We present the case of a 64-year-old female with stage IV gastric adenocarcinoma, pulmonary, and abdominal wall metastases, and no history of cardiovascular disease. In palliative care, she received systemic cytotoxic treatment with fluorouracil, leucovorin, oxaliplatin, and docetaxel protocol, which was well tolerated over five cycles. During cycle 6, she presented with cardiovascular symptoms with hemodynamic consequences while receiving oxaliplatin injection without docetaxel or 5-fluorouracil. She was transferred to the emergency department and then to the intensive care unit. She developed no complications during the hospital stay and was discharged after 10 days with preserved systolic function and no structural changes at the myocardial level. The electrocardiogram, echocardiogram, cardiac catheterization, and magnetic resonance imaging findings indicated an oxaliplatin-associated Takotsubo syndrome. The immunochemistry analysis showed PD-L1 expression level TPS: 40% and the foundation one genomic profiling revealed high mutation load, microsatellite instability, and HER2 not found. The patient is currently asymptomatic and on pembrolizumab monotherapy with good tolerance and partial treatment response.

Objectives:To evaluate the effectiveness of adding dapagliflozin as an intensification strategy for the treatment of patients with uncontrolled type 2 diabetes mellitus (T2DM). Materials and methods: A historical cohort study was conducted in 123 adult patients over 18 years old who were diagnosed with uncontrolledT2DM, who received dapagliflozin add-on to their dual base treatment: metformin plus glibenclamide (n = 32), metformin plus saxagliptin (n = 29), metformin plus exenatide (n = 28), or metformin plus insulin (n = 34).The endpoints were evaluated using analysis of variance. All the patients completed a 52-week follow-up. Overall, 52.85% of patients were female, the Hispanic population represented the largest proportion of patients in all groups (60.98%), and the mean +/- SD patient age and body weight were 55.05 +/- 7.58 years and 83.55 +/- 9.65 kg, respectively. The mean +/- SD duration ofT2DM, glycated hemoglobin (Hbk(1c)), and fasting plasma glucose (FPG) were 5.93 +/- 2.98 years, 8.1 +/- 0.53%, and 166.03 +/- 26.80 mg/dL, respectively. The grand mean changes of HbA(1c), FPG, body weight and blood pressure showed a decreasing trend during the study period and it was statistically significant in all groups (p-value = <0.001). The proportion of patients achieving HbA(1c) target (<7%) was highest in the group that used a dapagliflozin add-on to metformin plus saxagliptin. Conclusion . The addition of dapagliflozin as an alternative for intensification of dual therapy consistently improved, not only FPG and HbA(1c), but also body weight and blood pressure, with statistically significant results.

Purpose: Diabetes is a public health problem that requires strategies to impact glycemic control and reduce the risk of long-term medical complications. Pharmacological management is a necessary treatment for this disease. Therefore, semaglutide is an essential tool to achieve the treatment targets. The present study aimed to evaluate the semaglutide effects on a cohort with type 2 diabetes mellitus (T2DM) in Colombia. Materials and Methods: The cohort included 49 patients with T2DM that have been treated in a specialized care center. Their glycemic outcomes, weight, renal function, and adverse events were evaluated through a 3-, 6- and 12-month follow-up. Results: Significant differences were observed in the outcome evaluation: reduction of glycated hemoglobin levels (MD − 2.74 CI − 1.95 to − 3.52 in 6 months), fasting plasma glucose levels, body weight (MD − 7.11 CI − 5.97 to − 8.24), and the albumin-to-creatinine ratio. The results were maintained throughout the treatment period. The adverse event rate was 16.3%, predominating gastrointestinal events. Conclusion: This real-world evidence shows the efficacy of semaglutide in achieving treatment goals in patients with T2DM.

Background/Objectives: Diabetic ketoacidosis (DKA) is an acute and potentially life-threatening complication characterized by the accumulation of ketone bodies in the blood, primarily occurring in patients with type 1 diabetes and occasionally in those with type 2 diabetes under certain conditions. DKA presents with symptoms such as polyuria, polydipsia, polyphagia, and, in severe cases, mental status changes. Identifying the triggering factor is crucial to prevent complications and effectively manage this medical emergency. Methods: This report describes the case of a 58-year-old male patient with stage IIIb nodular melanoma, diagnosed in November 2022. Results: After receiving five cycles of pembrolizumab, the patient developed de novo DKA, presenting with blurred vision, asthenia, adynamia, polyuria, and polydipsia. He was admitted to the emergency department with a blood glucose level of 764 mg/dL, confirming hyperglycemia and metabolic acidosis. He was transferred to the intensive care unit for fluid resuscitation and insulin infusion. After adequate clinical evolution and meeting the criteria for DKA resolution, possible autoimmune endocrinopathies secondary to immunotherapy were considered. Due to this complication, the oncological treatment was changed. Finally, the patient was discharged with the need to continue insulin therapy and oral hypoglycemic agents, along with thyroid hormone supplementation. Conclusions: The novelty of this case lies in the presentation of DKA as an immune-mediated complication induced by pembrolizumab, highlighting the importance of closely monitoring patients receiving immune checkpoint inhibitors to detect and manage emerging autoimmune endocrinopathies. It is essential to adjust oncological treatment according to the patient’s response and promptly manage autoimmune endocrinopathies to improve clinical outcomes and the patient’s quality of life.

La coinfección por SARS-CoV-2 e Influenza (conocida como Flurona) representa un reto diagnóstico y terapéutico relevante en el contexto pandémico y pospandémico, dada la similitud clínica y mecanismo de transmisión entre ambos virus, pero con diferencias importantes en su tratamiento. La sospecha oportuna de coinfección viral es clave, especialmente en pacientes con comorbilidades o evolución clínica atípica. Se realizó una revisión de literatura en PubMed, Scopus y Google Académico (español e inglés), identificando escasos reportes clínicos documentados en Colombia. Descripción del caso: Paciente masculino de 83 años, con antecedentes cardiovasculares significativos, hospitalizado en unidad de cuidado intensivo por insuficiencia cardíaca congestiva y valvulopatía aórtica severa. Durante la hospitalización desarrolló insuficiencia respiratoria, confirmándose coinfección por Influenza y SARS-CoV-2. Recibió tratamiento con Oseltamivir, oxigenoterapia y toracocentesis terapéutica. Se indicó implantación valvular aórtica transcatéter (TAVI), pero el paciente falleció durante el procedimiento. Conclusión:La coinfección por SARS-CoV-2 e Influenza debe ser considerada en el diagnóstico diferencial de pacientes con compromiso respiratorio agudo, particularmente en contextos de circulación viral simultánea. El reconocimiento oportuno permite una intervención terapéutica dirigida. El abordaje multidisciplinario es fundamental para optimizar el pronóstico en pacientes con comorbilidades complejas.

Objetivo: reportar un caso poco frecuente de síndrome de lisis tumoral (SLT) en un tumor sólido (TS) asociado al uso de pazopanib y gemcitabina.Materiales y métodos: estudio observacional descriptivo tipo reporte de caso; se realizó una búsqueda de literatura en las bases de datos PubMed, Scopus, así como en Google académico en los idiomas español e inglés.