T therapy, autonomic dysfunction was resolved. LESSONS: New-onset autonomic dysfunction can occur as manifestation of ICANS in patients who experience persistent neurologic and cardiovascular symptoms after resolution of acute neurotoxicity and should be early recognized. Differences in differential diagnosis, mechanisms and treatment approaches are discussed.

Predictors of myositis in mixed connective tissue disease: A multicentre retrospective study.

OBJECTIVES: We aimed to identify clinical and serological predictors of myositis in mixed connective tissue disease (MCTD). METHODS: We performed a nationwide, retrospective, multicentre study including adult-onset MCTD patients fulfilling at least one of the following diagnostic criteria: Sharp's, Kasukawa, Alarcón-Segovia, or Kahn's. Univariate analysis was performed using Chi-square, Fisher exact, Student's t or Mann-Whitney U tests, as appropriate. Multivariate analysis was performed using binary logistic regression. RESULTS: Ninety-eight patients were included. Myositis was observed in 43.9% of patients, of whom 60.5% had myositis at disease onset. Proximal muscle weakness was described in 30 patients with muscle involvement (70%). Gastrointestinal involvement was identified in 28% and respiratory involvement in 29% of myositis patients. In the same subgroup of patients, 41.7% had a myopathic pattern on electromyography, and 47.1% had histological myositis features in the muscle biopsy. Fever (OR=6.96, p=0.022) was an independent predictor of myositis, regardless of sex, age at diagnosis, ancestry, and respiratory involvement. African ancestry (OR=8.39, p=0.019), leukopenia at the disease onset (OR 6.24, p=0.021), and younger age at diagnosis (OR=1.07/year, p=0.035) were identified as independent predictors of myositis at disease onset, regardless of sex and scleroderma pattern in capillaroscopy. CONCLUSIONS: Myositis is a common manifestation of MCTD, even at the disease onset. African ancestry, leukopenia at the disease onset, younger age at diagnosis, and fever should prompt a thorough evaluation for myositis.

GEMA-Na and MELD 3.0 severity scores to address sex disparities for accessing liver transplantation: a nationwide retrospective cohort study.

Background: The Gender-Equity Model for liver Allocation corrected by serum sodium (GEMA-Na) and the Model for End-stage Liver Disease 3.0 (MELD 3.0) could amend sex disparities for accessing liver transplantation (LT). We aimed to assess these inequities in Spain and to compare the performance of GEMA-Na and MELD 3.0. Methods: Nationwide cohort study including adult patients listed for a first elective LT (January 2016-December 2021). The primary outcome was mortality or delisting for sickness within the first 90 days. Independent predictors of the primary outcome were evaluated using multivariate Cox's regression with adjusted relative risks (RR) and 95% confidence intervals (95% CI). The discrimination of GEMA-Na and MELD 3.0was assessed using Harrell c-statistics (Hc). Findings: The study included 6071 patients (4697 men and 1374 women). Mortality or delisting for clinical deterioration occurred in 286 patients at 90 days (4.7%). Women had reduced access to LT (83.7% vs. 85.9%; p = 0.037) and increased risk of mortality or delisting for sickness at 90 days (adjusted RR = 1.57 [95% CI 1.09-2.28]; p = 0.017). Female sex remained as an independent risk factor when using MELD or MELD-Na but lost its significance in the presence of GEMA-Na or MELD 3.0. Among patients included for reasons other than tumours (n = 3606; 59.4%), GEMA-Na had Hc = 0.753 (95% CI 0.715-0.792), which was higher than MELD 3.0 (Hc = 0.726 [95% CI 0.686-0.767; p = 0.001), showing both models adequate calibration. Interpretation: GEMA-Na and MELD 3.0 might correct sex disparities for accessing LT, but GEMA-Na provides more accurate predictions of waiting list outcomes and could be considered the standard of care for waiting list prioritization. Funding: Instituto de Salud Carlos III, Agencia Estatal de Investigación (Spain), and European Union.

Predictive Value of Conjunctival Cytology in Bleb-dependent Glaucoma Surgery.

