Safety of prasterone in breast cancer survivors treated with aromatase inhibitors: the VIBRA pilot study.

BACKGROUND: Due to safety concerns on estrogen-based treatments for genitourinary syndrome of menopause (GSM) in breast cancer survivors (BCS), new options are appearing, such as androgen-based treatments, which according to proprieties would not be transformed systemically to estrogens in patients receiving aromatase inhibitors (AIs). OBJECTIVE: The aim of this pilot study is to assess the security and efficacy of vaginal prasterone (dehydroepiandrostenedione [DHEA]) in BCS treated with AIs. METHODS: This open, prospective, pilot study included 10 BCS treated with AIs. All participants complained of severe GSM. DHEA was administrated as a vaginal ovule. Participants were instructed to use one ovule every night during the first month, and one ovule every two nights for the entire five remaining months. The patients were requested to attend seriated visits after the beginning of the prasterone treatment to evaluate symptoms, physical improvement and serum estradiol. RESULTS: Mean serum estradiol remained low from 3.4 pg/ml to 4.3 pg/ml (p = 0.9136) after 6 months of follow-up. The visual analog scale of dyspareunia improved from 8.5 to mean values after treatment of 0.4 (p = 0.0178). The Vaginal Health Index (VHI) scale and Female Sexual Function Index improved from 9.75 to 15.8 (p = 0.0277) and from an initial score of 11.2 to 20.6 (p = 0.0277), respectively. Vaginal pH changed from basal 8.1 to final 6.5 (p = 0.0330). CONCLUSION: Symptoms and physical examination regarding sexuality and vaginal health improved significantly, while serum estradiol remained at low levels. Prasterone seems a safe and effective option to treat GSM in BCS receiving AIs.

Prevalence and Co-Occurrence of Different Types of Body Dysmorphic Disorder Among Men Having Sex with Men.

Body dysmorphic disorder (BDD) is a relatively common psychiatric condition of which the prevalence has not been fully investigated in the non-clinical population, and in particular among men having sex with men (MSM). MSM have proven to be more inclined to develop body dissatisfaction and body image disorders compared to non-MSM. Our study investigates the prevalence of BDD and the prevalence and co-occurrence of muscle dysmorphia (MD) and penile dysmorphic disorder (PDD) in a sample of 261 Italian MSM recruited online. From our data, gathered through self-report measures, the prevalence of BDD, MD, and PDD in our populations was 5.4%, 8.8%, and 4.2%, respectively. Compared to their elders, younger adults (ages 18-34) appear to be at higher risk of BDD and especially of MD. Non-significant differences have been observed for the prevalence of PDD depending on the age range. Our study shows that the risk of body image disorders among MSM is quite common, especially among young adults, and higher than what is found among heterosexual men.

[A clinical management protocol for COVID-19 infection in pregnant women]. / Guía de actuación para el manejo de la infección por COVID-19 durante en el embarazo.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) has caused a large global outbreak and has had a major impact on health systems and societies worldwide. The generation of knowledge about the disease has occurred almost as fast as its global expansion. Very few studies have reported on the effects of the infection on maternal health, since its onset. The mother and foetus do not seem to be at particularly high risk. Nevertheless, obstetrics and maternal-foetal medicine practice have made profound changes in order to adapt to the pandemic. In addition, there are aspects specific to COVID-19 and gestation that should be known by specialists. In this review an evidenced-based protocol is presented for the management of COVID-19 in pregnancy.

Parent and peer attachment as predictors of facebook addiction symptoms in different developmental stages (early adolescents and adolescents).

Facebook Addiction (FA) is a problem that concerns minors all over the world. The attachment bond with peers and parents has been proven to be a risk factor for the onset of FA. However, the family and peer group can have a different importance depending on the developmental period of the minor. This study examined the influence of peer and parental attachment on the symptoms of FA in early adolescents and adolescents to verify whether attachment to peers and parents predicts FA symptoms in both categories respectively. The sample was composed of 598 participants (142 early adolescents) between the ages of 11 and 17 years (M age = 14.82, SD = 1.52) recruited in the school setting. Multivariate multiple regressions were performed. For early adolescents the relationships with their parents influenced the levels of FA the most (such as withdrawal, conflict, and relapse), whereas peer relationships (such as, peer alienation) were the most relevant for adolescents. Our study provides support to the role of attachment to peers and parents as a risk factor for symptoms of FA. In line with developmental theories, parents and peers acquire a different weight in predicting the relationship between attachment and FA for early adolescents and adolescents respectively. Clinical implications and future research directions are discussed.

