Neuroinvasive disease due to West Nile virus: Clinical and imaging findings associated with a re-emerging pathogen.

The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.

The Johns Hopkins University Center for Systems Science and Engineering COVID-19 Dashboard: data collection process, challenges faced, and lessons learned.

On Jan 22, 2020, a day after the USA reported its first COVID-19 case, the Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE) launched the first global real-time coronavirus surveillance system: the JHU CSSE COVID-19 Dashboard. As of June 1, 2022, the dashboard has served the global audience for more than 30 consecutive months, totalling over 226 billion feature layer requests and 3·6 billion page views. The highest daily record was set on March 29, 2020, with more than 4·6 billion requests and over 69 million views. This Personal View reveals the fundamental technical details of the entire data system underlying the dashboard, including data collection, data fusion logic, data curation and sharing, anomaly detection, data corrections, and the human resources required to support such an effort. The Personal View also covers the challenges, ranging from data visualisation to reporting standardisation. The details presented here help develop a framework for future, large-scale public health-related data collection and reporting.

Enfermedad neuroinvasiva por el virus del Nilo Occidental: características clínicas y en neuroimagen de un patógeno reemergente / Neuroinvasive disease due to West Nile virus: clinical and imaging findings associated with a re-emerging pathogen

El virus del Nilo Occidental es un arbovirus que puede infectar al ser humano y causar una enfermedad neuroinvasiva grave. Tomando como referencia el brote que tuvo lugar en España en 2020, se ha realizado una revisión clínica y de neuroimagen de dicha patología. Para ello, se han recogido datos demográficos, clínicos, analíticos y pruebas de imagen (tomografía computarizada y resonancia magnética) de 30 pacientes diagnosticados de infección por virus del Nilo Occidental en nuestro centro. Las principales manifestaciones clínicas fueron fiebre, cefalea y alteración del nivel de conciencia. Los estudios de neuroimagen, especialmente la resonancia, son de gran importancia para el diagnóstico y seguimiento. Los hallazgos más frecuentes fueron focos de aumento de señal en T2 en el tálamo y tronco del encéfalo, que ilustramos en esta revisión con casos de nuestro centro hospitalario.(AU)

The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.(AU)

Effect of Androgen Suppression on Clinical Outcomes in Hospitalized Men With COVID-19: The HITCH Randomized Clinical Trial.

Importance: SARS-CoV-2 entry requires the TMPRSS2 cell surface protease. Antiandrogen therapies reduce expression of TMPRSS2. Objective: To determine if temporary androgen suppression induced by degarelix improves clinical outcomes of inpatients hospitalized with COVID-19. Design, Setting, and Participants: The Hormonal Intervention for the Treatment in Veterans With COVID-19 Requiring Hospitalization (HITCH) phase 2, placebo-controlled, double-blind, randomized clinical trial compared efficacy of degarelix plus standard care vs placebo plus standard care on clinical outcomes in men hospitalized with COVID-19 but not requiring invasive mechanical ventilation. Inpatients were enrolled at 14 Department of Veterans Affairs hospitals from July 22, 2020, to April 8, 2021. Data were analyzed from August 9 to October 15, 2021. Interventions: Patients stratified by age, history of hypertension, and disease severity were centrally randomized 2:1 to degarelix, (1-time subcutaneous dose of 240 mg) or a saline placebo. Standard care included but was not limited to supplemental oxygen, antibiotics, vasopressor support, peritoneal dialysis or hemodialysis, intravenous fluids, remdesivir, convalescent plasma, and dexamethasone. Main Outcomes and Measures: The composite primary end point was mortality, ongoing need for hospitalization, or requirement for mechanical ventilation at day 15 after randomization. Secondary end points were time to clinical improvement, inpatient mortality, length of hospitalization, duration of mechanical ventilation, time to achieve a temperature within reference range, maximum severity of COVID-19, and the composite end point at 30 days. Results: The trial was stopped for futility after the planned interim analysis, at which time there were 96 evaluable patients, including 62 patients randomized to the degarelix group and 34 patients in the placebo group, out of 198 initially planned. The median (range) age was 70.5 (48-85) years. Common comorbidities included chronic obstructive pulmonary disorder (15 patients [15.6%]), hypertension (75 patients [78.1%]), cardiovascular disease (27 patients [28.1%]), asthma (12 patients [12.5%]), diabetes (49 patients [51.0%]), and chronic respiratory failure requiring supplemental oxygen at baseline prior to COVID-19 (9 patients [9.4%]). For the primary end point, there was no significant difference between the degarelix and placebo groups (19 patients [30.6%] vs 9 patients [26.5%]; P = .67). Similarly, no differences were observed between degarelix and placebo groups in any secondary end points, including inpatient mortality (11 patients [17.7%] vs 6 patients [17.6%]) or all-cause mortality (11 patients [17.7%] vs 7 patents [20.6%]). There were no differences between degarelix and placebo groups in the overall rates of adverse events (13 patients [21.0%] vs 8 patients [23.5%) and serious adverse events (19 patients [30.6%] vs 13 patients [32.4%]), nor unexpected safety concerns. Conclusions and Relevance: In this randomized clinical trial of androgen suppression vs placebo and usual care for men hospitalized with COVID-19, degarelix did not result in amelioration of COVID-19 severity. Trial Registration: ClinicalTrials.gov Identifier: NCT04397718.

