The Effect of Apalutamide on Thyroid Function in Prostate Cancer Patients.

Context: Apalutamide (APT) is a nonsteroidal antiandrogen medication used to treat metastatic castrate-sensitive and nonmetastatic castrate-resistant prostate cancer. Early clinical trials of APT identified thyroid dysfunction as a common adverse effect of therapy, but the clinical presentation and management of APT-induced hypothyroidism has not been studied. Objective: The objective of our study is to elucidate the clinical presentation and treatment approach of APT-associated thyroid dysfunction in prostate cancer patients. Methods: We report a case series of 16 patients with APT-associated thyroid dysfunction during prostate cancer treatment at 2 academic medical centers. Patient clinical parameters, thyroid function laboratory data, and thyroid hormone requirements over the course of APT treatment were analyzed. Results: Among the 16 patients in our case series with APT-associated hypothyroidism, 3 had no prior thyroid disease and 13 had preexisting hypothyroidism. The patterns of thyroid dysfunction included overt and subclinical hypothyroidism. The median time from APT initiation to thyroid function test abnormality was 19 weeks, but occurred in some cases as early as 2 to 4 weeks. Hypothyroidism was effectively managed with thyroid hormone replacement using levothyroxine (LT4), though some patients with preexisting hypothyroidism required a 2- to 3-fold dose increase while on APT to achieve a euthyroid state. In the subset of patients who completed or stopped APT therapy, thyrotropin levels fell at a median of 11 weeks post APT therapy and thyroid hormone requirements decreased to near pre-APT levels. Conclusion: APT-associated thyroid dysfunction presents as new or worsening hypothyroidism and should prompt initiation or increase in thyroid hormone replacement. Monitoring of thyroid function tests is recommended every 1 to 2 months for all patients on APT and 2 to 3 months after completion of APT.

Interventions to improve symptomatology in patients with hypothyroidism and persistent symptoms: A systematic review.

BACKGROUND: Levothyroxine (LT4) monotherapy is the standard treatment for hypothyroidism; however, 10-15% of patients have persistent hypothyroid symptoms despite normalizing thyroid hormone levels with LT4. This study aims to summarize the best available evidence on interventions to improve symptomatology in patients with hypothyroidism and persistent symptoms. METHODS: A systematic search was conducted in March 2022 for randomized controlled trials and observational studies on interventions for adult patients with persistent hypothyroid symptoms despite biochemical euthyroidism on thyroid hormone replacement. RESULTS: A total of 277 articles were reviewed and seven fulfilled the inclusion criteria. 455 participants were included. Most intervention participants were female (78.6%) with a mean age of 47.5 (±2.8) years. Five clinical trials evaluating ginger (vs. starch), L-carnitine (vs. placebo), combination LT4 and liothyronine (LT3) (vs. LT4 or placebo), and surgery for patients with serum antithyroid peroxidase (TPO Ab) titers greater than 1000 IU/ml (vs. LT4) found inconsistent improvement in hypothyroidism related symptoms and general health. The two clinical trials with the largest improvement in fatigue scores were the use of ginger and surgery. One observational study comparing thyroidectomy vs observation found no significant difference on general health. Lastly, another observational study evaluating combination LT4/LT3 (vs. LT4 monotherapy) found improvement in fatigue and quality of life. There were 31 (12%) adverse events in the intervention group and 18 (10.8%) in the comparator group. CONCLUSIONS: There is no high-quality evidence supporting any intervention for persistent symptoms in hypothyroidism. Available evidence, limited by the risk of bias, inconsistency, and heterogeneity, suggests that some persistent symptoms, particularly fatigue, could improve with ginger and thyroidectomy.

Overuse of thyroid ultrasound.