PURPOSE: Metaplasia, chronic inflammation and subconjunctival fibrosis favor failure of bleb-dependent glaucoma surgery. The aim of the study is to identify the patients at a higher risk of post-surgical failure. MATERIALS AND METHODS: Prospective, open study, performed in the Glaucoma Unit of the Hospital Universitario Virgen Macarena, from April to November 2021, with a minimum follow-up of one year. 38 eyes with ocular hypertension or chronic open-angle glaucoma were included. All patients underwent preoperative conjunctival sampling in the operating room, under topical or locoregional anesthesia. PARAMETERS MEASURED: Sex, age, and laterality; number, type and mean time of preoperative drugs use; type of surgery performed; cytology results and degree of metaplasia; percentage of patients in whom the bleb was closed. Evaluation of potential correlation between bleb closure and any of the other variables. RESULTS: 20 women and 18 men participated, with a mean age of 67 years. The mean number of preoperative hypotensive drugs was 2.7. The mean time of use was 90,97 +/- 48,97 months. Most patients had normal cytology, 8% had inflammatory infiltrate and 21% had squamous metaplasia. When relating bleb failure and cytology, we saw that in those who failed surgery, more than half had cytological alterations. A multiple logistic regression was performed, in which we observed that there was statistically significant association (p = .02) between surgical closure and altered cytology. CONCLUSIONS: According to these results, preoperative conjunctival cytology can help predict those cases with a lower probability of surgical success.

The Crucial Role of Inflammation and the Immune System in Colorectal Cancer Carcinogenesis: A Comprehensive Perspective.

Chronic inflammation drives the growth of colorectal cancer through the dysregulation of molecular pathways within the immune system. Infiltration of immune cells, such as macrophages, into tumoral regions results in the release of proinflammatory cytokines (IL-6; IL-17; TNF-α), fostering tumor proliferation, survival, and invasion. Tumors employ various mechanisms to evade immune surveillance, effectively 'cloaking' themselves from detection and subsequent attack. A comprehensive understanding of these intricate molecular interactions is paramount for advancing novel strategies aimed at modulating the immune response against cancer.

Differing contributions of the gut microbiota to the blood pressure lowering effects induced by first-line antihypertensive drugs.

BACKGROUND AND PURPOSE: This study analyses whether first-line antihypertensive drugs ameliorate the dysbiosis state in hypertension, and to test if this modification contributes to their blood pressure (BP) lowering properties in a genetic model of neurogenic hypertension. EXPERIMENTAL APPROACH: Twenty-week-old male Wistar Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) were untreated or treated with captopril, amlodipine or hydrochlorothiazide. A faecal microbiota transplantation (FMT) experiment was also performed by gavage of faecal content from donor SHR-treated groups to SHR recipients for 3 weeks. KEY RESULTS: Faeces from SHR showed gut dysbiosis, characterized by lower acetate- and higher lactate-producing bacteria and lower strict anaerobic bacteria. All three drugs increased the anaerobic bacteria proportion, captopril and amlodipine restored the proportion of acetate-producing bacterial populations to WKY levels, whereas hydrochlorothiazide decreased butyrate-producing bacteria. Captopril and amlodipine decreased gut pathology and permeability and attenuated sympathetic drive in the gut. Both drugs decreased neuroinflammation and oxidative stress in the hypothalamic paraventricular nuclei. Hydrochlorothiazide was unable to reduce neuroinflammation, gut sympathetic tone and gut integrity. FMT from SHR-amlodipine to SHR decreased BP, ameliorated aortic endothelium-dependent relaxation to acetylcholine, lowered NADPH oxidase activity, aortic Th17 infiltration and reduced neuroinflammation, whereas FMT from SHR-hydrochlorothiazide did not have these effects. CONCLUSIONS AND IMPLICATIONS: First-line antihypertensive drugs induced different modifications of gut integrity and gut dysbiosis in SHR, which result in no contribution of microbiota in the BP lowering effects of hydrochlorothiazide, whereas the vasculo-protective effect induced by amlodipine involves gut microbiota reshaping and gut-immune system communication.

Spanish Students' Categorical Perceptions of Feminist Movements.

Identifying a society's perceptions and, by extension, opinions of a certain social movement can help to understand to what extent the movement has been successful in effecting change. When working to gain such an understanding, a focus on the student population is essential, as their opinions provide insight into the future conditions of society and, thus, into whether the movement has been successful in effecting lasting social change. The present work focusses on the feminist movements and, in line with the above, analyses the perceptions held by a sample of 600 Spanish students enrolled in compulsory secondary, pre-university, and university education. The method employed begins with the use of association tests to extract lexical networks. Then, following a theoretical transformation, the traditional lexical availability index is applied in combination with fuzzy set theory to the sample of lists obtained so as to map the structure of the collective network, a novel approach that results in different levels of compatibility. The highest levels of compatibility reveal the prototypical conceptualisation as well as the sample's shared cognitive perception. The results suggest that although the population under study may have absorbed the feminist movements' messages of equality and respect, distorted perceptions could still remain in certain groups analysed. This work therefore recommends that education centres may wish to consider communicating objective information on the feminist movements specifically to women, as this could ultimately lead to all students fully embracing a feminist awareness distanced from extreme ideologies.