Neuroinvasive disease due to West Nile virus: clinical and imaging findings associated with a re-emerging pathogen. / Enfermedad neuroinvasiva por el virus del Nilo Occidental: características clínicas y en neuroimagen de un patógeno reemergente.

The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.

Tratamiento del cáncer de próstata y cáncer renal con fármacos orales (abiraterona y antiangiogénicos): posicionamiento de la Asociación Española de Urología / Treatment of prostate and renal cancer with oral drugs (abiratarone and antiangiogenic agents): Positioning statement from the Spanish Association of Urology

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Increased 2-hydroxylation of estrogen is associated with lower body fat and increased lean body mass in postmenopausal women.

Menopause is associated with changes in bone, muscle and fat mass. The importance of postmenopausal estrogen metabolism in bone health has been established. However, its relationship to body composition in postmenopausal women remains undetermined. The objective of this study is to determine the association between estrogen metabolism and body composition in postmenopausal women. This is a cross sectional study of 97 postmenopausal Caucasian women, 49-80 y.o., ≥1 year from the last normal menstrual period or those who have had oophorectomy. Inactive [2-hydroxyestrone (2OHE(1))] and active [16α-hydroxyestrone (16α-OHE(1))] urinary metabolites of estrogen were measured by ELISA. The whole and regional body composition was measured by DXA. We have found that both 2OHE(1), and 2OHE(1)/16α-OHE(1) ratio were negatively correlated with % total fat, and % truncal fat but positively correlated with % total lean mass. Comparing the fat and lean parameters of body composition according to tertiles of 2OHE(1) and 2OHE(1)/16αOHE(1) ratio showed that subjects in the lowest tertiles, had the highest % total fat, and % truncal fat and the lowest % total lean mass. Multiple regression analysis also showed 2OHE(1) and calcium intake as statistically significant predictors of all body composition parameters. In conclusion, in postmenopausal women, an increase in the metabolism of estrogen towards the inactive metabolites is associated with lower body fat and higher lean mass than those with predominance of the metabolism towards the active metabolites.

Sepsis puerperal tardía con shock séptico y disfunción cardiaca / Late-onset postpartum sepsis with septic shock and heart dysfunction

Presentamos el caso de una mujer de raza blanca de 37 años con diagnóstico de sepsis puerperal tardía por endometritis causada por estreptococo del grupo A (SGA) y shock séptico con insuficiencia mitral y disfunción cardiaca. La instauración precoz de antibioterapia de amplio espectro y soporte hemodinámico fue fundamental para la evolución favorable de la paciente. Debido al resurgir de cepas virulentas de SGA y las consecuencias fatales que pueden llegar a desencadenar, es importante incluir este microorganismo en el diagnóstico diferencial de las infecciones maternas relacionadas con el puerperio. La afectación cardiaca es poco frecuente en el contexto de infección por este microorganismo, sin embargo ante una sepsis con mala evolución el diagnóstico con ecocardiografía parece imprescindible para descartar disfunción cardiaca(AU)

We report a case of late-onset postpartum sepsis from endometritis due to group A streptococci (GAS) in a 37-year-old white woman. The patient developed septic shock, with mitral regurgitation and cardiac dysfunction. Early treatment with broad-spectrum antibiotics and hemodynamic support was essential for a favorable outcome. Because of the resurgence of virulent strains of GAS that can cause fatal infections, these pathogens should be included in the differential diagnosis of postpartum infections in the mother. Although cardiac dysfunction is rare in association with GAS infection, it should be ruled out by echocardiography when the condition of a patient with sepsis does not improve(AU)

