Precision medicine in sepsis and septic shock:From omics to clinical tools

Sepsis is a heterogeneous disease with variable clinical course and several clinical phenotypes.As it is associated with an increased risk of death,patients with this condition are candidates for receipt of a very well-structured and protocolized treatment.All patients should receive the fundamental pillars of sepsis management,which are infection control,initial resuscitation,and multiorgan support.However,specific subgroups of patients may benefit from a personalized approach with interventions targeted towards specific pathophysiological mechanisms.Herein,we will review the framework for identifying subpopulations of patients with sepsis,septic shock,and multiorgan dysfunction who may benefit from specific therapies.Some of these approaches are still in the early stages of research,while others are already in routine use in clinical practice,but together will help in the effective generation and safe implementation of precision medicine in sepsis.

Cardiac monitoring for patients with palpitations

Palpitations are one of the most common reasons for medical consultation. Theytend to worry patients and can affect their quality of life. They are often asymptom associated with cardiac rhythm disorders, although there are otheretiologies. For diagnosis, it is essential to be able to reliably correlate the symptomswith an electrocardiographic record allowing the identification or rulingout of a possible rhythm disorder. However, reaching a diagnosis is not alwayssimple, given that they tend to be transitory symptoms and the patient isfrequently asymptomatic at the time of assessment. In recent years, electrocardiographicmonitoring systems have incorporated many technical improvements thatsolve several of the 24-h Holter monitor limitations. The objective of this review isto provide an update on the different monitoring methods currently available,remarking their indications and limitations, to help healthcare professionals toappropriately select and use them in the work-up of patients with palpitations.

Advancing towards accurate phenotyping based on metabolic and fibrosis risk in metabolic-dysfunction associated steatotic liver disease:one step closer to personalized care

Relevance of liver fibrosis amongst diabetic patients with metabolic-dysfunction associated steatotic liver disease(MASLD)and knowledge gaps Insulin resistance is paramount in the crosstalk between intrahepatic and extrahepatic pathophysiological mechanisms leading to MASLD(1),hence gaining special relevance in patients diagnosed with type 2 diabetes(T2D).MASLD is the term that was recently endorsed by an international multidisciplinary consensus panel to replace non-alcoholic fatty liver disease[as non-alcoholic steatohepatitis(NASH)was replaced by metabolic dysfunction-associated steatohepatitis(MASH)](2).

ACE Score Identifies HBeAg-negative Inactive Carriers at a Single-point Evaluation,Regardless of HBV Genotype

Background and Aims:Hepatitis B virus(HBV)biomark-ers have been used for a better categorization of patients,even though the lack of simple algorithms and the impact of genotypes limit their application.Our aim was to assess the usefulness of noninvasive markers for the identification of HBV inactive carriers(ICs)in a single-point evaluation and to design a predictive model for their identification.Meth-ods:This retrospective-prospective study included 343 consecutive HBeAg-negative individuals.Clinical,analytical,and virological data were collected,and a liver biopsy was performed if needed.Subjects were classified at the end of follow-up as ICs,chronic hepatitis B and gray zone.A pre-dictive model was constructed,and validated by 1000-boot-strap samples.Results:After 39 months of follow-up,298 subjects were ICs,36 were chronic hepatitis B CHB,and nine were gray zone.Eighty-nine(25.9%)individuals re-quired a liver biopsy.Baseline HBV DNA hazard ratio(HR)6.0,p<0.001),HBV core-related antigen(HBcrAg)(HR 6.5,p<0.001),and elastography(HR 4.6,p<0.001)were inde-pendently associated with the IC stage.The ACE score(HBV DNA,HBcrAg,elastography),obtained by bootstrapping,yielded an area under the receiver operating characteris-tics(AUROC)of 0.925(95%CI:0.880-0.970,p<0.001)for identification of ICs.The AUROC for genotype D was 0.95,0.96 for A,0.90 for E,and 0.88 for H/F.An ACE score of<1 had a positive predictive value of 99.5%,and a score≤12 points had a diagnostic accuracy of 93.8%.Conclusions:Low baseline HBV DNA,HBcrAg,and liver stiffness were in-dependently associated with the IC phase.A score including those variables identified ICs at a single-point evaluation,and might be applied to implement less intensive follow-up strategies.