PURPOSE OF REVIEW: Thyroid ultrasound (TUS) is a common diagnostic test that can help guide the management of patients with thyroid conditions. Yet, inappropriate use of TUS can lead to harmful unintended consequences. This review aims to describe trends in the use and appropriateness of TUS in practice, drivers and consequences of inappropriate use, and potential solutions to decrease overuse. RECENT FINDINGS: TUS use has increased in the U.S. and is associated with increased diagnosis of thyroid cancer. Between 10-50% of TUSs may be ordered outside of clinical practice recommendations. Patients who receive an inappropriate TUS and are incidentally found to have a thyroid nodule may experience unnecessary worry, diagnostic interventions, and potential overdiagnosis of thyroid cancer. The drivers of inappropriate TUS use are not yet fully understood, but it is likely that a combination of clinician, patient, and healthcare system factors contribute to this problem. SUMMARY: Inappropriate TUS is a factor leading to the overdiagnosis of thyroid nodules and thyroid cancer, resulting in increased healthcare costs and potential harm to patients. To effectively address the overuse of this diagnostic test, it is necessary to gain a deeper understanding of the frequency of inappropriate TUS use in clinical practice and the factors that contribute to it. With this knowledge, interventions can be developed to reduce the inappropriate use of TUS, leading to improved patient outcomes and more efficient use of healthcare resources.

Neutralizing antibodies levels are increased in individuals with heterologous vaccination and hybrid immunity with Ad5-nCoV in the north of Mexico.

The coordinated efforts to stop the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) include massive immunization of the population at a global scale. The humoral immunity against COVID-19 is conferred by neutralizing antibodies (NAbs) that occur during the post-infection period and upon vaccination. Here, we provide robust data showing that potent neutralizing antibodies are induced in convalescent patients of SARS-CoV-2 infection who have been immunized with different types of vaccines, and patients with no previous history of COVID-19 immunized with a mixed vaccination schedule regardless of the previous infection. More importantly, we showed that a heterologous prime-boost in individuals with Ad5-nCoV (Cansino) vaccine induces higher NAbs levels in comparison to a single vaccination scheme alone.

COVID-19 Neutralizing Antibodies in Breast Milk of Mothers Vaccinated with Three Different Vaccines in Mexico.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused the largest pandemic of this century, and all aspects of this virus are being studied. The efforts to mitigate the negative effects associated with the SARS-CoV-2 pandemic have culminated in the development of several vaccines that are effective and safe for use to the general population. However, one aspect that remains relatively underexplored is the efficacy of different vaccines technologies (mRNA and Adenovirus) in providing passive immunity to infants through breastmilk of vaccinated mothers, and whether the antibodies passed through breast milk are functional. In this study, using a Micro-neutralization assay, we evaluate the presence of neutralizing antibodies in breast milk of lactating mothers vaccinated against SARS-CoV-2 with the Pfizer-BioNtech, Johnson & Johnson (J&J)/Janssen, and CanSino Biologics vaccines. Our results show the greatest neutralizing effect in breast milk from mothers vaccinated with Pfizer, followed by mothers vaccinated with J&J. CanSino vaccinations yielded the breast milk with the least neutralizing effects. The results found in this study relating to the neutralizing capacity of breast milk against SARS-CoV-2 highlight the importance of corresponding health authorities recommending vaccination to lactating mothers and of the continuance of breastfeeding to infants due to the potential health benefits.

USA Vs Europe: Who Is Leading the Diabetes Tech Race?

PURPOSE OF REVIEW: To highlight global advancements in diabetes technology and compare available technologies and device approval processes in the USA and Europe and their impact on safety and innovation. RECENT FINDINGS: The last two decades have seen a rapid growth in diabetes technology driven by the impetus to improve glycemic control, avoid complications of insulin therapy, improve quality of life, and hand more autonomy to individuals with diabetes. Meanwhile, changes to regulatory processes in the USA and Europe aim to facilitate entry of new devices into the marketplace. Major strides have been made in digitization of insulin pens, continuous glucose monitors and their integration with insulin pumps, automated insulin delivery systems, and closed-loop insulin pump systems. The centralized regulatory body in the USA and more decentralized approval bodies in Europe have led to differences in the rate of market availability of diabetes devices. While both US and Europe systems have different advantages and disadvantages in device approval, they continue to struggle with balancing accelerated device access with adequate clinical evidence and monitoring to ensure safety of such devices.

