Quality of analgesic care in labor: A cross-sectional study of the first national register-based benchmarking system.

OBJECTIVE: Unlike other types of acute pain, labor pain is considered physiological. Due to the heterogeneous management during labor, there is a lack of intention to define quality of care of peripartal analgesia. This study presents the first results of the national register for this evaluation. METHODS: This prospective cross-sectional study, conducted in five different German level-three hospitals, included women after vaginal childbirth between January 2020 and January 2022. A validated questionnaire was completed 24 h postpartum, including information about labor pain, satisfaction, and expectations regarding analgesia. Data were centrally recorded with obstetric records using the database of the QUIPS (Quality Improvement in Postoperative Pain Management) Project. RESULTS: A total of 514 women were included. On an 11-point Numerical Rating Scale, pain intensity during labor was severe (8.68 ± 1.8) while postpartal pain was 3.9 (±2.1). The second stage of labor was considered the most painful period. Only 62.6% of the parturients obtained pharmacological support, with epidural being the most effective (reduction of 3.8 ± 2.8 points). Only epidural (odds ratio [OR] 0.22) and inhalation of nitrous oxide (OR 0.33) were protective for severe pain. In benchmarking, a relation between satisfaction, pain intensity, and the use of epidural was found; 40.7% of the women wished they had received more analgesic support during labor. CONCLUSION: This study highlights deficiencies in analgesic management in high-level perinatal centers, with more than 40% of parturients considering actual practices as insufficient and wishing they had received more analgesic support, despite the availability of analgesic options. Using patient-reported outcomes can guarantee qualitative tailored analgesic care in women.

Implementation of a piritramide based patient-controlled analgesia (PCA) as a standard of care for pain control in late abortion induction: A prospective cohort study from a patient perspective.

Objective: To assess whether the implementation of patient-controlled analgesia (PCA) with piritramide using an automatic pump system under routine conditions is effective to reduce pain in late abortion inductions. Study design: Prospective observational cohort study. Setting: Patients requiring medically indicated abortion induction from 14 weeks of pregnancy onwards between July 2019 and July 2020 at the department of Obstetrics and Prenatal Medicine of the Bonn University Hospital in Germany. Methods: Evaluation of pain management after implementation of a PCA system compared with previous nurse-controlled tramadol-based standard under routine conditions. Patients answered a validated pain questionnaire and requirement of rescue analgesics was assessed. Pain intensity and satisfaction were measured on a ten-point numeric rating scale. Main Outcome Measure Maximal pain intensity. Results: Forty patients were included. Patients using Piritramide-PCA complained of higher pain sores than those in the standard group (6.90 (± 2.34) vs. 4.83 (± 2.87), (p < 0.05)). In both groups the level of satisfaction with the analgesia received was comparable (8.00 (± 2.45) vs 7.67 (± 2.62), (p = 0.7)). Patients in the PCA group suffered more nausea (63.2 % vs 30 % respectively, OR 4.0, 95 % CI 1.05-15.20, p < 0.05) and expressed more the desire for more analgesic support compared to the control group (OR 5.7 (1-33.25), p = 0.05). Conclusion: Women with abortion induction after 14 weeks of gestation suffer from relevant severe pain, which requires adequate therapy. However, addition of PCA does not seem to bring any advantage in patients undergoing this procedure.

Photodegradation and in vitro phototoxicity of aceclofenac.

Aceclofenac (Airtal) (1) is a photoallergic and phototoxic anti-inflammatory and analgesic agent. This drug is photolabile under aerobic and anaerobic conditions. Irradiation of an ethanol-solution of aceclofenac under oxygen or argon at 290-320 nm affords via decarboxlation compound 2 as the main isolated and spectroscopically identified photoproduct, besides hydroxylamine derivates 3 and 4. A radical intermediate was evidenced spectrophotometrically with GSH and DTNB, as well as by the dimerization of cysteine. Red blood cell lysis photosensitized by 1-4 was investigated. Furthermore, in a lipid-photoperoxidation test with linoleic acid the in vitro phototoxicity of aceclofenac was also verified. The photoinduced generation of peroxide by compound 1 was determined during the irradiation in presence of NADPH by chemiluminescence. In relation to the photoallergic activity of this drug, the interaction of aceclofenac with human serum albumin (HSA) has been studied through fluorescence spectroscopy. No photoinduced binding was observed after irradiation of compounds 1 in the presence of human serum albumin.

