Obesity and female sexual dysfunctions: A systematic review of prevalence with meta-analysis.

Obesity represents a major global health challenge. Female sexual dysfunctions have a negative impact on quality of life and overall health balance. A higher rate of female sexual dysfunctions in obese women has been suggested. This systematic review summarized the literature on female sexual dysfunction prevalence in obese women. The review was registered (Open Science Framework OSF.IO/7CG95) and a literature search without language restrictions was conducted in PubMed, Embase and Web of Science, from January 1990 to December 2021. Cross-sectional and intervention studies were included, the latter if they provided female sexual dysfunction rate data in obese women prior to the intervention. For inclusion, studies should have used the female sexual function index or its simplified version. Study quality was assessed to evaluate if female sexual function index was properly applied using six items. Rates of female sexual dysfunctions examining for differences between obese vs class III obese and high vs low quality subgroups were summarized. Random effects meta-analysis was performed, calculating 95% confidence intervals (CI) and examining heterogeneity with I2 statistic. Publication bias was evaluated with funnel plot. There were 15 relevant studies (1720 women participants in total with 153 obese and 1567 class III obese women). Of these, 8 (53.3%) studies complied with >4 quality items. Overall prevalence of female sexual dysfunctions was 62% (95% CI 55-68%; I2 85.5%). Among obese women the prevalence was 69% (95% CI 55-80%; I2 73.8%) vs 59% (95% CI 52-66%; I2 87.5%) among those class III obese (subgroup difference p=0.15). Among high quality studies the prevalence was 54% (95% CI 50-60%; I2 46.8%) vs 72% (95% CI 61-81%; I2 88.0%) among low quality studies (subgroup difference p=0.002). There was no funnel asymmetry. We interpreted that the rate of sexual dysfunctions is high in obese and class III obese women. Obesity should be regarded as a risk factor for female sexual dysfunctions.

[Pharmacological treatment in uncertainty times: Hydroxychloroquine/chloroquine use in the COVID-19 treatment]. / Tratamiento farmacológico en tiempos de incertidumbre: uso de la hidroxicloroquina/cloroquina en el tratamiento de COVID-19.

BACKGROUND AND OBJECTIVES: In this moments, of extreme gravity in which we find ourselves, and in the uncertainty face about the most effective treatment against COVID-19 disease and with the aim of find the evidence that support the chloroquine/hydroxychloroquine use recommendation to treat COVID-19 disease, a systematic review of published studies and RCT studies publishes until April 28, 2020 was carried out. MATERIAL AND METHODS: A systematic search was carried out in PubMed with the keywords COVID-19 and their synonyms and hydroxychloroquine/chloroquine. The data selection and extraction was elaborated by two researchers, independently. The results were discussed with a Primary Care physicians clinical group and the results were synthesized using GRADE methodology. RESULTS: A good quality systematic review was found that includes articles with a high risk of bias. And 8 EC launched that will produce results beyond May 2020. CONCLUSIONS: Although the conclusions of the systematic review generate a low confidence in the results, and the clinical variables that show benefit are intermediate variables, the side effects are acceptable and could be minimized with the use of QT lengthening risk tools, so it is could make a weak recommendation in favor of the use of chloroquine/hydroxychloroquine in patients with mild-moderate stage COVID-19.

Tratamiento farmacológico en tiempos de incertidumbre: uso de la hidroxicloroquina/cloroquina en el tratamiento de COVID-19 / Pharmacological treatment in uncertainty times: hydroxychloroquine/chloroquine use in the COVID-19 treatment

ANTECEDENTES Y OBJETIVOS: En los momentos de extrema gravedad en los que nos encontramos, y ante la incertidumbre acerca de los tratamientos más eficaces en la lucha contra la enfermedad COVID-19 y con el objetivo de conocer las evidencias que pueden sostener la recomendación de utilización de cloroquina/hidroxicloroquina en el COVID 19, se realizó una revisión sistemática de estudios publicados y EC puestos en marcha con fecha hasta 28 de abril 2020. MATERIAL Y MÉTODOS: Se realizó una búsqueda sistemática en PubMed con las palabras clave COVID-19 y sus sinónimos y cloroquina/hidroxicloroquina. La selección y extracción de los datos aparecidos en dicha búsqueda fue realizada por dos investigadores de forma independiente. Los resultados se discutieron con un grupo clínico de médicos de Atención Primaria y se sintetizaron los resultados mediante tablas de GRADE. RESULTADOS: Se encontró una revisión sistemática de buena calidad que incluye artículos con elevado riesgo de sesgos. Y 8 EC puestos en marcha que arrojarán resultados más allá de mayo de 2020. CONCLUSIONES: Aunque las conclusiones de la revisión sistemática generan una baja confianza en los resultados, y las variables clínicas que muestran beneficio son variables intermedias, los efectos secundarios son asumibles y podrían ser minimizados con el uso de herramientas de riesgo de alargamiento del QT, por lo que se podría hacer una recomendación débil a favor del uso de cloroquina/hidroxicloroquina en pacientes con COVID-19 en estadio leve-moderado