Stunting Is Preceded by Intestinal Mucosal Damage and Microbiome Changes and Is Associated with Systemic Inflammation in a Cohort of Peruvian Infants.

Stunting, defined as height-for-age Z score equal to or lower than -2, is associated with increased childhood mortality, cognitive impairment, and chronic diseases. The aim of the study was to investigate the relationship between linear growth, intestinal damage, and systemic inflammation in infants at risk of stunting. We followed up 78 infants aged 5-12 months living in rural areas of Peru for 6 months. Blood samples for biomarkers of intestinal damage (intestinal fatty-acid-binding protein [I-FABP] and zonulin) and systemic inflammation (interleukin-1ß, interleukin-6, tumor necrosis factor α [TNF-α], soluble CD14, and lipopolysaccharide-binding protein [LBP]) and fecal samples for microbiome analysis were collected at baseline and closure of the study. The children's growth and health status were monitored through biweekly home visits by trained staff. Twenty-one percent of the children became stunted: compared with non-stunted children, they had worse nutritional parameters and higher levels of serum I-FABP at baseline. The likelihood of becoming stunted was strongly associated with an increase in sCD14 over time; LBP and TNF-α showed a trend toward increase in stunted children but not in controls. The fecal microbiota composition of stunted children had an increased beta diversity compared with that of healthy controls throughout the study. The relative abundance of Ruminococcus 1 and 2, Clostridium sensu stricto, and Collinsella increased in children becoming stunted but not in controls, whereas Providencia abundance decreased. In conclusion, stunting in our population was preceded by an increase in markers of enterocyte turnover and differences in the fecal microbiota and was associated with increasing levels of systemic inflammation markers.

Primary CNS Lymphoma Arising from the 4th Ventricle: A Case Report and Review of the Literature.

A 65-year-old male with a history of ischemic strokes, seizures, and subarachnoid hemorrhage presented with a 4-week history of progressive diplopia, vertigo, nausea, and vomiting. Magnetic resonance imaging (MRI) revealed a 2.5 × 1.8 × 1.7 cm posterior fossa mass arising from the roof of the 4th ventricle extending into the cerebellar vermis. Posterior fossa craniotomy with stereotactic biopsy confirmed a locally invasive diffuse large B-cell lymphoma (DLBCL). Primary central nervous system lymphoma (PCNSL) arising from the 4th ventricle is a rare extranodal manifestation of non-Hodgkin lymphoma (NHL), with few cases documented in the literature. Review of available cases lends support that lymphoma arising from the 4th ventricle has a variable clinical presentation, occurs most commonly in immunocompetent males, and should be on the differential of any immunocompetent adult presenting with a posterior fossa mass. Optimal treatment modalities are based largely on phase 2 clinical trials, and recommended guidelines regardless of anatomic location should be adhered to.

Gastric Siderosis and Ulceration from Intravenous Iron Supplementation Manifesting as Chronic Upper Gastrointestinal Bleeding: A Case Report and Review of the Literature.

Iron deficiency is the most common etiology of anemia worldwide and is often managed with varying methods of iron supplementation. Although rare, oral iron supplementation can perpetuate iron deficiency anemia by causing gastric ulceration and upper gastrointestinal bleeding in high-risk populations. However, this complication has not been previously described with intravenous iron supplementation. We present a case of a 63-year-old male with severe iron deficiency anemia on biweekly intravenous iron infusions and weekly packed red blood cell transfusions who presented with melena over several months. Upper endoscopy demonstrated a clean-based gastric body ulcer and nonbleeding gastric varices. Histology of the gastric ulcer was suggestive of iron-induced gastric mucosal injury. This case demonstrates that frequent utilization of intravenous iron and packed red blood cell transfusions may predispose certain patients to the development of iron-induced gastritis and ulceration.

Autosplenectomy in a Patient with Paroxysmal Nocturnal Hemoglobinuria (PNH).