Cosmovisión ancestral y comprensión de los conceptos salud, cuidado y enfermería en habitantes del resguardo muisca de Chía, 2010 / Ancestral worldview and understanding of the concepts of health, care and nursing in the population of a muisca reservation in Chía, 2010

El reconocimiento, fortalecimiento y recuperación de prácticas de cuidado en culturas diversas favorece la calidad de las acciones de enfermería; el Enfoque Biopsicosocial, cultural y espiritual y la teoría Transcultural aportan a este objetivo y sirven de soporte al diseño de estrategias orientadas a preservar, adaptar y reestructurar los cuidados culturales; acciones que desde la comprensión de la salud en este grupo, se propone sean lideradas por el profesional de enfermería. La investigación descriptiva cualitativa contó con la participación voluntaria de familias y líderes muiscas reconocidos como cuidadores por la comunidad; se presenta como abordaje metodológico que posibilita reconocer la comprensión actual de los conceptos salud, cuidado y enfermería. La información recolectada mediante la observación, encuestas y entrevistas, en las categorías enunciadas, se analizó por triangulación de fuentes y de investigadores. Se identificó un marcado proceso de aculturación en las tres categorías analizadas: el concepto “cuidado” guarda mayor proximidad con la cosmovisión ancestral; la comprensión de la salud no incorpora dimensiones reconocidas ancestralmente; y, la enfermería se identifica como un “quehacer” propio del género femenino que articula las dimensiones comunicacional, afectiva y de protección próximas a lo descrito como cuidado por los líderes en salud ancestrales.

[Late-onset postpartum sepsis with septic shock and heart dysfunction]. / Sepsis puerperal tardía con shock séptico y disfunción cardiaca.

We report a case of late-onset postpartum sepsis from endometritis due to group A streptococci (GAS) in a 37-year-old white woman. The patient developed septic shock, with mitral regurgitation and cardiac dysfunction. Early treatment with broad-spectrum antibiotics and hemodynamic support was essential for a favorable outcome. Because of the resurgence of virulent strains of GAS that can cause fatal infections, these pathogens should be included in the differential diagnosis of postpartum infections in the mother. Although cardiac dysfunction is rare in association with GAS infection, it should be ruled out by echocardiography when the condition of a patient with sepsis does not improve.

Sepsis puerperal tardía con shock séptico y disfunción cardiaca / Late-onset postpartum sepsis with septic shock and heart dysfunction

Presentamos el caso de una mujer de raza blanca de 37 años con diagnóstico de sepsis puerperal tardía por endometritis causada por estreptococo del grupo A (SGA) y shock séptico con insuficiencia mitral y disfunción cardiaca. La instauración precoz de antibioterapia de amplio espectro y soporte hemodinámico fue fundamental para la evolución favorable de la paciente. Debido al resurgir de cepas virulentas de SGA y las consecuencias fatales que pueden llegar a desencadenar, es importante incluir este microorganismo en el diagnóstico diferencial de las infecciones maternas relacionadas con el puerperio. La afectación cardiaca es poco frecuente en el contexto de infección por este microorganismo, sin embargo ante una sepsis con mala evolución el diagnóstico con ecocardiografía parece imprescindible para descartar disfunción cardiaca(AU)

We report a case of late-onset postpartum sepsis from endometritis due to group A streptococci (GAS) in a 37-year-old white woman. The patient developed septic shock, with mitral regurgitation and cardiac dysfunction. Early treatment with broad-spectrum antibiotics and hemodynamic support was essential for a favorable outcome. Because of the resurgence of virulent strains of GAS that can cause fatal infections, these pathogens should be included in the differential diagnosis of postpartum infections in the mother. Although cardiac dysfunction is rare in association with GAS infection, it should be ruled out by echocardiography when the condition of a patient with sepsis does not improve(AU)

Reduced bone mineral density is not associated with significantly reduced bone quality in men and women practicing long-term calorie restriction with adequate nutrition.

