Mother-to-child Chagas disease transmission: The challenge of detection and prevention in areas without the risk of vectorial transmission.

Chagas disease (CD) is caused by the parasite Trypanosoma cruzi. Although it is endemic in many Latin American (LA) countries, mother-to-child transmission has caused it to expand to other countries and continents. In places where vector transmission is controlled or absent, the epidemiological importance of T. cruzi transmission of the infected mother to her child during pregnancy or childbirth (i.e., perinatal CD) increases. In countries where CD is not endemic, CD screening should be performed in pregnant or fertile women who are native to LA countries or whose mothers are native to LA countries. Diagnosis is established by detecting anti-T. cruzi IgG antibodies in a serum or plasma sample. Antiparasitic treatment cannot be offered during pregnancy, and since the majority of infected newborns are asymptomatic at birth, a diagnosis is made by direct observation or concentration (microhematocrit) or by using molecular testing techniques. Once the infected child receives a diagnosis, it is essential to offer treatment (benznidazole/nifurtimox) as soon as possible, with good tolerance and effectiveness in the first year of life. Even if the diagnosis is negative at birth, the newborn must be followed up for at least the first 9 months of life.

The Spanish Scientific Societies before the ESC 2021 guidelines on vascular disease prevention: Generalizing the measurement of albuminuria to identify vascular risk and prevent vascular disease.

The 2021 guidelines on the prevention of vascular disease (VD) in clinical practice published by the European Society of Cardiology (ESC) and supported by 13 other European scientific societies recognize the key role of screening for chronic kidney disease (CKD) in the prevention of VD. Vascular risk in CKD is categorized based on measurements of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR). Thus, moderate CKD is associated with a high vascular risk and severe CKD with a very high vascular risk requiring therapeutic action, and there is no need to apply other vascular risk scores when vascular risk is already very high due to CKD. Moreover, the ESC indicates that vascular risk assessment and the subsequent decision algorithm should start with measurement of eGFR and ACR. To optimize the implementation of the ESC 2021 guidelines on the prevention of CVD in Spain, we consider that: 1) Urine testing for albuminuria using ACR should be part of the clinical routine at the same level as blood glucose, cholesterolemia, and GFR estimation when these are used to make decisions on CVD risk. 2) Spanish public and private health services should have the necessary means and resources to optimally implement the ESC 2021 guidelines for the prevention of CVD in Spain, including ACR testing.

[Milk as a health vehicle in pregnancy and lactation]. / La leche como vehículo de salud en embarazo y lactancia.

INTRODUCTION: The importance of a correct diet and nutrition before pregnancy to the end of lactation seems to be without doubt with the scientific information and evidence that we have today. Despite this, recent studies have shown that the mother´s diet is not as adequate as it should be and deficiencies of certain critical nutrients have been detected at this stage. The importance of a correct nutrition of the mother at this stage has already been recognized for decades and today we can affirm that it will affect not only the development of the fetus but also the genetic organization of the future metabolic response of the child and later of the adult. Several recent publications seem to have made clear that they seem to relate maternal nutrition with a possible programming effect related to the appearance of various metabolic alterations in adult life giving rise to the possible appearance of various chronic diseases. For this reason, gestation is going to be a challenge for the mother at the nutritional level due to increase energy and nutrient needs and their relationship to maternal and child health. In the daily diet, milk and milk products are critical sources of nutrients for the correct development of the fetus and the early development of the child. The purpose of this text is to highlight them, to review the effects of conventional dairy products and dairy products fortified with various nutrients on nutritional status during pregnancy and lactation.

INTRODUCCIÓN: La importancia de una correcta alimentación y nutrición desde antes del embarazo hasta el final de la lactancia está fuera de cualquier duda basándonos en la información y en la evidencia científica disponibles en la actualidad. A pesar de ello, estudios recientes han puesto de manifiesto que la alimentación de las madres en nuestro medio es inadecuada. Se han detectado carencias en cuanto a la ingesta de determinados nutrientes críticos en esta etapa. La importancia de una correcta nutrición de la madre ya ha sido reconocida desde hace décadas, ya que influye no solo en el desarrollo fetal, sino también en la organización genética de la respuesta metabólica futura del niño, y después del adulto, como ponen de manifiesto varias publicaciones recientes que relacionan la nutrición materna con un posible efecto programador responsable de la aparición de diversas alteraciones metabólicas en la vida adulta que condicionan la aparición de varias enfermedades crónicas. Por estas razones, la gestación supone un reto para la madre en cuanto a su nutrición debido al incremento en los requerimientos de energía y nutrientes, que tiene por objetivo alcanzar una adecuada salud materno-fetal. En la alimentación cotidiana, la leche y los productos lácteos son fuente de nutrientes críticos para el correcto desarrollo del feto y, posteriormente, del recién nacido. En este artículo, se revisa la influencia de los productos lácteos convencionales y de los lácteos enriquecidos y fortificados con diversos nutrientes sobre el estado nutricional durante la gestación y la lactancia y los resultados perinatales relacionados con ello.