BACKGROUND AND OBJECTIVES: In this moments, of extreme gravity in which we find ourselves, and in the uncertainty face about the most effective treatment against COVID-19 disease and with the aim of find the evidence that support the chloroquine/hydroxychloroquine use recommendation to treat COVID-19 disease, a systematic review of published studies and RCT studies publishes until April 28, 2020 was carried out. MATERIAL AND METHODS: A systematic search was carried out in PubMed with the keywords COVID-19 and their synonyms and hydroxychloroquine/chloroquine. The data selection and extraction was elaborated by two researchers, independently. The results were discussed with a Primary Care physicians clinical group and the results were synthesized using GRADE methodology. RESULTS: A good quality systematic review was found that includes articles with a high risk of bias. And 8 EC launched that will produce results beyond May 2020. CONCLUSIONS: Although the conclusions of the systematic review generate a low confidence in the results, and the clinical variables that show benefit are intermediate variables, the side effects are acceptable and could be minimized with the use of QT lengthening risk tools, so it is could make a weak recommendation in favor of the use of chloroquine/hydroxychloroquine in patients with mild-moderate stage COVID-19

[Do we adequately prescribe antiplatelet treatment to type 2 diabetic patients?]. / Antiagregamos adecuadamente a los pacientes diabéticos tipo 2?

OBJECTIVE: To estimate how many type 2 diabetic patients receive antiplatelet therapy according to the American Diabetes Association (ADA) guidelines on primary and secondary prevention. DESIGN: A descriptive, cross-sectional study based on information in medical records. A random sample of 170 type 2 diabetics seen in an urban Health Centre was studied. MEASUREMENTS: The data collected including, age, sex, antiplatelet therapy according to the ADA, antiplatelet therapy indicated, cardiovascular risk factors, cardiovascular disease, and other clinical parameters. RESULTS: Of the subjects analysed, 56.9% were males, and the mean age was 67.8 years. The majority of patients (71.2%) were on primary prevention, and 44.4% of the diabetics were receiving adequate antiplatelet therapy according to the ADA. Among the subjects on secondary prevention, 90.9% received adequate antiplatelet therapy, while only 25.7% of those on primary prevention received it, which was significant. The most used antiplatelet drug was acetylsalicylic acid (ASA). CONCLUSIONS: A large proportion of diabetes on primary prevention does not receive adequate antiplatelet therapy, according to the ADA. However, patients on secondary prevention receive sufficient antiplatelet treatment. The benefits of ASA in reducing cardiovascular disease are well documented in patients with cardiovascular disease. On the other hand, the role of antiplatelet therapy in diabetics on primary prevention is not clear and is the subject of discussion. From 2006 to 2011, the ADA has modified the recommendation level of primary prevention antiplatelet therapy, thus decreasing the percentage of patients that may be given antiplatelet therapy with ASA, to the extent that it increases the cardiovascular risk calculation required for its indication.

¿Antiagregamos adecuadamente a los pacientes diabéticos tipo 2? / Do we adequately prescribe antiplatelet treatment to type 2 diabetic patients?

Objetivo. Estimar cuántos pacientes diabéticos tipo 2 deberían recibir tratamiento antiagregante, según las directrices de la Asociación Americana de Diabetes (ADA) en prevención primaria y secundaria. Diseño. Estudio descriptivo transversal, basado en información de historias clínicas. Muestra aleatoria de 170 diabéticos tipo 2 atendidos en el año 2006, en un centro de salud urbano. Mediciones. Edad, sexo, antiagregación según ADA, antiagregante indicado, factores de riesgo cardiovascular, eventos cardiovasculares, parámetros clínicos. Resultados. De los sujetos analizados, 56,9% eran varones, con edad media de 67,8 años. El 71,2% de los pacientes estaban en prevención primaria. El 44,4% de los diabéticos estaban adecuadamente antiagregados, según la ADA. Entre los sujetos en prevención secundaria están adecuadamente antiagregados el 90,9%, mientras que solamente lo están el 25,7% de los de prevención primaria, lo que es significativo. Cuando se antiagrega, el ácido acetilsalicílico (AAS) es el fármaco más usado. Conclusiones. Una gran proporción de diabéticos en prevención primaria no está adecuadamente antiagregada, según la ADA. Sin embargo existe una correcta antiagregación en los pacientes de prevención secundaria. El beneficio del AAS en la reducción de eventos cardiovasculares está correctamente documentado en pacientes con enfermedad cardiovascular. En cambio, el papel de la antiagregación en diabéticos de prevención primaria es poco conciso y objeto de discusión. Desde 2006 a 2011, la ADA ha modificado el grado de recomendación de antiagregación en prevención primaria, disminuyendo el porcentaje de pacientes susceptibles de recibir tratamiento antiagregante con AAS a medida que aumenta el cálculo del riesgo cardiovascular necesario para la indicación (AU)