Gender Asymmetries: An Exploratory Study of Women's Experiences in Portuguese Football Organizations.

The main objective of this exploratory study is to analyze the negative effects associated with the phenomenon of tokenism for Portuguese women in non-playing football roles, as well as their strategies for integration into a context where they are a minority and the social functions are dominated by men. To this end, we carried out semi-structured individual interviews with eight men and eight women, undertaking functions in the fields of coaching, psychology, medical team, planning, refereeing, and management in football organizations, and with their contents then subject to thematic analysis. Our analysis confirms how the football context strongly demarcates gender differences with women being more visible and leads to the stereotypical roles being associated with traditional femininity. The findings also observe how, in order to integrate, women align with the norms imposed by the dominant group (men) and accept being circumscribed to the spaces that hegemonic gender ideologies and practices attribute to them.

Beyond sicca: high prevalence and predictors of baseline and worsening systemic involvement in patients with Sjögren's disease.

Objectives: Systemic extraglandular involvement in SS has been reported in one-third of patients but may be more frequent. We aimed to evaluate systemic disease prevalence at baseline and throughout follow-up and find its predictors. Methods: We conducted a retrospective cohort study including SS patients followed in a tertiary centre. The cumulative EULAR SS disease activity index (ESSDAI) was calculated by adding each domain's maximum score throughout follow-up. We identified independent predictors of systemic involvement (ESSDAI ≥1 at baseline and/or follow-up) through logistic regression modelling. A survival analysis was conducted to identify predictors of new/worsening ESSDAI domains. Results: A total of 216 patients were included, most of whom had systemic involvement (86%), frequently at diagnosis (76%). Biological (53%) and articular ESSDAI domains (44%) were most commonly involved, but all were affected at least once. Around half of the patients with baseline systemic disease developed an additional/worsening domain throughout follow-up. Although most patients had low disease activity at baseline, 60% eventually reached moderately active disease. Younger age at diagnosis [odds ratio (OR) 0.95 (95% CI 0.91, 0.99)], a positive minor salivary gland biopsy [OR 4.08 (95% CI 1.40, 11.86)] and RF [OR 4.67 (95% CI 1.52, 14.33)] were independent predictors of systemic involvement. Patients with baseline constitutional involvement [hazard ratio (HR) 2.23 (95% CI 1.13, 4.40)] and RF [HR 1.89 (95% CI 1.20, 3.00)] were more likely to develop new/worsening systemic disease activity. Conclusion: Systemic involvement is seen in most SS patients. Younger and RF and salivary gland biopsy-positive patients are at higher risk of systemic disease. Around half of patients with systemic involvement experienced aggravated disease over time, especially those with constitutional involvement or RF.

Burnout syndrome in Spanish, Portuguese and Latin American ophthalmologists: a cross-sectional analysis.

PURPOSE: Despite the well-known consequences of burnout syndrome, there has been little research into this syndrome in the field of ophthalmology. Our objective is to determine the frequency of burnout syndrome between Spanish, Portugal and Latin-American ophthalmologists, as well as to analyse its relationship with different sociodemographic variables. METHODS: This is an observational cross-sectional descriptive study including ophthalmologists from Spain, Portugal and 15 Latin American countries. Burnout syndrome was evaluated by the Maslach Burnout Inventory-Human Services Survey. Burnout syndrome was defined as high emotional exhaustion, high depersonalization or low personal accomplishment. In addition, we recorded sociodemographic variables and aspects related to the type of work. A conditional backwards stepwise multivariate binomial logistic regression analysis was run to assess the variables associated with burnout syndrome, expressed as an odds ratio (OR). RESULTS: A total of 527 surveys were analysed, the majority from Spain (401; 76.1%), followed by Argentina (45; 8.5%), and Mexico (31; 5.9%). The number of ophthalmologists with burnout syndrome was 351 (66.6%). The results show the profile of a young ophthalmologist (age OR 0.985), carrying out a public activity (OR 2.118) and dedicated to general ophthalmology (OR 1.860). CONCLUSIONS: The frequency detected in this study confirms a steady increase in rates of burnout among ophthalmologists. As the consequences of this are well known, it is vital for health centre managers to develop a strategic plan to allow the causes to be understood better and to implement steps to improve the situation in each medical centre.

Influence of anterior chamber depth and vault on anterior chamber angle morphology after phakic posterior chamber intraocular lens implantation.