Calorie restriction (CR) reduces bone quantity but not bone quality in rodents. Nothing is known regarding the long-term effects of CR with adequate intake of vitamin and minerals on bone quantity and quality in middle-aged lean individuals. In this study, we evaluated body composition, bone mineral density (BMD), and serum markers of bone turnover and inflammation in 32 volunteers who had been eating a CR diet (approximately 35% less calories than controls) for an average of 6.8 ± 5.2 years (mean age 52.7 ± 10.3 years) and 32 age- and sex-matched sedentary controls eating Western diets (WD). In a subgroup of 10 CR and 10 WD volunteers, we also measured trabecular bone (TB) microarchitecture of the distal radius using high-resolution magnetic resonance imaging. We found that the CR volunteers had significantly lower body mass index than the WD volunteers (18.9 ± 1.2 vs. 26.5 ± 2.2 kg m(-2) ; P = 0.0001). BMD of the lumbar spine (0.870 ± 0.11 vs. 1.138 ± 0.12 g cm(-2) , P = 0.0001) and hip (0.806 ± 0.12 vs. 1.047 ± 0.12 g cm(-2) , P = 0.0001) was also lower in the CR than in the WD group. Serum C-terminal telopeptide and bone-specific alkaline phosphatase concentration were similar between groups, while serum C-reactive protein (0.19 ± 0.26 vs. 1.46 ± 1.56 mg L(-1) , P = 0.0001) was lower in the CR group. Trabecular bone microarchitecture parameters such as the erosion index (0.916 ± 0.087 vs. 0.877 ± 0.088; P = 0.739) and surface-to-curve ratio (10.3 ± 1.4 vs. 12.1 ± 2.1, P = 0.440) were not significantly different between groups. These findings suggest that markedly reduced BMD is not associated with significantly reduced bone quality in middle-aged men and women practicing long-term calorie restriction with adequate nutrition.

[Mortality following cardiac surgery in the National Health Service Hospitals of the Community of Valencia in 2007: a descriptive analysis]. / Análisis descriptivo de mortalidad en cirugía cardiaca en los hospitales públicos de la Comunidad Valenciana en el año 2007.

OBJECTIVE: To analyze clinical records of cardiac surgery patients in an attempt to identify factors associated with mortality in the postoperative critical care units of the public health service hospitals in the Community of Valencia, Spain, in 2007. METHODS: Retrospective study of cases from January 1, 2007 to December 31, 2007. The charts of all patients who underwent cardiac surgery with or without extracorporeal circulation were reviewed. A data collection protocol was followed to obtain information on age, sex, body mass index (BMI), presurgical risk factors, type of surgery, duration of extracorporeal circulation, duration of ischemia, cause of death, and length of stay in the postoperative critical care unit. RESULTS: The study population consisted of 2113 patients at 5 public hospitals; 124 patients (70 men, 54 women) died. The mean (SD) age was 70 (9.43) years (range, 36-91 years). The mean BMI was 28.19 kg/m2 (maximum, 42 kg/m2). The mean Euroscore was 21.92 (maximum, 94.29). Hypertension was present as a preoperative risk factor in most patients (74.2%); dyslipidemia was present in 51.6%, diabetes mellitus in 38.7%, stroke in 73%, and renal failure in 2.4%. It was noteworthy was that the group who underwent coronary revascularization had the highest mortality rate (nearly 35% of the 124 patients). The next highest mortality rate (19.4%) was in patients who had combined procedures (valve repair or substitution plus coronary revascularization). Mortality was 18.5% in the group undergoing aortic valve surgery and 11.3% in those undergoing mitral valve surgery. The mean duration of extracorporeal circulation was 148.63 minutes. The mean duration of myocardial ischemia was 94.91 minutes. The most frequent cause of death was cardiogenic shock (54.8%). This was followed by distributive shock (29.8%) and hemorrhagic shock (8.9%). The mean length of stay in the postoperative critical care unit was 13.6 days. Overall mortality was 5.87%. CONCLUSIONS: The highest mortality rate among cardiac surgery patients in postoperative critical care units in hospitals in the Community of Valencia in 2007 was in patients who underwent coronary revascularization. The most prevalent preoperative risk factor was hypertension. Cardiogenic shock and distributive shock were the most frequent causes of death in these patients. A system for classifying risk is needed in order to predict mortality in critical care units and improve perioperative care.