AEEM-SEGO position statement on menopausal hormone therapy / Posicionamiento AEEM-SEGO sobre la terapia hormonal de la menopausia

According to the latest data from the medical literature, the Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia [AEEM]) has brought together a group of experts to re-evaluate the use of menopausal hormone therapy so that women can make an informed, evidence-based decision to determine the most appropriate dose, formulation, route of administration, and duration of menopausal hormone therapy. There is some disagreement between scientific evidence on the efficacy and safety of menopausal hormone therapy and how this evidence is perceived by menopausal women and the clinicians who care for them, leading to an unnecessary loss of quality of life in those who reject it or in the unjustified fear of those who choose to use it. A critical review of the most recent available literature was conducted. The review mainly covered randomized clinical trials and epidemiological studies published since January 2015. This paper reviews clinical trials published since then, as well as new information on the potential risks and benefits of HT for the treatment of menopausal symptoms. Decisions about menopausal hormone therapy should be based on a woman’s specific health risks, age, and time since onset of the menopause, as well as on the goals of therapy. The Spanish Menopause Society (Asociación Española para el Estudio de la Menopausia) and the Spanish Society of Gynecology and Obstetrics (Sociedad Española de Ginecología y Obstetricia) updated their position statement on menopausal hormone therapy. This statement updates the clinical practice guidelines on the menopause

Conocidos los últimos datos de la literatura médica, la Asociación Española para el Estudio de la Menopausia ha reunido a un grupobde expertos para reevaluar el uso de la terapia hormonal de la menopausia con el fin de adoptar una decisión informada, basada en la evidencia que determina el tipo más apropiado de dosis, formulación, vía de administración y duración del uso de la terapia hormonal de la menopausia. Existe una discordancia entre las evidencias de carácter científico, sobre la eficacia y la seguridad de la terapia hormonal de la menopausia y la percepción que tienen de ello las mujeres que están en la menopausia y los médicos que las atienden, lo que redunda en una pérdida innecesaria de la calidad de vida en las que lo rechazan o en el temor injustificado de las que optan por su utilización. Se ha realizado una revisión crítica de la literatura disponible más reciente, fundamentalmente de ensayos clínicos aleatorizados y estudios epidemiológicos, publicados desde enero de 2015. El presente documento revisa los nuevos ensayos clínicos publicados desde entonces, así como nueva información sobre los posibles riesgos y beneficios de la terapia hormonal de la menopausia para el tratamiento de los síntomas de la menopausia. Las decisiones sobre la terapia hormonal de la menopausia deben basarse en los riesgos de salud específicos de cada mujer, la edad o el tiempo desde la menopausia y los objetivos de la terapia. La Asociación Española para el Estudio de la Menopausia y la Sociedad Española de Ginecología y Obstetricia actualizaron su posicionamiento con respecto a la terapia hormonal de la menopausia. Dicho posicionamiento de la Asociación Española para el Estudio de la Menopausia/Sociedad Española de Ginecología y Obstetricia actualiza las guías de práctica clínica de menopausia ya publicadas

Percepción y actitudes de los ginecólogos españoles frente al síndrome genitourinario de la menopausia. Estudio VUVAGINE / Perception and attitudes of Spanish gynecologits against the genitourinary syndrome during the menopause. VUVAGINE Study