Autosplenectomy (AS) is a known complication of diseases such as sickle cell anemia, celiac disease, and inflammatory bowel disease. We report the first known case of AS due to paroxysmal nocturnal hemoglobinuria (PNH). A 24-year-old Caucasian male had evidence of hemolytic anemia at the age of 14 and was diagnosed with PNH at the age of 16. He had recurrent episodes of sepsis due to dialysis line infections from poor hygiene, and blood cultures had been positive for multiple organisms including Staphylococcus aureus, Enterococcus faecalis, and Streptococcus pneumoniae. The patient's peripheral blood smears since the age of 14 years demonstrated Howell-Jolly bodies in conjunction with thrombocytopenia and hemolytic anemia, but abdominal ultrasonography reported a normal appearing spleen. The patient presented with septicemia two years after starting eculizumab, and his peripheral blood smear showed extensive Howell-Jolly bodies, Pappenheimer bodies, acanthocytes, and target cells. Splenic ultrasonography demonstrated an atrophic spleen with multifocal scarring, and absent splenic uptake of liver-spleen scintigraphy, consistent with AS. Clinicians should remain vigilant of the potential sequelae of PNH and consider the possibility of the development of AS.

Diarrheagenic Escherichia coli: Prevalence and Pathotype Distribution in Children from Peruvian Rural Communities.

Diarrheagenic Escherichia coli (DEC) are common pathogens of childhood gastrointestinal infections worldwide. To date, research tracking DEC has mainly been completed in urban areas. This study aims to determine the prevalence and pathotype distribution of DEC strains in children from rural Peruvian communities and to establish their association with malnutrition. In this prospective cohort, 93 children aged 6-13 months from rural communities of Urubamba (Andes) and Moyobamba (jungle) were followed for 6 months. Diarrheal and control stool samples were analyzed using multiplex real-time polymerase chain reaction to identify the presence of virulence genes of DEC strains. The overall isolation rate of DEC was 43.0% (352/820). Enteroaggregative E. coli (EAEC, 20.4%), enteropathogenic E. coli (EPEC, 14.2%), and diffusely aggregative E. coli (DAEC, 11.0%) were the most prevalent pathotypes. EAEC was more frequently found in Moyobamba samples (P < 0.01). EPEC was the only strain significantly more frequent in diarrheal than asymptomatic control samples (P < 0.01). DEC strains were more prevalent among younger children (aged 6-12 months, P < 0.05). A decline in height-for-age Z-score (HAZ) was observed in 75.7% of children overall. EAEC was more frequently isolated among children who had a greater HAZ decline (P < 0.05). In conclusion, DEC strains were frequently found in stool samples from children in rural communities of the highlands and jungle of Peru. In addition, children with a greater decline in their growth rate had higher EAEC isolation rates, highlighting the importance of this pathogen in child malnutrition.

Genotipificación del virus del papiloma humano en mujeres que asisten a un hospital gineco-obstétrico de tercer nivel de la Ciudad de México / Genotyping of human papillomavirus in women attending a third-level of gynecological-obstetric hospital in Mexico City

Objetivo: Determinar la frecuencia de infección por el virus del papiloma humano en pacientes que acudieron a un hospital de tercer nivel de atención en la Ciudad de México. Método: Se realizó un estudio prospectivo, transversal y descriptivo que incluyó 65 mujeres entre 15 a 46 años que asistieron a consulta para atención gineco-obstétrica. A todas las participantes se les tomó una muestra cervical para la detección/genotipificación del papiloma virus mediante la prueba Linear Array HPV Genotyping Test in vitro® (Roche Molecular Systems, Inc., Branchburg, NJ). Resultados: Un total de 36 (55,4%) pacientes resultaron positivas al virus, en las que se identificaron 65 genotipos virales tanto en infección única (38,9%) como en infección por múltiples (61,1%) genotipos. El 29,2% de los genotipos identificados, fueron de alto riesgo. Los genotipos de alto riesgo más frecuentes fueron: VPH52 y 51; mientras que los genotipos de bajo riesgo más comunes fueron: VPH6 y 53. Un tercio de las pacientes con infección mostraron al menos un genotipo de alto riesgo. Conclusión: En este estudio, se observó una frecuencia relativamente baja de genotipos de alto riesgo del virus del papiloma humano, sin embargo se identificó un porcentaje importante de co-infección por múltiples genotipos. Por esta razón, se considera necesario dar seguimiento a mediano y largo plazo para monitorear la evolución de la infección.

