Inborn errors of metabolism (IEM) constitute an important group of conditions characterized by an altered metabolic pathway. There are numerous guidelines for the diagnosis and management of IEMs in the pediatric population but not for adults. Given the increasing frequency of this group of conditions in adulthood, other clinicians in addition to pediatricians should be aware of them and learn to identify their characteristic manifestations. Early recognition and implementation of an appropriate therapeutic approach would improve the clinical outcome of many of these patients. This review presents when and how to investigate a metabolic disorder with the aim of encouraging physicians not to overlook a treatable disorder.

Background: Infection remains a relevant complication after kidney transplantation (KT). A well‐established strategy in modern medicine is the application of bundles of evidence‐based practice in clinical settings. The objective of this study is to explore the application of a personalized bundle of measures aimed to reduce the incidence of infection in the first 12 months after KT.Methods: A single‐center prospective cohort of 148 patients undergoing KT between February 2018 and September 2019 that received an individualized infection prevention strategy was compared to a preintervention cohort (n = 159). The bundle comprised a review of the patient's immunization history, infection risk by country of origin, screening for latent tuberculosis infection (LTBI), antimicrobial prophylaxis, and immunological assessment. Individualized recommendations were accordingly provided at a scheduled visit at day +30 after transplantation.Results: The intervention cohort showed a higher compliance rate with the recommended vaccine schedule, screening for geographically restricted infections and LTBI, and intravenous immunoglobulin and vitamin D supplementation (p values <.001). The 1‐year incidence rate of infection was lower in the intervention cohort (42.6% vs. 57.9%; p value = .037), as was the rate of infection‐related hospitalization (17.6% vs. 32.1%; p value = .003) and the incidence of severe bacterial infection. There were no differences in graft rejection or mortality rates between groups.Conclusions: A multifaceted intervention, including a bundle of evidence‐based practices, enhanced compliance with recommended preventive measures and was correlated with a reduction in the 12‐month incidence of infection after KT. image

Background: The aim of the study was to analyze the clinical manifestations and outcome of the oldest old (people aged ≥85 years) who were admitted to the hospital with a confirmed influenza A virus infection in comparison with younger patients and to assess the role of inflammation in the outcome of influenza infection in this population. Methods: This is an observational prospective study including all adult patients with influenza A virus infection hospitalized in a tertiary teaching hospital in Madrid, in 2 consecutive influenza seasons (2016–17 and 2017–18). Results: Five hundred nine hospitalized patients with influenza A infection were included, of whom 117 (23%) were older than 85 years (median age: 89.3 ± 3.2). We compared the clinical characteristics and outcome with those of the rest of the population (median age: 72.8 ± 15.7). Overall, mortality was higher in older patients (10% vs. 4%; p = 0.03) with no differences in clinical presentation. Patients older than 85 years who ultimately died (12 out of 117) showed increased systemic inflammation expressed by higher levels of C-reactive protein (CRP) and ferritin compared to survivors who were discharged (odds ratio [OR] of CRP >20 mg/dL: 5.16, 95% confidence interval [CI]: 1.29–20.57, and OR of ferritin >500 mg: 4.3, 95% CI: 1.04–17.35). Conclusions: Patients aged 85 and older with influenza A virus infection presented a higher in-hospital mortality than younger subjects. CRP and ferritin levels were higher in the oldest old who died, suggesting that inflammation could play a key role in the outcome of this subset of patients.

Background/Objectives: Malnutrition and nutritional vulnerability are common in patients with cancer and are associated with adverse clinical outcomes, particularly among hospitalised patients. However, data specifically describing nutritional risk in patients admitted to medical oncology departments remain limited. This study aimed to estimate the prevalence of nutritional risk at hospital admission and to evaluate factors associated with nutritional risk and its clinical consequences. Methods: The REGIO registry is a national multicentre prospective cohort including adult patients with solid tumours admitted to medical oncology departments in 17 Spanish hospitals between February 2024 and January 2025. Nutritional risk was assessed within the first working day of hospitalisation using the Malnutrition Screening Tool (MST), with a score ≥ 2 indicating nutritional risk. Multivariable logistic regression models were used to identify factors associated with nutritional risk and its association with prolonged hospital stay and mortality. Results: A total of 1229 patients were included (median age 67.8 years; 59% male; 64% metastatic disease). Nutritional risk was identified in 53% of patients. In multivariable analysis, poorer functional status, tumour progression, recent exposure to cytotoxic chemotherapy, and tumour types with higher nutritional impact were independently associated with nutritional risk. Patients at nutritional risk had longer hospital stays (median 10 vs. 7 days; p < 0.001), a higher likelihood of prolonged hospitalisation (adjusted OR 1.38), and increased mortality at 30 days (adjusted OR 1.63) and 60 days after discharge (adjusted OR 1.53). Conclusions: In this large multicentre cohort, nutritional risk was highly prevalent and independently associated with worse clinical outcomes, supporting the clinical relevance of systematic nutritional screening at hospital admission in patients with cancer.

The number of patients with solid tumours requiring intensive care is increasing as cancer survival improves and oncological treatments become more complex. Intensive care unit (ICU) admission decisions should not be based on cancer diagnosis, metastatic status or palliative treatment intent alone. This narrative review presents a practical, multidisciplinary framework for assessing critically ill patients with solid tumours. It integrates acute illness severity and reversibility, organ failure, baseline performance status and frailty, cancer trajectory, remaining treatment options, expected functional recovery and patient preferences. We discuss contemporary anticancer treatment toxicities, cancer-associated thromboembolic disease, older adults, palliative care, communication and ethical decision-making. We also propose an algorithm ranging from full ICU support to a time-limited ICU trial with predefined reassessment or comfort-focused care. Early joint assessment by oncology and intensive care teams, followed by dynamic reassessment, may reduce both inappropriate escalation and premature exclusion from potentially beneficial organ support. Future research should prioritize structured pathways, improved prognostic tools and outcomes beyond survival, including functional recovery, quality of life and the ability to resume meaningful cancer treatment.