The steroid antagonist RU486 given at pro-oestrus induces hypersecretion of follicle-stimulating hormone from oestrus afternoon to early metoestrus in the rat.

Administration of the steroid antagonist RU486 to cyclic rats at pro-oestrus blunts the preovulatory surge of LH and suppresses the first and second surges of FSH. In addition, administration of oestradiol to RU486-treated rats reactivates the LH surge the following day. The present study explored the effects of RU486 (4 mg/0.2 ml oil), administered at 0800 h on the day of pro-oestrus, on serum FSH and LH concentrations through oestrus and early metoestrus. RU486 induced a hypersecretion of FSH, which started at 1400 h on the day of oestrus and was maintained until 0800 h on the day of metoestrus. Because the timing and magnitude of this secretion of FSH were similar to those of the periovulatory secretion of FSH during pro-oestrus and early oestrus in intact cyclic rats, we investigated the effects of: 1) LHRH antagonist (LHRHa) injected at either 0900 h or 2000 h on the day of oestrus, 2) oestradiol benzoate injected at 1600 h on the day of pro-oestrus and at 0900 h on the day of oestrus, 3) bovine follicular fluid (bFF) given either at 1100 h or at 2000 h on the day of oestrus, or 4) adrenalectomy (ADX) at 1100 h on the day of oestrus, on serum FSH and LH concentrations at 1800 h on the day of oestrus and at 0200 h on the day of metoestrus in rats injected with RU486 at pro-oestrus. The results showed that 1) both components (late oestrus and early metoestrus) of FSH hypersecretion in RU486-injected rats in pro-oestrus were inhibited by oestradiol benzoate and bFF, 2) the metoestrous component was not affected by LHRHa, whereas the oestrous component was partially reduced, and 3) ADX partially reduced serum FSH concentrations only on the day of metoestrus, possibly because, as the serum concentrations of corticosterone reflected, the antiglucocorticoid activity of 4 mg RU486 lasted only 24 h. The results support the hypothesis that blockade of progesterone actions at pro-oestrus results in the maintenance of the daily neural signal that activates the release of gonadotrophins. Whereas the expression of LH secretion requires high levels of oestradiol, FSH secretion is expressed against a background of low oestradiol levels. The results of this study also indicate that the release of FSH during oestrus and metoestrus in rats injected with RU486 at pro-oestrus is a consequence of the lack of ovarian negative feedback inhibition on the pituitary.

Endometriosis: «Nivel de conocimiento y expectativas de formación específica entre profesionales especialistas en medicina de familia y comunitaria y matronas en atención primaria en la isla de Gran Canaria» / Endometriosis: “Level of knowledge and expectations of specific training among primary care doctors and midwives on the island of Gran Canaria, Spain”

Objetivo: Analizar el nivel de conocimiento entre profesionales sanitarios de atención primaria sobre endometriosis e identificar sus necesidades formativas en esta materia. Diseño: Estudio descriptivo realizado en atención primaria del Área de Salud de Gran Canaria, mediante cuestionario online anónimo. Resultados: Ciento diecinueve especialistas en medicina de familia y comunitaria y 37 matronas respondieron el cuestionario. El 54,6% de profesionales médicos y el 67,6% de matronas consideran escaso su conocimiento sobre endometriosis. Menos del 50% de profesionales conoce la guía de atención a las mujeres con endometriosis en el Sistema Nacional de Salud. Los síntomas más frecuentes relacionados con endometriosis son: dismenorrea moderada/severa, dolor pélvico crónico, esterilidad. Los menos relacionados son los digestivos y las alteraciones urinarias catameniales. Un 80% de profesionales médicos señalan como menor de 10 el número anual de pacientes en las que piensan que puedan tener endometriosis y menos de 20 para el 75% de matronas. El 40% de profesionales médicos trataría a una paciente con solo dismenorrea y sin planes de gestación con anticonceptivos orales; el 8% considera que el dolor con la menstruación es algo común. El 25% de profesionales especialistas en medicina de familia y comunitaria señalan la terapia de larga duración con antiinflamatorios no esteroideos como tratamiento de primera línea. Menos del 25% de ellos derivarían al especialista en Ginecología con solo sospechar endometriosis. Mayoritariamente los profesionales manifiestan interés en mejorar su formación en endometriosis. El 94,6% de las matronas consideran que tienen un papel estratégico en el manejo de pacientes con endometriosis. Conclusión: La demora en el diagnóstico de la endometriosis se debe en parte al desconocimiento de la enfermedad. Los profesionales de atención primaria constituyen la primera línea de atención sanitaria.(AU)