Objetivo: describir y analizar los resultados de un cuestionario diseñado para evaluar diferencias de percepción y actitudes entre los ginecólogos españoles (varones y mujeres) en relación con el abordaje del síndrome genitourinario de la menopausia (SGUM). Material y métodos: estudio transversal mediante una encuesta, cumplimentada por ginecólogos españoles. Se analizan las características basales del ginecólogo, anamnesis proactiva en el SGUM, orientación terapéutica y preventiva y autoprescripción/a la pareja de los ginecólogos varones. Resultados: se analizaron 213 cuestionarios. Son destacables las diferencias entre lo que el ginecólogo preferiría teóricamente prescribir (terapia hormonal asociada a lubricantes), lo que prescribe y lo que estima mejor aceptado por las pacientes (solo hidratantes). Eliminando la influencia de las variables de confusión, no existen diferencias significativas entre los resultados en ginecólogos varones y mujeres, de forma que la variable que condiciona las diferencias es el tipo de actividad del profesional. En la praxis privada se pregunta significativamente más sobre sintomatología vulvovaginal, urinaria y disfunciones sexuales; se dispone de más tiempo para incidir en ella, y mayor uso de probióticos. La terapia autoprescrita mayoritaria es la hormonal, asociada o no a hidratantes (73,1 vs. 63,6% en la pública y privada, respectivamente). Conclusión: la mayoría de los ginecólogos encuestados abordan en su práctica clínica el diagnóstico y tratamiento del SGUM, si bien se identifican diferencias entre los ginecólogos que desarrollan su actividad en el ámbito público frente al privado. Del mismo modo, existe diferencia entre prescripción y autoprescripción, si bien la terapia hormonal asociada o no a hidratantes resulta ser la mayoritaria en todos los subgrupos (AU)

Objective: To describe and analyse the results of a questionnaire designed to evaluate the existence of differences between perceptions and attitudes of Spanish gynaecologists (male and female) regarding the approach of Genitourinary Syndrome of Menopause (GSM). Material and methods: A cross-sectional study was made by means of a survey form completed by Spanish gynaecologists. The gynaecologist’s baseline characteristics, data on proactive history taking about GSM symptom, prevention and therapeutic approach and self-prescription/recommendations to the gynecologist’s couple were analysed. Results: Two hundred-thirteen valid questionnaires were analysed. In that analysis, the significant differences between what the gynaecologists theoretically would prescribe (hormonal therapy associated to moisturizers), what they in the daily practice prescribe and what they think the patients would accept (only lubricants and/or moisturizers). There are no significant differences between male and female gynaecologists in each category or in each age group, excluding the influence of confusion variables. This means that the differences are due to the professional activity area. Thus in private practice is significantly often to be asked about vulvovaginal and urinary symptoms and sexual disfunction, there is more time to inquire about it, the price is less considered when prescribing and there is a better knowledge and greater use of probiotics. The majority self-prescripted therapy was the hormonal therapy associated or not to moisturizers/lubricants (73.1 vs. 63.6% of self-medication in public and private practice respectively). Conclusion: The majority of the asked gynaecologists deal with diagnosis and treatment of GSM in their daily practice, although there are significant differences between the gynaecologists that work mainly at the public practice and the ones that work at the private practice. In the same way, there is a slight difference in prescription and self-prescription, even though hormonal therapy associated or not to moisturizers are the most prevalent products used in all groups (AU)

Papel de ospemifeno en el tratamiento de la atrofia vulvovaginal en la mujer posmenopáusica / Role of ospemifene in the treatment of vulvar and vaginal atrophy in postmenopausal woman

A pesar de que los síntomas de atrofia vulvovaginal (AVV) tienen un impacto significativo en la vida de una mujer, el grado de insatisfacción con las terapias disponibles es elevado. Si además consideramos que muchas mujeres son reacias a aceptar los tratamientos vaginales o no pueden utilizarlos, se hace patente la necesidad médica no cubierta en el manejo de la AVV. Ospemifeno es el primer tratamiento oral que no contiene hormonas indicado para mujeres posmenopáusicas con AVV no candidatas a estrógenos locales, y el único modulador selectivo de los receptores estrogénicos (SERM) con actividad antagonista en la mama, neutral en el útero y agonista en los huesos y vagina. Ospemifeno restaura el epitelio vaginal mejorando significativamente los síntomas de sequedad vaginal y dispareunia, y la salud sexual. Además de un óptimo tratamiento, los profesionales deberían abordar proactivamente la salud vaginal como parte del cuidado de la mujer posmenopáusica, especialmente a la luz del escaso conocimiento que muestran las mujeres acerca de esta condición (AU)

Despite symptoms of vulvar and vaginal atrophy (VVA) can have a significant impact on a woman’s life, the level of dissatisfaction with available VVA treatments is high. If we also consider that many women are reluctant to accept vaginal treatments or are unable to use it, the unmet medical need in the management of VVA becomes evident. Ospemifene is the first oral treatment that does not contain hormones, for post-menopausal women with VVA who are not candidates for local estrogens, and the only SERM with antagonistic effect in breast, neutral in uterus, and agonistic in bone and vagina. Ospemifene restores the vaginal epithelium and show significant improvements in symptoms of vaginal dryness and dyspareunia and therefore in the woman’s sexual function. Besides an optimal treatment, professionals should proactively address the vaginal health as part of postmenopausal women care, particularly in view of survey results highlighting the poor understanding of this condition that women have (AU)