Swimming pool attendance and risk of asthma and allergic symptoms in children.

Increased asthma risk has been associated with pool attendance in children but evidence is inconsistent and inconclusive. A survey was conducted of 3,223 9-12-yr-old children in Sabadell (Spain) to evaluate association between swimming pool attendance and prevalence of asthma and allergic conditions and symptoms. Parents completed a questionnaire on lifetime frequency of pool attendance and symptoms in the last 12 months (wheezing, asthma medication, rhinitis and allergic rhinitis), ever having asthma and eczema, and potential confounders. Indicators of indoor and outdoor swimming pool attendance early in life, cumulatively and currently were calculated. Swimming pool attendance before the age of 2 yrs was associated with slightly lower prevalence of current asthma (OR 0.79, 95% CI 0.43-1.46), rhinitis (OR 0.86, 95% CI 0.68-1.08) and allergic rhinitis symptoms (OR 0.72, 95% CI 0.54-0.96) compared to those who started attending swimming pools after 4 yrs of age. An increased prevalence of eczema was associated with duration of lifetime pool attendance (OR 1.71, 95%CI 1.38-2.12 for >5 yrs versus 0 yrs). Swimming pool attendance in Spanish children was associated with slightly less upper and lower respiratory tract symptoms and with more eczema. Longitudinal studies are required to confirm these findings and avoid potential reverse causation.

[Secondary amyloidosis (AA-type) due to localized cutaneous vasculitis]. / Amiloidosis secundaria asociada a vasculitis cutánea localizada.

We report a case of a 49 year old man, diagnosed soon after the outcome of casual proteinuria, of AA-type amyloidosis in relation to small and medium vessel cutaneous vasculitis without systemic involvement. This combination is a rare entity and only two cases of cutaneous hypersensibility vasculitis complicated with AA-type amyloidosis had been reported. We describe the results of the use of several immunosuppressive drugs during four years follow up with temporally total remission of the disease.

[Renal involvement in amyloidosis. Clinical outcomes, evolution and survival]. / Afectación renal en la amiloidosis. Características clínicas, evolución y supervivencia.

BACKGROUND: Systemic amyloidosis is a disease resulting from extracellular deposition of fibrillar protein in various organs. Main systemic amyloidosis are: primary (AL) and Secondary (AA). The kidney is usually involved, conferring and adverse prognosis. In the last decade there has been a change in the aetiology of AA amyloidosis. OBJECTIVES: To analyse the incidence of AL and AA amyloidosis in our current population as well as the aetiology of AA amyloidosis. To describe clinical outcomes, renal involvement and survival. PATIENTS AND METHODS: We performed a descriptive analysis of all cases of amyloidosis diagnosed from 1992 to 2004 in our hospital. Diagnosis was assessed on histological criteria: positivity Congo Red stain. Clinical data, renal involvement, dialysis treatment and survival were analysed. RESULTS: 76 cases, 44 women, mean age 70.7 +/- 12. Types: 55 AA (72%), 21 AL (28%) systemic amyloidosis. AA aetiology was: 66% rheumatic disorders, 28% infectious disease, 6% others. Incidence for AL was 4.6 and for AA 12.2 cases/million. Renal involvement was present in 75% at diagnosis (69% Creatinine clearance < 60 ml/min, 37% urinary protein > 3 g/24 hours). 21 cases (28%) progressed to renal disease stage V in the 8.1 +/- 9.8 months follow up period, and 14 cases started dialysis treatment (10 HD, 4 CAPD). In 7 cases (33%) dialysis was not indicated due to their poor clinical condition, short life expectancy and bad quality of life. Mean global survival at diagnosis was 55% and 40% at 12 and 24 months (AL 58% and 19%; AA 55% and 44%). Mean survival from the start of dialysis was 30% and 5% at 12 and 24 months. CONCLUSIONS: Although amyloidosis has a low incidence in our population, the kidney is usually involved. Rheumatological disorders are the principal aetiology of AA amyloidosis. Long term survival is poor, specially for AL.