Análisis descriptivo de mortalidad en cirugía cardiaca en los hospitales públicos de la Comunidad Valenciana en el año 2007 / Mortality following cardiac surgery in the national health service hospitals of the Community of Valencia in 2007: a descriptive analysis

OBJETIVO: Analizar los datos clínicos y tratar de identificarlos factores asociados que pudieran haber influidoen la mortalidad postoperatoria de los pacientes decirugía cardiaca durante su permanencia en la Unidadde Cuidados Críticos de los hospitales de la sanidadpública de la Comunidad Valenciana durante el 2007.MÉTODO: Estudio retrospectivo desde 1 enero de 2007hasta 31 diciembre del 2007. Se revisaron todas las historiasclínicas de los pacientes operados de cirugía cardiacacon y sin circulación extracorpórea y se aplicó unformulario de recogida de datos que permitió obtener lainformación necesaria para determinar edad, sexo, índicede masa corporal, factores de riesgo prequirúrgicos,tipo de intervención quirúrgica realizada, tiempo de circulaciónextracorpórea, tiempo de isquemia, causa demortalidad y tiempo de estancia en la Unidad de CuidadosCríticos.RESULTADOS: En los 5 centros públicos donde se realizacirugía cardiaca la población estudiada fue de 2.113pacientes. El número de pacientes fallecidos fue de 124,de ellos 70 fueron hombres y 54 mujeres. La media deedad fue 70 años (DE 9,43) oscilando entre 36 y 91 años.El valor medio del índice de masa corporal fue de 28,19kg/m2 con un máximo de 42 kg/m2. El valor medio delEuroscore fue de 21,92 con un máximo de 94,29. Entrelos factores de riesgo estudiados la hipertensión arterialestaba presente en la mayoría de los pacientes (74,2%),dislipemia en el 51,6% de los casos, diabetes mellitus enel 38,7%, accidentes cerebrovasculares previos en el7,3% e insuficiencia renal previa a la cirugía en el 2,4%...(AU)

OBJETIVE: To analyze clinical records of cardiacsurgery patients in an attempt to identify factorsassociated with mortality in the postoperative criticalcare units of the public health service hospitals in theCommunity of Valencia, Spain, in 2007.METHODS: Retrospective study of cases from January1, 2007 to December 31, 2007. The charts of all patientswho underwent cardiac surgery with or without miocárdiextracorporealcirculation were reviewed. A datacollection protocol was followed to obtain informationon age, sex, body mass index (BMI), presurgical riskfactors, type of surgery, duration of extracorporealcirculation, duration of ischemia, cause of death, andlength of stay in the postoperative critical care unit.RESULTS: The study population consisted of 2113patients at 5 public hospitals; 124 patients (70 men, 54women) died. The mean (SD) age was 70 (9.43) years(range, 36-91 years). The mean BMI was 28.19 kg/m2(maximum, 42 kg/m2). The mean Euroscore was 21.92(maximum, 94.29). Hypertension was present as apreoperative risk factor in most patients (74.2%);dyslipidemia was present in 51.6%, diabetes mellitus in38.7%, stroke in 7.3%, and renal failure in 2.4%. It wasnoteworthy was that the group who underwent coronaryrevascularization had the highest mortality rate (nearly35% of the 124 patients). The next highest mortality rate(19.4%) was in patients who had combined procedures(valve repair or substitution plus coronaryrevascularization). Mortality was 18.5% in the groupundergoing aortic valve surgery and 11.3% in thoseundergoing mitral valve surgery. The mean duration ofextracorporeal circulation was 148.63 minutes...(AU)

Effects of dietary calcium compared with calcium supplements on estrogen metabolism and bone mineral density.

BACKGROUND: High calcium intake has been associated with both high bone mineral density (BMD) and high urinary estrogen metabolites. However, the role of dietary calcium and calcium supplements on estrogen metabolism and BMD remains unknown. OBJECTIVE: The objective was to investigate the importance of the source of calcium intake on estrogen metabolism and BMD. DESIGN: The average total daily calcium intake from supplements and diet, urinary estrogen metabolites, and spine and proximal femur BMD were studied in 168 healthy postmenopausal white women. RESULTS: Women who obtained calcium primarily from the diet or from both the diet and supplements had significantly (P=0.03) lower ratios of nonestrogenic to estrogenic metabolites (2-hydroxyestrone 1/16 alpha-hydroxyestrone) than did those who obtained calcium primarily from supplements. Adjusted BMD z scores were significantly greater in the subjects who obtained calcium primarily from the diet or from both the diet and supplements than in those who obtained calcium primarily from calcium supplements at the spine (P=0.012), femoral neck (P=0.02), total femur (P=0.003), and intertrochanter (P=0.005). This difference was evident especially in those who obtained calcium primarily from the diet, whose total calcium intake was lower than that in those who obtained calcium primarily from supplements. CONCLUSION: Calcium from dietary sources is associated with a shift in estrogen metabolism toward the active 16 alpha-hydroxyl metabolic pathway and with greater BMD and thus may produce more favorable effects in bone health in postmenopausal women than will calcium from supplements.