Objective: To analyze the level of knowledge of endometriosis in primary care doctors and midwives and to identify their training needs in this area. Design: Descriptive study conducted in the primary care services of the Health Area of Gran Canaria, through an anonymous online questionnaire. Results: One hundred and nineteen doctors and 37 midwives completed the questionnaire; 54.6% of doctors and 67.6% of midwives considered that their knowledge about endometriosis was poor. Less than 50% of healthcare professionals knew the National System of Health's guidelines for the management of women with endometriosis. Symptoms most frequently associated to endometriosis included: moderate/severe dysmenorrhea, chronic pelvic pain and sterility. Less frequently related ones included: digestive symptoms and catamenial urinary disorders; 80% of doctors suspected endometriosis in <10 women per year; 75% of midwives suspected this condition in <20 women per year; 40% of doctors would prescribe oral contraceptives to patients with dysmenorrhea who were not planning pregnancy; 8% of doctors considered that menstruation-associated pain was common. Medical therapy was the most frequently chosen first-line treatment; 25% of doctors would choose long-term NSAIDs therapy as a first-line treatment; less than 25% of them would refer a patient to the Gynecology service only for suspected endometriosis. Most health professionals expressed their interest in improving their knowledge about endometriosis; 94.6% of midwives considered that they played a strategic role in the identification and management of patients with endometriosis. Conclusion: Delays in the diagnosis of endometriosis are partially due to ignorance of the disease. Primary care professionals constitute the first line of health care. In this context, it is essential to develop specific training strategies, which would be welcome by health professionals.(AU)

Úlceras vulvares: un reto diagnóstico / Vulvar ulcers: A diagnostic challenge

Las úlceras vulvares son una entidad patológica relevante por su repercusión en la calidad de vida de la mujer y suponen un desafío diagnóstico dada la variedad etiológica y de presentación clínica. El diagnóstico se basa en la anamnesis, la exploración física detallada y pruebas complementarias.Presentamos el caso clínico de una paciente de 39 años con diagnóstico de úlceras vulvares graves, recidivantes, que requirió ingreso hospitalario prolongado en tres ocasiones. Se describe el proceso de identificación, los posibles diagnósticos diferenciales y el resultado del tratamiento aplicado.(AU)

Vulvar ulcers are an important pathological condition due to their impact on the quality of life of women. It is a diagnostic challenge given the aetiological variety and clinical presentation. The diagnosis is based on anamnesis, detailed physical examination, and complementary tests.The clinical case is presented of a 39-year-old patient diagnosed with severe, recurrent vulvar ulcers, and who required prolonged hospital admission on three occasions. The diagnostic process, possible differential diagnoses, and the outcome of the applied treatment are described.(AU)

Diagnóstico y tratamiento de la enfermedad pélvica inflamatoria / Diagnosis and treatment of pelvic inflammatory disease

Objetivo: Estudiar los factores de riesgo y la relación entre los hallazgos clínico-ecográficos y los hallazgos microbiológicos y anatomopatológicos en el contexto de una enfermedad pélvica inflamatoria. Material y métodos: Estudio observacional retrospectivo realizado entre enero de 2010 y noviembre de 2015. Se incluyó a aquellas pacientes con diagnóstico de enfermedad pélvica inflamatoria registradas en la base de datos informatizada del Servicio de Obstetricia y Ginecología del Complejo Hospitalario Universitario Insular Materno-Infantil y con criterios para ser hospitalizadas. Se excluyeron las pacientes tratadas de forma ambulatoria. Resultados: Se obtuvo una muestra de 112 pacientes con una edad media de 35,4 años. Solamente el 11,6% cumplían todos los criterios mínimos de diagnóstico de enfermedad pélvica inflamatoria. Los patógenos aislados en mayor porcentaje fueron clamidia y gonococo. Se hizo biopsia de endometrio en un 55,6% de los casos y la ecografía informó de una imagen sugestiva de EPI en un 56,3%. La pauta antibiótica más empleada fue la asociación de clindamicina y gentamicina. Se instauró tratamiento de la pareja sexual en el 48,2% de los casos. El 82,15% de las pacientes recibieron tratamiento quirúrgico. Conclusión: La población estudiada es atípica en cuanto a edad media y factores de riesgo, aunque la recogida de datos en la anamnesis es mejorable. La incidencia de gonorrea ha disminuido en nuestro medio, coincidiendo con la aparición de nuevos patógenos que adquieren mayor importancia. Se debe insistir en la toma de biopsia de endometrio para aumentar el índice de sospecha y en la realización del tratamiento a la pareja sexual. Aun así, los resultados del tratamiento hospitalario y quirúrgico fueron favorables

