Knowledge, attitude and adherence of Spanish healthcare professionals to asthma management recommendations during pregnancy

Background: The aim of the present study was to evaluate the knowledge, attitude and adherence to asthma management recommendations during pregnancy of Spanish health care professionals. Methods: A multiple choice survey with 14 questions was designed. Items assessed opinion about asthma guidelines and attitudes towards treatment, spirometry, specific immunotherapy and labour in pregnant asthmatic patients. Test completion was voluntary, individual, and anonymous. Results: A total of 1000 questionnaires were fulfilled: respiratory medicine specialists (19.8%); allergy specialists (17.2%); primary care physicians (46.1%); and gynaecologists/obstetricians (16.9%). Guidelines were considered useful by 96.5% although 64% admitted that they followed them seldom or never. Most physicians (55.9%) answered that they would maintain asthma therapy in clinically stable patients. Almost 30% of physicians would not perform spirometry in pregnant asthma patients. 19% declared they would interrupt specific immunotherapy which had proven safe and effective. Univariate analysis revealed low adherence to be associated with the following variables: age, primary care or gynaecology/obstetrician specialisation, number of asthmatics attended per month, and declared use of guidelines for pregnant asthmatic patients. Multivariate analysis showed that being a primary care physician and a gynaecologist/obstetrician, attending a low number of asthma patients per month, and poor use of spirometry during pregnancy are associated to low adherence to asthma guidelines. Conclusion: Even though the majority of Spanish physicians surveyed seem to consider guidelines useful, their adherence to those is very low if translated to managing pregnant asthmatic patients. Educational strategies seem unavoidable and should be targetted mainly to primary care and gynaecology/obstetrician physicians(AU)

Knowledge, attitude and adherence of Spanish healthcare professionals to asthma management recommendations during pregnancy.

BACKGROUND: The aim of the present study was to evaluate the knowledge, attitude and adherence to asthma management recommendations during pregnancy of Spanish health care professionals. METHODS: A multiple choice survey with 14 questions was designed. Items assessed opinion about asthma guidelines and attitudes towards treatment, spirometry, specific immunotherapy and labour in pregnant asthmatic patients. Test completion was voluntary, individual, and anonymous. RESULTS: A total of 1000 questionnaires were fulfilled: respiratory medicine specialists (19.8%); allergy specialists (17.2%); primary care physicians (46.1%); and gynaecologists/obstetricians (16.9%). Guidelines were considered useful by 96.5% although 64% admitted that they followed them seldom or never. Most physicians (55.9%) answered that they would maintain asthma therapy in clinically stable patients. Almost 30% of physicians would not perform spirometry in pregnant asthma patients. 19% declared they would interrupt specific immunotherapy which had proven safe and effective. Univariate analysis revealed low adherence to be associated with the following variables: age, primary care or gynaecology/obstetrician specialisation, number of asthmatics attended per month, and declared use of guidelines for pregnant asthmatic patients. Multivariate analysis showed that being a primary care physician and a gynaecologist/obstetrician, attending a low number of asthma patients per month, and poor use of spirometry during pregnancy are associated to low adherence to asthma guidelines. CONCLUSION: Even though the majority of Spanish physicians surveyed seem to consider guidelines useful, their adherence to those is very low if translated to managing pregnant asthmatic patients. Educational strategies seem unavoidable and should be targetted mainly to primary care and gynaecology/obstetrician physicians.

Embarazo ectópico cervical. Tratamiento médico conservador / Cervical ectopic pregnancy. Conservative medical treatment

Objetivo: La gestación cervical es una rara complicación con unas graves consecuencias si no se diagnostica y trata precozmente; por tanto, es un evento en el que siempre se debería pensar ante toda hemorragia vaginal en el primer trimestre. Método: Se presenta un caso de una gestante a la que se le detectó un embarazo ectópico cervical en la sexta semana de gestación; tras su ingreso fueron necesarias 3 dosis de metotrexato intramuscular. Después de éstas, la situación se resolvió clínica (expulsión del saco gestacional) y bioquímicamente (descenso de los valores de gonadotropina coriónica humana). Conclusión: Esta grave e infrecuente circunstancia (ectópico cervical) se puede resolver de una manera conservadora sin necesidad de recurrir a terapias más agresivas, manteniendo la paciente su fertilidad conservada

Objective: Cervical ectopic pregnancy is a rare complication that can have severe consequences if an early diagnosis is not made. This diagnosis should always be considered in vaginal bleeding in the first trimester of pregnancy. Method: We present a case of cervical ectopic pregnancy diagnosed in the sixth week of gestation. Three doses of methotrexate resolved the situation clinically (expulsion of the gestational sac) and biochemically (decreased â-human chorionic gonadotrophin levels). Conclusion: Cervical ectopic pregnancy is a serious and infrequent entity that can be resolved by conservative medical therapy that maintains the patient's fertility and avoids the need to resort to more aggressive treatment

Diagnóstico prenatal del corazón univentricular / Prenatal diagnosis of univentricular heart

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Systemic to pulmonary fistulas in Hodgkin's disease.

Systemic to pulmonary fistula is an unusual entity and its association with hematological diseases like Hodgkin's is extremely rare. We present a case of a 26-year-old woman with a thoracic mass and large arteriovenous fistula. The diagnosis of Hodgkin's disease, nodular sclerosis, was obtained by a biopsy of the supraclavicular lymph node. We achieved an excellent response after combined treatment with chemotherapy, radiotherapy and arterial embolization with complete disappearance of the mass.