PURPOSE: This study aims to investigate the influence of anterior chamber depth (ACD) and vault on the anterior chamber angle (ACA) morphology in myopic individuals implanted with posterior chamber phakic intraocular lenses. METHODS: This retrospective case series involved 231 eyes receiving a 13.2-mm implantable collamer lens (ICL). Preoperative anterior chamber anatomy was assessed using anterior segment optical coherence tomography (AS-OCT) and optical tomography, while postoperative evaluation employed AS-OCT. ACA morphology was characterized pre- and postoperatively through trabecular iris angle (TIA750), ACA distance opening (AOD750) and trabecular iris space area (TISA750). The influence of ACD and vault was examined by categorizing the sample into ACD (shallow, average and deep) and vault (low, optimal and high) groups. RESULTS: Preoperative ACA morphology varied based on ACD, with shallower ACDs exhibiting narrower TIA750, smaller AOD750 and TISA750. ICL implantation induced greater ACA narrowing more in the deep ACD group (TIA750 = 20.1 degrees; AOD750 = 0.82 mm and TISA750 = 0.44 mm2) compared to the shallow ACD group (TIA750 = 15.2 degrees; AOD750 = 0.44 mm and TISA750 = 0.21 mm2). Postoperatively, deeper ACDs showed larger ACAs. Increasing vault magnitude led to increased ACA narrowing, with the low vault group exhibiting smaller closure (TIA750 = 14.3 degrees; AOD750 = 0.56 mm and TISA750 = 0.29 mm2) compared to the high vault group (TIA750 = 20.8 degrees; AOD750 = 0.73 mm and TISA750 = 0.36 mm2). The magnitude of ACA narrowing associated with the vault had a consistent effect across different ACD groups. CONCLUSIONS: Posterior chamber intraocular lens implantation results in ACA narrowing, the extent of which is contingent upon preoperative anterior chamber and ACA morphology, with additional influence from vault magnitude.

Barriers to disengagement from an athletic career: An Interpretative Phenomenological Analysis with retired elite-level female footballers / Barreras que conducen a la desvinculación en la trayetória deportiva: un análisis fenomenológico interpretativo con futbolistas de élite retiradas / Obstáculos ao desinvestimento na carreira atlética: Uma análise fenomenológica interpretativa com ex-jogadoras de futebol de elite

En el contexto de la práctica deportiva, tan pronto como se pasa el período ideal para alcanzar ciertasmetas y la inversión en una meta ya no es alcanzable, la desinversión en una determinada meta bloqueada y la reinversión en metas alternativas contribuirán a un desarrollo adaptativo, como argumentan las teorías de autorregulación. El objetivo del presente estudio fue explorar las barreras experimentadas por cuatro ex jugadoras de fútbol de élite durante su período de adaptación a largo plazo. Eneste sentido, el presente estudio se desarrolló de acuerdo con los principios del análisis fenomenológico interpretativo. Los resultados sugieren que los ex deportistas tuvieron dificultades para desprenderse de sus objetivos profesionales durante la transición a la retirada del deporte, habiendo enumerado cuatro razones: i) elmiedo a ser olvidados; ii) el intentode crear un vínculo para una futura implicación como futuras entrenadoras; iii) la creencia de que como practicantes disfrutan de un rol muy gratificante; iv) la presión social para seguir practicando a un nivel deportivo de élite. Estos resultados muestran que con el acercamiento de la edad de retiro, las atletas pueden beneficiarse de intervenciones psicológicas que ayuden a esta transición de carrera.(AU)

Once the optimal age for achieving certain goals has passed and the investmentin a goal is no longer possible, self-regulation theories claim that disengagement from the goal and re-engagement in alternative goals will contribute to adaptive development. The present study explored the barriers experienced by four retired female elite-level footballers when adapting to retirement in the long term. To achieve this, the study was designed according to the principles of InterpretativePhenomenological Analysis. Our findings suggest that the ex-athletes found it difficult to disengage from their career goals during their transitions out of elite sport and listed four main reasons for this: i) the fear of being forgotten; ii) the attempt to create a link for future involvement as future coaches; iii) the belief that as practitioners they enjoy a very rewarding role in terms of achievement; iv) the social pressure to continue practicing at an elite sporting level. These findings suggest athletes approaching retirement might benefit from support interventions to help prevent distress and to promote well-being during their transitions out of elite sport. Therefore, clubs and federations should encourage and foster the development of adequate career transition programs, to achieve a fairer environment and a better quality of life for the players.(AU)

