Impact of different COVID-19 waves on kidney replacement therapy epidemiology and mortality: REMER 2020.

BACKGROUND: Kidney replacement therapy (KRT) confers the highest risk of death from coronavirus disease 2019 (COVID-19). However, most data refer to the early pandemic waves. Whole-year analysis compared with prior secular trends are scarce. METHODS: We present the 2020 REMER Madrid KRT registry, corresponding to the Spanish Region hardest hit by COVID-19. RESULTS: In 2020, KRT incidence decreased 12% versus 2019, while KRT prevalence decreased by 1.75% for the first time since records began and the number of kidney transplants (KTs) decreased by 16%. Mortality on KRT was 10.2% (34% higher than the mean for 2008-2019). The 2019-2020 increase in mortality was larger for KTs (+68%) than for haemodialysis (+24%) or peritoneal dialysis (+38%). The most common cause of death was infection [n = 419 (48% of deaths)], followed by cardiovascular [n = 200 (23%)]. Deaths from infection increased by 167% year over year and accounted for 95% of excess deaths in 2020 over 2019. COVID-19 was the most common cause of death (68% of infection deaths, 33% of total deaths). The bulk of COVID-19 deaths [209/285 (73%)] occurred during the first COVID-19 wave, which roughly accounted for the increased mortality in 2020. Being a KT recipient was an independent risk factor for COVID-19 death. CONCLUSIONS: COVID-19 negatively impacted the incidence and prevalence of KRT, but the increase in KRT deaths was localized to the first wave of the pandemic. The increased annual mortality argues against COVID-19 accelerating the death of patients with short life expectancy and the temporal pattern of COVID-19 mortality suggests that appropriate healthcare may improve outcomes.

[Adnexal torsion caused by Fallopian tube cancer]. / Torsión anexial causada por cáncer de trompa de Falopio.

Fallopian tube cancer is the less frequent gynecological cancer. It occurs typically between 40 and 65 years old. Diagnosis is usually achieved earlier than in ovarian cancer cases, due to early symptoms (typically abdominal pain, hydro-hematorrhea and adnexal mass). Preoperative correct diagnosis is infrequent, being most cases diagnosed during the surgery or in the pathological study. Histologically and clinically is similar to ovarian cancer, being the serous low differentiated the most frequent type. An early suspicion and a correct intervention are essential to obtain correct diagnosis and treatment. Treatment protocols are similar to those of ovarian cancer recommended by the FIGO.

[Mammary ductal ectasia child. Diagnostic and therapeutic approach]. / Ectasia ductal mamaria infantil. Aproximación diagnóstica y terapéutica.

Mammary duct ectasia in childhood is a rare disease. It appears typically as a periareolar mammary mass and/or nipple discharge. Even though in the adult age is an acquired disease, its occurrence in children suggests it may constitute a development mammary gland anomaly. Sonography is highly useful in the diagnosis. Differential diagnosis must include other nipple discharge and mammary mass causes as the juvenile fibroadenoma or malignant pathology. This usually is a self-limited process, so that a conservative approach is recommended, even though occasionally surgical treatment is required. We report the case of a 13 years old girl with nipple discharge who finally was diagnosed bilateral mammary duct ectasia.

Ultrasonographic and pathological endometrial findings in asymptomatic postmenopausal women taking antihypertensive drugs.

OBJECTIVES: To assess whether abnormal sonographic endometrial findings are more frequent in asymptomatic postmenopausal women receiving anti-hypertensive drugs than in normotensive women. METHODS: A prospective study on 187 postmenopausal asymptomatic normotensive (group A) and 182 postmenopausal asymptomatic women receiving anti-hypertensive drugs (group B) was performed. All patients were evaluated initially by transvaginal ultrasound and endometrial sampling (Pipelle device). Those women with abnormal sonographic findings (endometrial thickness > or =5 mm or heterogeneous echogenicity) or abnormal endometrial sampling results underwent hysteroscopy and guided biopsy. RESULTS: Patients in group B had significantly higher percentage of endometrial thickness > or =5 mm (26.9 vs. 12.8%, P<0.001) and heterogeneous endometria (23.1 vs. 12.8%, P<0.001) than in group A. Patients in group B had a significantly higher incidence of endometrial polyps (17.6 vs. 9.6%, P<0.001) too. These findings were not associated with the type of anti-hypertensive drug taken and were independent of the body mass index. CONCLUSIONS: Postmenopausal hypertensive asymptomatic women receiving pharmacological anti-hypertensive therapy show a higher percentage of abnormal sonographic endometrial findings than normotensive women.