Objective: To identify which are the most frequent genotypes of human papilloma virus among a group of gynecologic-obstetric patients at tertiary care hospital in Mexico City. Method: A prospective and descriptive cross-sectional study was carried out among a group of 65 women, aged 15-46 years, receiving gynecological-obstetric care. Cervical specimens were taken from all participants for direct HPV detection/ genotyping by means of a Linear Array HPV Genotyping Test in vitro® (Roche Molecular Systems, Inc., Branchburg, NJ). Results: Virus detection was achieved in 36 patients (55.4%), with a total of 65 genotypes, either as single (38.9%) or multiple-genotype (61.1%) infections. High risk genotypes accounted for only 29.2% of all genotype. The most frequent high risk genotypes were HPV52 and 51, while HPV6 and 53 were the most frequent low risk ones. At least one high risk genotype was present in one third of infected patients. Conclusion: The relative low frequency of oncogenic human papilloma virus genotypes among the women in this study was observed, however a significant percentage of co-infection with multiple genotypes were identified. Thus, mid- to long-term follow up might be necessary for those patients to monitor the evolution of the infection.

Enfermedad de Paget extensa de la vulva: Presentación de un caso y propuesta de manejo conservador / Extensive Paget's disease of the vulva: Case report and a conservative management proposal

La enfermedad de Paget extramamaria (EPE) es una patología maligna observada, sobre todo, en áreas donde existe alta densidad de glándulas apocrinas. Presentamos el caso clínico de una paciente de 68 años de edad, atendida en la Clínica de Colposcopia del Servicio de Oncología, del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, con diagnóstico de enfermedad de Paget a nivel vulvar, vagina, región de periné y región perianal, manejada con sesiones de vaporización con láser, con evolución satisfactoria. Dado que es una enfermedad poco frecuente, más común en el sexo femenino y en la raza blanca, con mayor incidencia en la séptima década de la vida, como es el caso de nuestra paciente, el objetivo de este trabajo es presentar una revisión de la evaluación clínica, haciendo énfasis en el diagnóstico diferencial, uso de colposcopia para diagnóstico y tratamiento conservador fraccionado con vaporización de láser. La baja incidencia de la enfermedad de Paget de la vulva, vagina, periné y región perianal, así como la ausencia de informes sobre la posibilidad de tratamiento no quirúrgico, motivan a informar a la comunidad científica sobre el manejo con vaporización láser, con la intención de evitar la morbilidad que puede traer consigo el manejo quirúrgico convencional.

Extramammary Paget's disease (EPD) is a malignant disease observed, especially in areas with high density of apocrine glands. We report a case of a patient of 68 years old, attended at the Colposcopy Clinic of Oncology, National Institute of Perinatology Isidro Espinosa de los Reyes, diagnosed with Paget's disease of the vulva, vagina, perineum region and perianal region, and managed with laser vaporization sessions with satisfactory outcome. Since it is a rare disease, more common in females and in whites, with the highest incidence in the seventh decade of life, as is the case of our patient, propose in this paper to present a review of the clinical evaluation with emphasis on the differential diagnosis, use of colposcopy for diagnosis and dividing up conservative treatment with laser vaporization of the disease. The low incidence of Paget's disease of the vulva, vagina, perineum and perianal region, and the absence of reports on the possibility of nonsurgical treatment encouraged to inform the scientific community about the management with laser vaporization, with the intention of avoiding morbidity that can lead to the conventional surgical maneuvers.