Tratamiento adyuvante de la vaginitis con probióticos. Grado de acuerdo basado en el método Delphi / Probiotics as adjuvant therapy for vaginitis. Agreement based on the Delphi method

Objetivo: Reconocer el grado de acuerdo/desacuerdo entre un grupo de ginecólogos españoles sobre el papel de los probióticos como tratamiento adyuvante en la vaginitis. Material y métodos: Estudio prospectivo de metodología Delphi, multicéntrico, con 123 ginecólogos de España, sobre 55 cuestiones, estructuradas en 3 bloques (vaginitis/vaginosis, uso clínico de los probióticos y microbiota vaginal). Resultados: Acuerdo muy consistente en la relación entre vaginitis y edad reproductiva, hormonas y uso de antibióticos como factores favorecedores; alta tasa de recurrencias y complicaciones asociadas a la infección, así como sobre el papel beneficioso de los probióticos. Acuerdo en que los probióticos modulan la proliferación de patógenos vaginales cuando son utilizados principalmente por vía vaginal (cápsulas o tampones). Menor acuerdo con el papel de los probióticos en reducir la transmisión de otras infecciones distintas a candidiasis y vaginosis bacteriana. Conclusiones: Existe un acuerdo muy consistente entre los ginecólogos españoles participantes, sobre el beneficio del uso de probióticos, asociado al antibiótico, para el tratamiento de la vaginitis en la prevención de recurrencias y posibles complicaciones (AU)

Objective: To determine the degree of agreement/disagreement among a group of Spanish gynecologists on the role of probiotics as adjuvant therapy for vaginitis. Material and methods: A prospective, multicenter study with Delphi methodology was performed with 123 Spanish gynecologists on 55 structured issues in 3 blocks (vaginitis/vaginosis, clinical use of probiotics, and vaginal microbiota). Results: There was highly consistent agreement on the relationship between vaginitis and reproductive age, hormones and antibiotics as predisposing factors, on the high rate of recurrence and complications associated with the infection, and on the beneficial role of probiotics. There was agreement that probiotics modulate the growth of vaginal pathogens when used mainly vaginally (capsules or tampons). There was less agreement on the role of probiotics in reducing the transmission of infections other than candidiasis and bacterial vaginosis. Conclusions: There was highly consistent agreement among the participating Spani h gynecologists on the benefits of probiotics associated with antibiotics for the treatment of vaginitis in preventing recurrences and complications (AU)

[Hormonal treatments for hemorrhaging secondary to fibroids. An alternative or complement to surgery?]. / Tratamientos hormonales en las hemorragias por mioma. ¿Una alternativa o un complemento a la cirugía?

The main objective of treatment in women with uterine fibroids is the control of associated symptoms such as abnormal uterine bleeding, pain and pressure. Although the cost and potential adverse effects of the long-term use of medical treatment may limit its use for a long time, this alternative should be considered before indicating surgical treatment. At present, we have a considerable variety of drugs that, although not specific treatments for fibroids, may be used for the short to medium-term management of bleeding; however, we have still not found an alternative that eliminates the need for invasive treatments. Further research in this field is therefore warranted. Given the heterogeneity of fibroids and the lack of effective treatments in controlling their growth, the identification of signals that stimulate the onset and growth of these fibroids opens doors to the development of new therapies. In the future we may be able to differentiate classes of fibroids by molecular techniques and thereby implement specific treatments that control their development and their associated symptoms.

Tratamientos hormonales en las hemorragias por mioma. ¿Una alternativa o un complemento a la cirugía? / Hormonal treatments for hemorrhaging secondary to fibroids. An alternative or complement to surgery?