Objective: To analyse the risk factors and the relationship between clinical and sonographic findings and microbiological and pathological findings in the context of pelvic inflammatory disease. Materials and methods: Retrospective observational study conducted between January 2010 and November 2015. Patients with a diagnosis of pelvic inflammatory disease, registered in the electronic database of the Department of Obstetrics and Gynaecology of Complejo Hospitalario Universitario Insular Materno-Infantil, who met the hospitalisation criteria for the Gynaecology Department, were selected. Patients treated on an outpatient basis were excluded. Results: A sample of 112 patients was obtained, with a mean age of 35.4 years. Only 11.6% of patients met all minimum diagnosis criteria of pelvic inflammatory disease. Chlamydia and gonorrhoea were the most frequently isolated pathogens. Endometrial biopsy was performed in 55.6% of the cases, while ultrasonography showed images suggestive of pelvic inflammatory disease in 56.3% of the patients. The combination of clindamycin and gentamicin was the most used antibiotic regimen, with 48.2% of sexual partners being treated. A number of 82.15% of patients underwent surgery. Conclusion: The study population is atypical in terms of average age and risk factors, although there is room for improvement in relation to data collected from the patients’ medical history. The incidence of gonorrhoea has declined in our area, which is consistent with the emergence of new pathogens that are more prevalent. Endometrial biopsy should be performed to increase the index of suspicion and the treatment of sexual partners. On the whole, however, the hospital and surgical treatment results were favourable

A novel paraptosis pathway involving LEI/L-DNaseII for EGF-induced cell death in somato-lactotrope pituitary cells.

We have recently reported that EGF triggers an original form of cell death in pituitary cell line (GH4C1) with a phenotype sharing some characteristics of both apoptosis (internucleosomal DNA fragmentation) and paraptosis (caspase-independence and cytoplasmic vacuolization). However, the endonuclease involved in EGF-induced DNA fragmentation has not been assessed so far. In the present work we therefore further explored the putative paraptosis involvement in EGF-induced cell death and asked whether L-DNaseII might be involved. Indeed, this endonuclease is known to mediate internucleosomal DNA fragmentation in caspase independent manner. Our Western blot, immunocytochemistry and enzymatic measurement assays show that EGF triggers a cleavage of Leukocyte Elastase Inhibitor (LEI) precursor into L-DNaseII, its subsequent enzymatic activation and nuclear translocation thus pointing to the involvement of this endonuclease pathway in caspase-independent DNA fragmentation. In addition, EGF-induced cell death can be blocked by paraptosis inhibitor AIP-1/Alix, but not with its anti-apoptotic C-terminal fragment (Alix-CT). Altogether these data suggest that EGF-induced cell death defines a novel, L-DNaseII-mediated form of paraptosis.

[Indirect ultra-micro-ELISA for detecting IgG antibodies in patients with fascioliasis]. / UltramicroELISA indirecto para la detección de anticuerpos IgG en pacientes con fascioliasis.

The standardization of an ultramicroELISA for the detection of IgG antibodies anti excretory-secretory antigens of Fasciola hepatica (UME-Fasciola) is described. It was studied a considerable group of sera of which 56 were from patients with fascioliasis, 168 from patients with other parasitic diseases, and 300 from sound persons that were used as negative controls. As regards the parasitology test considered as "Gold Standard", the UME-Fasciola showed a sensitivity of 100%, an specificity of 98%, and predictive values for positives and negatives of 90.3% and 100%, respectively. Cross-reaction was only observed with the sera from patients infected with Opistorchis felineus. On comparing the UME-Fasciola with the conventional ELISA, it was obtained a concordance index of 95.5%.

