Efficacy and safety of administering oral misoprostol by titration compared to vaginal misoprostol and dinoprostone for cervical ripening and induction of labour: study protocol for a randomised clinical trial.

BACKGROUND: Among the various methods available, the administration of prostaglandins is the most effective for inducing labour in women with an unfavourable cervix. Recent studies have compared treatment with various titrated doses of oral misoprostol with vaginal misoprostol or dinoprostone, indicating that the use of an escalating dose of an oral misoprostol solution is associated with a lower rate of caesarean sections and a better safety profile. The objective of this study is to assess which of these three therapeutic options (oral or vaginal misoprostol or vaginal dinoprostone) achieves the highest rate of vaginal delivery within the first 24 h of drug administration. METHODS: An open-label randomised controlled trial will be conducted in Araba University Hospital (Spain). Women at ≥41 weeks of pregnancy requiring elective induction of labour who meet the selection criteria will be randomly allocated to one of three groups: 1) vaginal dinoprostone (delivered via a controlled-release vaginal insert containing 10 mg of dinoprostone, for up to 24 h); 2) vaginal misoprostol (25 µg of vaginal misoprostol every 4 h up to a maximum of 24 h); and 3) oral misoprostol (titrated doses of 20 to 60 µg of misoprostol following a 3 h on + 1 h off regimen up to a maximum of 24 h). Both intention-to-treat analysis and per-protocol analysis will be performed. DISCUSSION: The proposed study seeks to gather evidence on which of these three therapeutic options achieves the highest rate of vaginal delivery with the best safety profile, to enable obstetricians to use the most effective and safe option for their patients. TRIAL REGISTRATION: NCT02902653 Available at: https://clinicaltrials.gov/show/NCT02902653 (7th September 2016).

Growing teratoma syndrome after ovarian inmature teratoma: a case report and review of the literature.

Growing teratoma syndrome is an uncommon complication of malignant germ cell cancer, characterised by the development of large tumours during or after chemotherapy, despite normalisation of tumour marker levels and metastasis, which contain only mature teratoma. Given its low incidence, little is data available. The authors present the case of a 15-year-old girl with a growing teratoma and the literature review outlines the current knowledge of its pathogenesis, common sites, diagnosis, natural course, treatment, and prognosis.

Salud sexual en Chile: una aproximación descriptiva al comportamiento y la satisfacción sexual de los chilenos / Sexual health in Chile: a descriptive approach to the behavior and sexual satisfaction of Chileans

ANTECEDENTES: El año 2006, la Organización Mundial de la Salud definió a la "salud sexual" como un estado de bienestar físico, emocional, mental y social en relación a la propia sexualidad. De este modo, corresponde a un concepto más amplio que la ausencia de malestares, disfunciones o enfermedades, relacionándose con un nivel de bienestar general. Pese a la relevancia del concepto, aún es escasa la evidencia empírica al respecto a nivel local. OBJETIVOS: El artículo analiza el concepto de "salud sexual" a nivel de población general en Chile. MÉTODOS: Se diseñó una muestra probabilística, polietápica y estratificada en el Gran Santiago, encuestándose a 767 personas mayores de 18 años, siguiendo la metodología de autorreporte de hogares. RESULTADOS: El estudio evidencia diferencias según género y edad en la mayor parte de las variables relativas a la satisfacción sexual y a conductas sexuales seguras. CONCLUSIÓN: Se concluye que los hombres inician su vida sexual más tempranamente, tienen más parejas sexuales y reportan mayor satisfacción sexual que las mujeres, con excepción de la cohorte más joven. Ellas, a su vez, declaran mayores niveles de protección y cuidado de la vida sexual.

BACKGROUND: In 2006, the World Health Organization endorsed the concept of "sexual health" as a state of physical, emotional, mental and social well-being in relation to sexuality. Thus, it corresponds to a broader concept that the absence of disease, dysfunction or infirmity, being related to a general level of well-being. Despite the relevance of the concept, locally, there is still scarce empirical evidence about it. AIMS: The article analyses the concept of "sexual health" among the Chilean general population. Methods: In order to achieve this objective, a probabilistic, polyphasic and stratified sample was designed for the province of Santiago, being surveyed 767 people over 18 years, through a self-reported method in their own households. RESULTS: The study shows differences by gender and age in both sexual satisfaction and safe sexual behaviours. CONCLUSION: It is possible to conclude that men begin their sexual life earlier, have more sexual partners and report higher sexual satisfaction than women, except for the youngest cohort. Women, in turn, report higher levels of protection and care of sexual life.

[A case report. Factitious disorder with psychological symptoms. Is confrontation useful?]. / Trastorno facticio con síntomas psicológicos. Diagnóstico y tratamiento. ¿Es útil la confrontacion?

Factitious disorder is defined by the intentional production or feigning of physical or psychological symptoms with the objective of assuming the patient role. It is frequently difficult to adequately diagnose this disorder, above all, when the faked symptoms are those of a psychological or a psychiatric disorder. In these cases, there is often high comorbidity with other mental disorders, thus making it difficult to differentiate between real and factitious symptoms. Moreover, the lack of clear objective markers makes assessing the diagnosis even more difficult. In this article, we have aimed to clarify how a correct diagnosis of factitious disorder with psychological symptoms can be reached, to observe the different therapeutic strategies described in the literature and to analyze the utility of each one of them in a given case report.

Rapid and deep control of inflammation in rheumatoid arthritis with infliximab and its correlation with acute-phase reactants.

Rheumatoid arthritis (RA) is a chronic inflammatory disease with predominant joint involvement and possible systemic compromise, which leads to a handicapped status and poor quality of life. An optimal approach to treat RA requires early and intensive intervention with close monitoring of treatment response. Tumor necrosis factor (TNF) blockers are recommended in cases of active RA after the unsuccessful use of effective disease-modifying antirheumatic drugs (DMARDs); even adding them to treatment or replacing these drugs. Anti-TNF therapies have been demonstrated to reduce significant joint damage and to relieve symptoms during a prolonged time (see Scott and Kingsley, 2006). The efficacy of infliximab in an open-label trial is summarized with respect to speed of onset of action, durability of response, and its correlation between clinical and laboratory parameters. Safety for long-term treatment is also summarized. We studied 105 RA patients with more than 3 years' history of disease during 24 months on i.v. infliximab (75 completed study). We evaluated ACR responses at base line, and at 1, 6, 12, 16, 52, 77, and 104 weeks. Morning stiffness, swollen and tender joints, HAQ, SF-36% (PCS/MCS), polymerase chain reaction (PCR), erythrosedimentation rate (ESR), transaminases, rheumatoid factor (RF) levels, hemogram, and adverse events profile were all assessed. The treatment offered rapid and sustained clinical improvements as revealed by ACR responses and marked changes in the parameters previously described. Important changes were made in functional status and acute-phase reactants. Finally, infliximab was considered well tolerated and did not affect the safety profile of this trial.