Tumor phyllodes / Phyllodes tumours

El tumor phyllodes es una neoplasia fibroepitelial rara; constituye el 0.3 al 0.9% de tumores de mama y 2-3% de los tumores fibroepiteliales de mama. Puede presentarse a cualquier edad y no hay características confiables para predecir su comportamiento clínico. Se deben evaluar varios parámetros, incluyendo la celularidad estromal, atipia, mitosis, crecimiento estromal excesivo, infiltración de bordes y presencia o ausencia de necrosis. La mayor parte de estos tumores son benignos, pero hasta 30% pueden presentar tejido conectivo maligno. Las metástasis generalmente son hematógenas más que linfáticas y se presentan en un 13% de los casos. La disección de ganglios axilares generalmente no se recomienda. El tumor phyllodes benigno y maligno recurre de manera local en el 25%, por lo que se recomienda el seguimiento de los casos.

Phyllodes tumors is a rare fibroepithelial neoplasm; constitute about 0.3-0.9% of breast tumors and 2-3% of fibroepithelial breast tumors. They usually occur in middle-aged to elderly women but can occur at any age. No single feature is reliable to predict clinical behavior of phyllodes tumors. Several histological parameters should be evaluated, including stromal cellularity, atypia, mitoses, stromal overgrowth, infiltrative borders, and presence or absence of necrosis. Most of these tumors are benign, but up to 30% show malignant stroma. Metastases usually are hematogenous rather than lymphatic have been reported to occur at a rate of 13% as malignant phyllodes tumors usually spread by a hematogenous rather than a lymphatic route; axillary lymph node dissection is generally not recommended. The benign and malignant tumors phyllodes resort locally in 25% and follow up of patients is recomended.

[Conservative treatment of endometrial cancer as a way to preserve fertility. Five-year experience at Instituto Nacional de Perinatilogía Isidro Espinoza de los Reyes]. / Tratamiento conservador del cáncer de endometrio como una opción para preservar la fertilidad. Experiencia de cinco años en el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes.

BACKGROUND: Progestins have been used in the treatment of advanced and metastatic endometrial cancer since the early 1960s. There is evidence that progestins can be used in fertility-preserving treatments in young women diagnosed with well-differentiated clinical stage 1A(EC1A) endometrioid type endometrial carcinoma. OBJECTIVE: Describe a fertility preservation treatment in women with primary infertility and EC1A endometrioid type endometrial carcinoma. PATIENTS AND METHODS: A historical cohort study. We analyzed 6 cases of women under 35 years assisted at the Oncology and Reproductive Medicine Department of the Instituto Nacional de Perinatologia of Mexico who met our inclusion criteria. Five women were treated with 500 mg medroxyprogesterone acetate (MPA) every other day; one woman was treated with 40 mg/day megestrol acetate (MGA). The treatment was continued to a maximum period of 11 months, provided that women gave good response to the treatment. The change in endometrial histology was assessed at four and six months of treatment. The primary endpoint was pathological complete response (CR). RESULTS: Follow-up time averaged 31 months; 66.6% of women responded to the initial hormone treatment; the remaining 33.4% responded to a second period of progesterone with histology in endometrial biopsy negative for cancer. Average response time was 6.8 months. Two patients had recurrence at an average of 19.5 months. Endometrial routine was performed with a disease-free interval of 15 to 24 months during which assisted reproductive technologies (ART) could be applied. Two patients achieved full-term pregnancy thanks to ART. The remaining patients did not continue with ART on their own initiative. CONCLUSIONS: In young women diagnosed with well-differentiated endometrioid EC1A carcinoma, the fertility-preserving treatment with progestin may be proposed together with strict selection and close monitoring of the patient.

[Hormone therapy effect in postmenopausal women with history of endometrial cancer]. / Efecto de la terapia hormonal en mujeres posmenopáusicas con antecedente de cáncer de endometrio.