[Ischemic renal disease: revascularization or conservative treatment?]. / Nefropatía isquémica: revascularización o tratamiento médico conservador?

Ischemic nephropathy is recognized as a distinct cause of renal insufficiency and it is defined as a significant reduction in glomerular filtration rate in patients with hemodynamically significant renovascular occlusive disease. We argue the epidemiologic and clinical manifestations of atherosclerotic renovascular disease, and we evaluate the pronostic agents. Published studies of the outcome of revascularization for renal-artery stenosis have been excellent, offering a durable patency and functional improvement but they have had numerous limitations. The atherosclerosis is a systemic disease and it provides the general prognosis of patients. We conclude that ischemic renal disease is a nephropathy of smoker men, with proteinuria excretion similar to nephropathy with unilateral stenosis. The age of patients is the clinical feature that decide the treatment: surgery, angioplasty/stent or medical management. Comparative analysis of percutaneous transluminal angioplasty and operation for renal revascularization and medically treated patients have proved that the advanced chronic renal insufficiency is associated with an unfavourable response of treatment of the ischemic nephropathy. But, in this nephropathy the revascularization can be the better therapy for selected patients. The revascularization with angioplasty/stent for patients with unilateral renal stenosis and chronic renal insufficiency has a doubtful effectiveness, as the chronic renal failure is result of nephroangiosclerosis.

[Arteriovenous fistula: complication of renal biopsy. Superselective embolization]. / Fístula arteriovenosa: complicación de biopsia renal. Embolización supraselectiva.

The arteriovenous fistula can be a major and late complication of percutaneous renal biopsies of native kidneys. The incidence of arteriovenous fistulas appears to be low and has been infrequently mentioned in large series of biopsies although there are a number of individual reports. In most part of cases, no systemic effects of the arteriovenous fistulas were observed, so they close by themselves. Optimization of renal biopsy techniques aims not only at obtaining kidney tissue technically adequate for diagnosis, but at reducing biopsy-induced complications. When these complications are done, the new transvascular techniques can get the healing of fistula with the embolism by catheters. We describe the case of a 37-year-old woman who had chronic renal failure by a possible chronic glomerulonephritis. She developed deterioration of renal function after the percutaneous renal biopsy. An arteriovenous fistula of high flow was detected by Doppler ultrasound. Then, it was confirmed angiographically and closed by embolism's catheter without damage of renal tissue.

[Primary antiphospholipid syndrome associated with malignant hypertension]. / Síndrome antifosfolipídico primario e HTA maligna.

The antiphospholipid syndrome is defined by the presence of antiphospholipid antibodies and recurrent thrombosis, affecting the venous system more frequently than the arterial one. Renal involvement is only observed in approximately 20-25% of cases, main renal artery thrombosis has been exceptionally described. We report a 39-year-old woman with previous history of recurrent thrombosis diagnosed as primary antiphospholipid syndrome, who presented malignant hypertension in the context of a renal artery thrombosis. She had a high IgG anticardiolipin antibody titre and positive lupus anticoagulant. An isotopic renogram demonstrated asymmetrical activity (60% right vs 40% left kidney). Renal arteriography demonstrated preoclusive thrombosis in the left renal artery. Blood pressure was well controlled by the use of ACE-inhibitor and alpha blockers.

Long-acting lacidipine versus short-acting nifedipine in the treatment of asymptomatic acute blood pressure increase.

