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Introduction. Heart failure and dilated cardiomyopathy (DCM) in adults are rarely caused by hypoparathyroidism induced hypocalcemia. Case report. Female patient, 40 years old, diabetic, with previous history of thyroidectomy for Graves’ disease, was hospitalized for syncope and symptoms of heart failure. ECG revealed sinus tachycardia, long QT, negative T from V1 up to V4. Chest X-ray, cardiac ultrasound and contrast cardiac MRI confirmed dilated left chambers, severe systolic dysfunction of the left ventricle (left ventricle ejection fraction=15%) due to diffuse hypokinesia and restrictive type of diastolic dysfunction. Patient status insignificantly improved with specific heart failure depletion treatment but important signs of hypocalcemia occurred. Low levels of total and ionic serum calcium were detected (total serum calcium 3.6 mg/dL, ionic calcium=2.2 mg/dL) along with low serum levels of parathormone (10 pg/mL) and high level of phosphatemia (6.4 mg/dL). After one month of parenteral treatment with calcium and oral vitamin D, hypocalcemic signs disappeared and heart failure significantly improved. Conclusion. This rare adult condition is refractory to heart failure conventional therapy but promptly responds to restoration of normocalcemia. It is important to be aware of this pathophysiological setting, in order to treat it correctly. [ABSTRACT FROM AUTHOR]

Background: Secondary prevention of thromboembolic disease in cancer patients with oral anticoagulants is a challenging issue, due to the particular liver biology in this high-risk category of subjects.Aim: To compare novel oral anticoagulant dabigatran vs acenocumarol administered in patients with malignant disease and deep vein thrombosis.Method. We randomized 46 patients with paraneoplastic deep vein thrombosis in two groups, matched by age, sex, cancer type and Khorana score in 2 groups: first group (n=23) assigned to bid fixed-dose dabigatran (according to individual creatinine clearance), and second group (n= 23) assigned to qd adjusted-dose acenocumarol (according to individual INR determined monthly). Patients were followed-up 6 months.Results: 6 patients from the dabigatran group (13.95%) experienced an adverse outcome (major bleeding or recurrent thrombosis), vs. 12 patients (52.817%) from acenocumarol group, showing a significant difference (P=0.0349; 95%CI=0.2266-1.103). No patient developed pulmonary thromboembolism.There was one death due to major bleeding in the acenocumarol group vs. none in dabigatran group. No difference in the progression of underlying cancer was noticed between the two studied groups (4 deaths in dabigatran group vs 5 deaths in acenocumarol group, OR= 0.7579; 95% CI= 0.1752-3.279; P=0.3551). Patients in the dabigatran group reported a better QOL due to the fact that there was no need for monthly blood tests as in acenocumarol group.Conclusion: In our study dabigatran was associated with a smaller rate of complications and may be safer in cancer patients with venous thromboembolism. Larger studies are needed, but difficult to be performed in this specific class of patients. [ABSTRACT FROM AUTHOR]

Advances in cancer treatments have significantly improved their effectiveness, yet access to first-line therapies remains limited. A 2017 survey revealed that over 25 % of metastatic melanoma patients in Europe lacked access to recommended therapies. To address this, the European Association of Dermato-Oncology and the European Melanoma Registry conducted a follow-up study on the registration and reimbursement of first-line treatments.A web-based survey using LimeSurvey was distributed to melanoma experts across 27 European countries from February to April 2022 and updated from February to April 2024. The questionnaire covered the percentage of patients receiving recommended treatments, as well as treatment authorization and reimbursement dates for systemic and adjuvant therapies.There has been significant improvement in the registration and reimbursement of BRAFi/MEKi, anti-PD1, and anti-PD1/anti-CTLA4 therapies, increasing from 48 %, 63 %, and 37 % in 2017 to 96 %, 96 %, and 78 % in 2024, respectively. Despite these gains, restrictions persist. Anti-PD1/anti-CTLA4 combination immunotherapy is still not available without restrictions in 48 % of the surveyed countries. The nivolumab/relatlimab combination is licensed only for PDL-1-negative melanoma and reimbursed in seven countries of Europe. Tebentafusp is reimbursed in 15 countries and talimogene laherpervec in 5. In 2024, adjuvant treatments for stage III melanoma are reimbursed in 22 countries for dabrafenib/trametinib and 24 of 27 for anti-PD1 antibodies. Pembrolizumab and nivolumab are reimbursed in 15 and 8 countries, respectively, for stage IIB/IIC disease.While there have been improvements in the reimbursement of metastatic melanoma treatments in Europe, challenges and discrepancies remain. Further efforts at European and global levels are needed to harmonize and enhance access to cancer medicines. [ABSTRACT FROM AUTHOR]