Objective. To estimate how many type 2 diabetic patients receive antiplatelet therapy according to the American Diabetes Association (ADA) guidelines on primary and secondary prevention. Design. A descriptive, cross-sectional study based on information in medical records. A random sample of 170 type 2 diabetics seen in an urban Health Centre was studied. Measurements. The data collected including, age, sex, antiplatelet therapy according to the ADA, antiplatelet therapy indicated, cardiovascular risk factors, cardiovascular disease, and other clinical parameters. Results. Of the subjects analysed, 56.9% were males, and the mean age was 67.8 years. The majority of patients (71.2%) were on primary prevention, and 44.4% of the diabetics were receiving adequate antiplatelet therapy according to the ADA. Among the subjects on secondary prevention, 90.9% received adequate antiplatelet therapy, while only 25.7% of those on primary prevention received it, which was significant. The most used antiplatelet drug was acetylsalicylic acid (ASA). Conclusions. A large proportion of diabetes on primary prevention does not receive adequate antiplatelet therapy, according to the ADA. However, patients on secondary prevention receive sufficient antiplatelet treatment. The benefits of ASA in reducing cardiovascular disease are well documented in patients with cardiovascular disease. On the other hand, the role of antiplatelet therapy in diabetics on primary prevention is not clear and is the subject of discussion. From 2006 to 2011, the ADA has modified the recommendation level of primary prevention antiplatelet therapy, thus decreasing the percentage of patients that may be given antiplatelet therapy with ASA, to the extent that it increases the cardiovascular risk calculation required for its indication (AU)

[Treatment with interferon of chronic active hepatitis in patients with HIV infection]. / Tratamiento con interferón de la hepatitis crónica activa en pacientes con infección por VIH.

Clinical records of 14, CD4 cell counts > 400/mm3, mild symptoms or asymptomatic, HIV infected patients and with chronic active hepatitis (identified by hepatic biopsy) were under review. Four of them were infected with HBV, 8 with HCV, 1 with HDV and other one with HBV + HCV + HDV. They were treated with alpha interferon for 6 months. Effectiveness was evaluated. It was found that in 4 (50%) of HCV infected patients transaminases raised normal value two of them remained with normal values at the end of review (22 and 48 months of follow-up). All HBV infected patients (4) normalized transaminases. Three of them lost HBeAg, that persisted through 38 months of follow-up. It was found too, whose did not improved with 6 months treatment did not benefit with a longer treatment. Therefore, HIV infected patients uncompromised (CD4+ > 400/mm3) and with chronic active hepatitis were benefited by interferon treatment (57%). Reversal of HBeAg was remarkable.

[Edema as clinical manifestation of hyperthyroidism. Report of 2 cases]. / Edemas como manifestación clínica de hipertiroidismo. A propósito de dos casos.

We report two cases of hyperthyroidism clinically associated to edema, in which no usual causes for the latter were found. Correction of the hyperthyroidism state was associated with complete resolution of edema. The fact that one of the cases consisted of a farmacologically induced hyperthyroidism points to a direct effect of the thyroid hormone itself as the origin of this complication. The de novo occurrence of edema can be due to thyroid hyperfunction as the only underlying cause, the presence of other associated factors such as heart failure, hypoproteinemia or dermopathy not being necessary for its development.

[Descriptive study of 39 cases of hepatic abscess of pyogenic and amebic origin]. / Estudio descriptivo de 39 casos de abscesos hepáticos de origen piógeno (33) y amebiano (6).

Thirty nine cases of liver abscess--33 pyogenic (LAP) and 6 amebic (LAA)--attended in our hospital between 1980 and 1994, were reviewed. Mean patient age was 55.66 years (LAP) and 35.83 years (LAA), while the relation male/female was 2.3:1 and 5:1 respectively. The most usual underlying pathology in LAP was bile duct disease (39.39%). Four patients with LAA had travelled to endemic areas. Fever was the most frequent clinical finding (71.79%). Echography and/or CT scan confirmed the diagnosis in 32 patients (82.05%), with a sensitivity of 86.66 and 95.65% respectively. Positive cultures were found in 74.35% (39.13% polymicrobials), being E. Coli and K. Pneumoniae the most frequently isolated bacteria. In LAP pus cultures were positive in 73% and blood cultures in 55%. Diagnosis of LAA was made by wet mount smears/serology (3/3). Percutaneous drainage was performed in 41.02%, surgical drainage in 48.71 and 15.38% (all with LAP) received antibiotics exclusively. Four patients died (3 with LAP and 1 with LAA).