Effect of antiretroviral therapy on admissions of HIV-infected patients to an intensive care unit.

OBJECTIVES: To analyse the characteristics of HIV-infected patients admitted to an Intensive Care Unit (ICU) and to compare them in the pre-highly active antiretroviral therapy (HAART) and HAART eras. METHODS: All HIV-infected patients who were admitted to the ICU of our hospital between January 1990 and December 2003 were reviewed. Patients were divided into two groups based on whether they were admitted before or after the advent of HAART, the cut-off date being 31 December 1996. RESULTS: Data were collected on 66 patients, 17 in the pre-HAART and 49 in the HAART era. The proportion of HIV-infected patients admitted to the ICU in our HIV-infected population increased after the introduction of HAART (3.8 vs 0.5%; P=0.001), and the largest diagnostic group was respiratory pathology in both periods. More than a third of patients were diagnosed with HIV infection during the ICU income, and only 31.2% were on antiretroviral therapy. The in-hospital mortality was 53.0%, and later survival was high. There were no significant differences between the pre-HAART and HAART eras. CONCLUSIONS: Our results suggest that the characteristics of HIV-infected patients admitted to ICU have not changed: respiratory diseases are still the most frequent cause of admission, in-hospital mortality is high, and later survival rates are good.

[Clinical and biochemical characteristics of patients with pituitary disease]. / Características clínico bioquímicas de pacientes con patología hipofisaria.

OBJECTIVE: Descriptive studies in our country of hypophysis diseases are uncommon. Pituitary adenoma are unfrequent, however this pathology represent 10-12% of brain tumors. Pituitary adenomas are derived of adenohypophysis cells, depending of cellular line, clinical and biochemical characteristics are different. The aim of our study was to describe these characteristics in our patients. MATERIAL AND METHODS: We study 58 patients with diagnosis of pituitary tumor, with regular follow-up in our Hospital, between 1999-2001. The next data were recorded: epidemiological, clinical and biochemical data. RESULTS: Average age at diagnosis was 36.4 years (DS 16.34 years), with a 70.61% of females. The most frequent tumor was prolactinoma and non-functioning adenomas, amenorrhea was the most frequent symptom with the specialist physician (15%) and the general practice physician was the first step in diagnosis protocol. Cerebral image technique was realized in 54 patients, with a 15.5% of normal exploration and 78.6% with lesions, with 24.14% of microadenoma and macroadenoma. Invasive lesions (craniopharyngiomas, germinomas and invasive adenomas) representing a 6.9%. Depression, hypertension and diabetes mellitus were the most frequent diseases in these patients. CONCLUSIONS: Prolactinoma is the most frequent hypophysis pathology. Amenorrhea and/or galactorrhea are the most common symptom. Response to medical and surgical treatment was excellent in prolactinomas.

Características clínico bioquímicas de pacientes con patología hipofisaria / Clinical and biochemical characteristics of patients with pituitary disease