No contexto da prática desportiva, assim que o período ideal para que os praticantes alcancem determinadas metas é ultrapassado e o investimento em um objetivo já não é passível de ser alcançado, o desinvestimento em determinado objetivo bloqueado e o reinvestimento em objetivos alternativos poderá contribuir para um desenvolvimento adaptativo, conforme sustentam as teorias da autorregulação. O presente estudo teve como propósito explorar as principais barreiras experienciadas por quatro ex-atletas de futebol de elite durante o seu período de adaptação a longo prazo. Para tal recorreu-se aos princípios da análise fenomenológica interpretativa. Os resultados sugerem que as ex-atletas apresentaram dificuldades em desinvestir dos objetivos de carreira durante a transição para a reforma da prática desportiva, tendo para tal elencado quatrorazões principais: i) o medo de serem esquecidas; ii) a tentativa de criarem uma ligação para um futuro envolvimento enquanto futuras treinadoras; iii) a crença de que enquanto praticantes usufruem de umpapel deveras gratificante em termos de realização;iv) a pressão social para continuarem a praticar ao nível do desporto de elite. Os resultados encontrados sugerem que, com a aproximação da idade da reforma, as atletas podem beneficiar de intervenções psicológicas que facilitem a transição de carreira e previnam elevados níveis de stresse, promovendo-se o bem-estar durante a respetiva transição. Deste modo, afigura-se recomendável que tanto clubes como federações encorajem e fomentem o desenvolvimento deprogramas adequados de transição de carreira, em nome de um mais justo enquadramento e de uma melhor qualidade de vida dos praticantes desportivos.(AU)

Sex and body mass index impact on digit circumference for Leeds Dactylitis Index calculation.

OBJECTIVES: To estimate digit circumference and the impact of sex and body mass index (BMI) for the calculation of the Leeds Dactylitis Index (LDI) in psoriatic arthritis (PsA) patients with bilateral dactylitis. METHODS: Digit circumference of the hands and the foot were measured with a dactylometer and were studied according to sex and BMI (divided in 4 weight categories) in healthy Portuguese subjects, using Student's t-test and One-way ANOVA, respectively. The effect size of sex and BMI were calculated using Cohen's d test and Eta squared, respectively. Multiple linear regression was used to calculate the effect of sex and BMI, as well as their interaction, to create a formula to predict digit circumference. RESULTS: Fifty-nine participants (33 women, 26 men) with a mean BMI of 24.8 were included. Men's mean digit circumferences were statistically higher than those of women (p<0.001), with a large sex effect size in most of the digits. Differences in the mean circumference between the four BMI categories were statistically significant (p<0.05) for all digits, with a large BMI effect size. Sex and BMI were independent variables to predict mean digit circumference (p<0.001). A new tool (based on regression analysis) allowing to estimate the circumference of digits for males and females of different BMIs is presented. CONCLUSIONS: Our data allows the calculation of digit circumference for males and females of different BMIs in the Portuguese population; and shows that BMI influences digital circumference supporting BMI inclusion in LDI references tables.

Alemtuzumab induces severe orbitopathy in relapsing-remitting multiple sclerosis.

CONTEXT: Treatment with Alemtuzumab (ALZ) in patients with Relapsing-Remitting Multiple Sclerosis (RRMS) is associated with the development of ALZ-induced Graves' disease (GD-ALZ). Some cases may develop associated Graves´ Orbitopathy (GO-ALZ), with possible visual compromise. AIM: The aim of this study was to describe the main clinical and biochemical characteristics of GD-ALZ, as well as the clinical course of a case series of GO-ALZ METHODS: This study is a retrospective observational study, carried out in a reference hospital for the care of patients with RRMS in Spain. Cases treated with ALZ in the period 2014-2022 were included. GO-ALZ cases were identified among those with clinical symptoms compatible with thyroid eye disease after initiating ALZ treatment. RESULTS: A total of 135 cases, with a mean follow-up of 69.6 months after the first ALZ cycle, were included. The incidence of GD-ALZ was 32.6% (44/135), with a predominance of women (77.3%) and mean age of 41.9 years. The presence of first-degree relatives with hypothyroidism was identified as risk factor for the development of GD-ALZ (adjusted P-value: 0.02). GO-ALZ was diagnosed in 6 cases (incidence: 13.6%), of which 3 had severe clinical forms of GO, requiring anti-IL-6 treatment. A favorable response was reported in all of them, with a significant decrease in disease activity and improvement in proptosis. CONCLUSIONS: We report one of the largest cohorts of GD-ALZ and GO-ALZ cases. The diagnosis of these entities should be taken into account in patients treated with Alemtuzumab, given the risk of developing severe clinical forms. In moderate-severe forms of GO-ALZ, drugs with anti-IL-6 activity are a safe and effective option.