El objetivo principal del tratamiento en la mujer con mioma uterino es el control de los síntomas asociados como sangrado uterino anormal, dolor o presión. Aunque el coste y los posibles efectos adversos del uso a largo plazo del tratamiento médico pueden limitar su uso durante un tiempo prolongado, esta alternativa debe contemplarse antes de la indicación de un tratamiento quirúrgico. En la actualidad disponemos de una gran variedad de fármacos que, aunque no son un tratamiento específico para los miomas, pueden ser usados para el control del sangrado a corto-medio plazo, pero aún no hemos encontrado ninguna alternativa que permita eliminar la necesidad de tratamientos invasivos, por lo que es necesario continuar con la investigación en este campo. Dada la heterogeneidad de los miomas y la falta de tratamientos efectivos en el control de su crecimiento, la identificación de las señales que estimulan la iniciación y el crecimiento de este abre las puertas al desarrollo de nuevas terapias. Es posible que en el futuro se puedan diferenciar clases de miomas por técnicas moleculares y así aplicar el tratamiento específico, que controle su desarrollo y los síntomas asociados a él (AU)

The main objective of treatment in women with uterine fibroids is the control of associated symptoms such as abnormal uterine bleeding, pain and pressure. Although the cost and potential adverse effects of the long-term use of medical treatment may limit its use for a long time, this alternative should be considered before indicating surgical treatment. At present, we have a considerable variety of drugs that, although not specific treatments for fibroids, may be used for the short to medium-term management of bleeding; however, we have still not found an alternative that eliminates the need for invasive treatments. Further research in this field is therefore warranted. Given the heterogeneity of fibroids and the lack of effective treatments in controlling their growth, the identification of signals that stimulate the onset and growth of these fibroids opens doors to the development of new therapies. In the future we may be able to differentiate classes of fibroids by molecular techniques and thereby implement specific treatments that control their development and their associated symptoms (AU)

Tolerability of different oral iron supplements: a systematic review.

OBJECTIVE: A systematic review was conducted to analyze the tolerability of several oral iron supplements based on data obtained in available publications and to report the incidence of adverse effects (AEs) for each supplement both overall and gastrointestinal. METHODS: Electronic databases - Medline, the Cochrane Library, and Embase were searched for studies published up to January 2009. Clinical or observational studies reporting data on the tolerability of oral iron supplements were included. Results were described statistically and a quasi-binomial logistic regression model was developed to evaluate and compare the tolerability of the supplements studied. RESULTS: For this review 111 studies were included, with data on 10,695 patients. Ferrous sulfate with mucoproteose had the lowest incidence of AEs (4.1% for overall AEs, 3.7% for gastrointestinal AEs [GAEs]) and was used as the reference supplement in the regression model. Incidence rates of overall AEs for the other supplements were 7.3% for iron protein succinylate [GAEs: 7%; OR for AE compared to the reference supplement, 1.96], 23.5% for ferrous glycine sulfate [GAEs: 18.5%; OR: 5.90], 30.9% for ferrous gluconate [GAEs: 29.9%; OR: 11.06], 32.3% for ferrous sulfate without mucoproteose [GAEs: 30.2%; OR: 11.21], and 47.0% for ferrous fumarate [GAEs: 43.4%; OR: 19.87]. The differences in incidence of AEs between extended-release ferrous sulfate with mucoproteose and all other supplements except iron protein succinylate were statistically significant at p < 0.001. These findings are subject to some limitations as the designs and methodologies of the studies included show heterogeneity among them that has partially been counteracted by the large sample size provided by the substantial number of trials, which is considered a strength in tolerability studies. CONCLUSION: Extended-release ferrous sulfate with mucoproteose appears to be the best tolerated of the different oral iron supplements evaluated.

Optimizing soy isoflavones effect in postmenopausal women: the impact of timing on climacteric symptoms.

BACKGROUND: The most common complaints during climacteric are vasomotor symptoms. A circadian rhythm has been observed when hot flashes start; however, not much information is available in this field. AIMS: To analyze whether the time (morning/evening) of administration of a compound containing 60 mg of dry soy seed extract (glycine max) with 40% of total isoflavones, primrose oil and α-tocopherol modifies the effect on the climacteric syndrome. TRIAL DESIGN: Multicentric, observational, open, prospective, longitudinal and cross-sectional study. Subjects and methods. One thousand six hundred eighty-two postmenopausal women with climacteric symptoms were allocated in two groups in order to receive the treatment in the morning (Group 1) or in the evening (Group 2), switching administration time after 3 months. Clinical evaluation was carried out at 0, 3 and 6 months of follow-up using Blatt-Kupperman and Greene scales. RESULTS: 233 (13.9%) women dropped out from the study. Both administration times improved the climacteric symptoms after 3 and 6 months of treatment, showing a reduction in the scores of Blatt-Kupperman and Greene scales (p < 0.001). No differences between both groups during the follow-up were identified. CONCLUSIONS: The time of administration of isoflavones does not modify its effect on climacteric symptoms.