We compared antihypertensive efficacy and safety of a single administration of equipotent doses of lacidipine versus nifedipine in the hypertensive urgencies. Twenty-nine asymptomatic essential hypertensive patients (nine men, 20 women) with a mean age of 55.03+/-11.19 years and baseline diastolic blood pressure (DBP) of > or =120 mm Hg after resting 30 min, not taking antihypertensive drugs for the last 24 h, were randomized in a single-blind fashion to receive lacidipine, 4 mg (LCD, 15 patients) or short-acting nifedipine, 20 mg (NFD, 14 patients) in a single dose. Blood pressure (BP) and heart rate (HR) were taken every 30 min during the first 8 h and every 2 h until 24 h of follow-up. Baseline BP values were similar in the two groups (LCD, 222.5+/-32.8/124.6+/-8.4 mm Hg vs. NFD, 215.9+/-20.6/128+/-7.7 mm Hg; p = NS). Both drugs promoted a significant reduction of systolic blood pressure (SBP; 169.6+/-27.8 vs. 170.6+/-25.3 mm Hg) and diastolic blood pressure (DBP; 104.1+/-16 vs. 102.9+/-12.4 mm Hg) after 8 h. However, either SBP (165+/-27.3 vs. 190.6+/-18.2 mm Hg; p = 0.008) and DBP (99.9+/-12.3 vs. 117.2+/-11.4 mm Hg; p = 0.001) were significantly higher in the NFD group after 24-h dosing. Eleven patients in the LCD group had a decrease in BP >25% of the baseline value both 8 and 24 h after the dose. Although 10 patients showed the same response in the NFD group 8 h after the dose, only four patients maintained these values at 24 h. One patient treated with NFD had a transient cerebrovascular ischemic attack. No adverse effects were observed in the LCD group. We conclude that the long-acting calcium antagonist lacidipine was more effective than the short-acting nifedipine in both controlling BP and maintaining this BP reduction over 8 h in essential hypertensive patients with acute asymptomatic BP increase.

[Factors harmful during the course of pregnancy]. / Factores nocivos para el desarrollo de la gestación.

The important repercussions which teratological factors have in perinatal cases have made it necessary to create methods which detect congenital defects before birth. By reading this article, nursing professionals should acquire sufficient basic knowledge about teratogenesis and teratological factors so that they may then provide women with a correct health education about these topics during their peri and postconception periods.

[Markers of hypercoagulability during pregnancy: thrombin-antithrombin-III complexes and D dimer]. / Marcadores de hipercoagulabilidad durante el embarazo: complejos trombina-antitrombina-III y dímero D.

Pregnancy can be regarded as a secondary hyper-coagulability state. The development of thrombin-anti-thrombin complexes (TATC), D dimer and anti-thrombin III (AT III) was analysed in the present work on 33 pregnant women. A significant increase of the TATC records was found between the first and third trimesters and between the second and third trimesters (p = 0.005 and p = 0.02, respectively). The AT III values were within the normal range. The values of the D dimer increased progressively during pregnancy, but only the figures achieved in the third trimester were statistically significant with respect to the control group (p = 0.14). The increase of TATC and D dimer during pregnancy are considered as hypercoagulability.

[Detection of thrombin-antithrombin complexes in hypercoagulability conditions. Analysis of 182 cases]. / Detección de complejos trombina-antitrombina-III en estados de hipercoagulabilidad. Análisis de 182 casos.

The detection of TATC may inform about the presence of thrombin generation and, and hence of a pre-thrombotic status. An ELISA test (Enzygnst TAT) has been developed here in order to evaluate the predictive role played by TATC, and it was applied on 182 patients who distributed in 14 with cirrhosis of the liver, 11 with sepsis, 17 with chronic arterial insufficiency, 55 with neoplasms, 9 with thrombosis, 15 in postoperative period, 15 with pneumonia, 16 with disseminated intravascular coagulation (DIC), 14 with multiple injuries and 16 with pancreatitis. TATC levels were significantly increased in all groups with regard to the control group. Patients with thrombosis, sepsis, multiple injuries, DIC and in the postoperative period showed especially high TATC figures. No correlation between TATC and fibrinogen, platelet count, activated partial thromboplastin time or prothrombin complex assay was found in the post-operative patient-group. It was concluded that TATC are a good indicator of hypercoagulability.