Objetivo: Los estudios descriptivos de patología hipofisaria en nuestro medio son escasos. Los adenomas pituitarios representan el 10-12% de todas las neoplasias intracraneales. Son tumores cuyo origen se encuentra en las células de la adenohipófisis, dependiendo de la estirpe el comportamiento clínico y bioquímico es diferente. El objetivo de nuestro estudio fue la descripción de las características clínicas y bioquímicas de los pacientes con patología hipofisaria de nuestro centro. Material y métodos: El estudio está basado en un análisis 58 pacientes con diagnóstico de tumor hipofisaria, en tratamiento y control periódico por la Sección de Endocrinología del Hospital Universitario Río Hortega de Valladolid entre los años 1999 y 2001. Se registraron los siguientes datos procedentes de la Historia Clínica de cada paciente: variables epidemiológicos, clínicos y analíticos. Resultados: La edad media en el momento del diagnóstico fue 36,4 años (DS 16,34 años), representando la población femenina el 70,61% del total. Los tumores más frecuentes fueron el prolactinoma y adenoma no funcionante siendo la amenorrea el motivo más frecuente de consulta al especialista (15%) y destacando el médico de Atención Primaria como el facultativo que con mayor frecuencia establece la sospecha diagnóstica. La resonancia magnética nuclear inicial se realizó en 54 pacientes, de las cuales un 15,5% era normal, y el 78,6% patológica, siendo los hallazgos más frecuentes los macro y microadenomas con una frecuencia ambos de 24,14%. Las lesiones invasivas (craneofaringiomas, germinomas, adenomas invasivos) constituyen el 6,9%. El síndrome depresivo, la hipertensión arterial y la diabetes mellitus en cualquiera de sus dos variantes destacaron como las patologías acompañantes más habituales en este tipo de pacientes. Conclusiones: Nuestro estudio demostró como el prolactinoma es la patología hipofisaria más frecuente. La amenorrea, seguida de la galactorrea o la combinación de ambas es la clínica inicial más predominante. La respuesta al tratamiento médico y quirúrgico de los prolactinomas fue excelente

Objective: Descriptive studies in our country of hypophisis diseases are uncommon. Pituitary adenoma are unfrequent, however this pathology represent 10-12% of brain tumors. Pituitary adenomas are derived of adenohypophisis cells, depending of cellular line, clinical and biochemical characteristics are diferents. The aim of our study was to describe these characteristics in our patients. Material and methods: We study 58 patients with diagnosis of pituitary tumor, with regular follow-up in our Hospital, between 1999-2001. The next data were recorded: epidemiological, clinical and biochemical datas. Results: Average age at diagnosis was 36.4 years (DS 16.34 years), with a 70.61% of females. The most frequent tumor was prolactinoma and non-functioning adenomas, amenorrhea was the most frequent symptom with the specialist physician (15%) and the general practice physician was the first step in diagnosis protocol. Cerebral image technique was realized in 54 patients, with a 15.5% of normal exploration and 78.6% with lesions, with 24.14% of microadenoma and macroadenoma. Invasive lesions (craneopharingioms, germinomes and invasive adenomas) representing a 6.9%. Depression, hipertension and diabetes mellitus were the most frequent diseases in these patients. Conclusions: Prolactinoma is the most frequent hypophisis patology. Amenorrhea and/or galactorrhea are the most common symptom. Response to medical and surgical treatment was excelent in prolactinomas

The oxidative metabolism of estrogen modulates response to ERT/HRT in postmenopausal women.

We have previously demonstrated that estrogen metabolism is one of the determinants of bone density after menopause. Increased hydroxylation to relatively nonestrogenic metabolites 2-hydroxyestrone (2OHE1) and 2-methoxyestrone (2MeOE1) was associated with low bone mineral density (BMD), while increased hydroxylation to the potent 16alpha-hydroxyestrone (16alphaOHE1) and weakly estrogenic estriol (E3) was associated with higher BMD. In this study, we tested the hypothesis that response to estrogen-hormone replacement therapy (ERT/HRT) is also related to individual differences in estrogen metabolism. Urinary estrogen metabolites were measured in 310 postmenopausal women using ESTRAMET enzyme immunoassay kit. Of these, 163 were on HRT with conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA, Premarin and Provera) or ERT with conjugated equine estrogen alone (Premarin), and 147 women not on ERT/HRT acted as comparison. Annual rates of BMD changes were calculated on a subset of 81 women on ERT/HRT who had more than one previous BMD measured by dual-energy X-ray absorptiometry (DEXA). Controlling for age, years since menopause (YSM), body mass index (BMI), waist to hip ratio, and smoking, we found that urinary estrogen metabolite levels were significantly higher in ERT/HRT-treated women compared to those not on ERT/HRT. Furthermore, women in the higher 2 tertiles of 2OHE1 and 2OHE1/16áOHE1 ratio had positive increments in BMD compared to those in the lowest tertile who lost bone while on ERT/HRT. Thus, women with estrogen metabolism favoring the 2-hydroxylation pathway respond favorably to ERT/HRT.