BACKGROUND: The increase of endometrial cancer survivors' incidence let the question if the management of postmenopausal hormone therapy will increase the risk of carcinogenesis. OBJECTIVE: To determine the recurrence rate, in postmenopausal patients managed with hormonal therapy (HT) compared with patients without HT treated in El Instituto Nacional de Perinatologia Isidro Espinosa de los Reyes. PATIENTS AND METHOD: Retrospective, analytical, historical cohort. We analyzed 29 patients who met the inclusion criteria from January 1, 2000 to December 31, 2008 RESULTS: The average age for diagnosis of endometrial cancer was 45 years. 100% of the patients had surgical treatment (82.8% routine endometrial open approach, laparoscopic 17.2%). The 93% of patients had criteria to begin HT, however, was administered alone to 37% due to medical criteria, 36% received tibolona, 64% received estrogen with an average administration time of 39 and 54 months for each one without affecting disease-free period. Patients who received hormonal therapy had no recurrence of disease-free period of 58 months. There was only one patient with recurrence for which no hormonal therapy was administered. CONCLUSIONS: Patients who were under hormonal therapy did not modify the rate of endometrial cancer recurrence compared with those without HT. Although we cannot conclude irrefutably the safety of hormone therapy, based on biological knowledge and the results of this study, hormone therapy can be safely administered in stage I and II.

[Adnexal tumor and pregnancy: diagnosis and treatment]. / Tumor anexial y embarazo: diagnóstico y tratamiento.

BACKGROUND: The finding of adnexal masses during pregnancy is an exceptional event. Its reported incidence is less than 5% and most cases resolve spontaneously as the pregnancy progresses. OBJECTIVE: Describe a case series of patients with adnexal mass and pregnancy. MATERIAL AND METHODS: We retrospectively reviewed the medical records of patients who had diagnosis of pregnancy and adnexal over a period of five years. RESULTS: The incidence was 0.22%. The mean age was 26 +/- 7.3 years, mean gestational age was 17 +/- 6.6 weeks. The diagnosis was established by ultrasound (USG) in 95% of cases, 48% had cystic characteristics, the mean diameter of the tumor was 99 +/- 42 mm. Cistectomy was performed during pregnancy or trans-cesarean section in 30% and 58% of patients respectably. The mean tumor size was 118 mm (range 2 a 40 mm), weight 1,370 g (range 10 a 5,800 g). The most frequent histological diagnosis were serous cyst (40%), mature teratoma (28%), mucinous (6%), malignancy (4%). There were not complications related to the surgical procedure. CONCLUSIONS: The USG constitute a safe method for the diagnosis, but the image method with the highest positive predictive value is the MRI. Tumor markers (CA-125, AFP, GCH-B,DHL, ACE), are not useful during pregnancy. If the tumor doesn't achieve surgical criteria the recommended follow up is clinical observation and USG. If surgery is decided, it should be performed between 16 a 23 weeks of pregnancy, and it's recommended to send the tumor to histological diagnosis, in case of malignancy the surgery will continue according to the tumor stage. The time and delivery route will be decided by the obstetrician.

Illness perception in eating disorders and psychosocial adaptation.

OBJECTIVE: The current study is based on the framework of the Self-Regulatory Model of Illness (SRM). The aim of this work was to examine perception of illness in eating disorder (ED) patients and investigate whether illness perception is related to psychosocial adaptation in these patients. METHOD: A total of 98 female ED patients completed the specific eating disorders Spanish version of the Revised Illness Perception Questionnaire (IPQ-R) and a range of adjustment variables including the Psychosocial Adjustment to Illness Scale (PAIS) and the Hospital Anxiety and Depression Scale (HAD). RESULTS: ED patients reported a moderate number of physical symptoms, and perceived their illness as controllable, treatable, highly distressing, as a chronic condition and with serious consequences. Emotional representation was the most significant dimension related to emotional adjustment. Illness identity and cure dimensions were the most significant dimensions associated with psychosocial adaptation. CONCLUSION: This study shows that patients' illness perceptions are related to illness adaptation. Illness identity was associated with emotional and psychosocial adjustment, and having faith that treatment may control the illness was related to positive benefits for ED. These results suggest that a psychological intervention, which addresses patients' illness representations, may assist in their adjustment to ED.