In vitro studies of the dual properties of Allopurinol anti- and photo-oxidants Mechanisms / Estudio in vitro de dos propiedades del Alopurinol.

The objective of this study was to investigate the ability of allopurinol (1) to inhibit free radical or reactive oxygen species (.OH, ¹O2, H2O2) as well as the study of its photochemical activity. We investigated the ability of 1 to scavenge oxygen metabolites generated by cell-free systems using luminol enhanced-chemiluminescence and electronic absorption spectra as monitors. Both absorbance and fluorescence scans reveal that 1 is able to react with equimolar quantities of H2O2. In the presence of 1 a dose-dependent inhibition period was observed in this system as assayed by isoluminol-enhanced chemiluminescence (ILCL) in the presence of horseradish peroxidase (HRP), as well as by luminol-enhanced chemiluminescence (LCL) in the presence of H2O2 or ferrous ion. On the other hand, 1 did not show an efficient scavenging activity of galvanoxyl radical in ethanolic solutions. Furthermore, in a separate experiment, it was not observed trapping of singlet oxygen (¹O2) generated by Rose Bengal, in the presence of 1. The activity of 1 was compared with that of vitamins E and C. In vitro experiments of photohemolysis in presence of 1 and cinoxacin, a phototoxic antibacterial quinolone, the photohemolytic effect of cinoxacin was diminished. Allopurinol alone did not show any phototoxic effect under irradiation with UV-A or visible light but was photo-unstable and phototoxic in vitro with UV-B light.

Se estudió la habilidad del alopurinol (1) para inhibir radicales libres o especies reactivas de oxigeno (.OH, ¹O2, H2O2), igualmente se determinó su actividad fotoquímica. De otro lado se midió la habilidad de 1 para eliminar los metabolitos de oxígeno generados por un sistema libre de células basado en quimioluminicencia aumentada de luminol y se monitoreo el espectro de absorción electrónica. Las dos determinaciones, absorbancia y fluorescencia, revelan que 1 es capaz de reaccionar con cantidades equimoleculares de H2O2. En presencia de alopurinol se observan periodos de inhibición dosis dependiente al usar isoluminol como intensificador de luminiscencia (ILCL) en presencia de peroxidasa de rábano o ión ferroso. Por otro lado, 1 no mostró una eficiente actividad frente a radicales galvanoxil en solución etanólica. En otros experimentos en presencia de 1 no se observó bloqueo de especies de oxígeno singlete (¹O2) generado por rosa bengala. La habilidad de 1 fue comparada con la de vitaminas E y C. En experimentos de fotohemólisis in vitro en presencia de 1 y cinoxacin, quinolona fototóxico antibanterial, el efecto fotohemolítico del cinoxacin fue disminuido. El alopurinol no mostró efecto fototóxico por irradiación con luz UV-A o luz visible, sin embargo se mostró foto - inestable y fototóxico in vitro bajo irradiación con luz UV-B.

Alteraciones ventilatorias encontradas en pacientes con artritis reumatoidea / Alterations opposing ventilators in patient with arthritis reumatoidea

Se hace un estudio de 56 pacientes escogidos al azar simple de un universo de 112 pacientes que asisten a la consulta de reumatología del Hospital Provincial Clínico Quirúrgico Docente Dr. Gustavo Aldereguía Lima, afectados de artritis rematoidea, a los que se les realizó pruebas funcionales respiratorias, se consideró la edad, sexo y tiempo de evolución de la enfermedad. Predominó el sexo femenino y el grupo etareo de 45 a 59 años. Todos los parámetros ventilatorios investigados mostraron diferentes alteraciones, pero el mas afectado fue la capacidad vital, también se mostraron mas alterados, mientras mas años de evolución presentó la enfermedad y las pruebas funcionales respiratorias normales predominaron en los pacientes con menos de 2 años de evolución de la artritis reumatoidea

Malformación adenomatoide quística / Cystic adenomatoid malformation

La adenomatosis quística pulmonar es una rara malformación congénita que consiste en un hamartoma torácico con un excesivo crecimiento de diversas capas de bronquío los y alvéolos que característicamente puede comprender desde quistes: a masas prácticamente sólidas localizadas en el pulmón y cuyo diagnóstico prenatal es posible mediante técnicas ultrasonográficas (AU)