Multidisciplinary management of cardiovascular disease in women: Delphi consensus.

Background: Current clinical guidelines on cardiovascular disease (CVD) do not specifically address the female population. The aim of this consensus is to know the opinion of a group of experts on the management of CVD in women. Methods: Through a Delphi consensus, 31 experts in cardiology, 9 in gynecology and obstetrics, and 14 primary care physicians, showed their degree of agreement on 44 items on CVD in women divided into the following groups: (1) risk factors and prevention strategies; (2) diagnosis and clinical manifestations; and (3) treatment and follow-up. Results: After two rounds, consensus in agreement was reached on 27 items (61.4%). Most of the non-consensus items (31.8%) belonged to group 3. The lack of consensus in this group was mainly among gynecologists and primary care physicians. The panelists agreed on periodic blood pressure control during pregnancy and delivery to detect hypertensive disorders, especially in women with a history of preeclampsia and/or gestational hypertension, and diabetes mellitus control in those with gestational diabetes. Also, the panelists agreed that women receive statins at a lower intensity than men, although there was no consensus as to whether the efficacy of drug treatments differs between women and men. Conclusions: The high degree of consensus shows that the panelists are aware of the differences that exist between men and women in the management of CVD and the need to propose interventions to reduce this inequality. The low level of consensus reveals the lack of knowledge, and the need for information and training on this topic.

Value of colposcopy with dynamic spectral imaging in the detection and evolution of high-grade cervical lesions.

OBJECTIVE: To analyze the performance of colposcopy assisted with dynamic spectral imaging (CC-DSI) compared to conventional colposcopy (CC) in diagnosing cervical intraepithelial neoplasia 2+ (CIN2+). METHODS: In total, 973 consecutive women were referred for colposcopy between 2012 and 2016 and were examined simultaneously by CC and CC-DSI; 877 were eligible. Comparisons between CC and CC-DSI were performed against the histological diagnosis performed by either punch biopsy or loop electrosurgical excision procedure (LEEP). RESULTS: In final histology, 494 women had no CIN, 250 had CIN1 and 133 had CIN2+. The sensitivity to identify women with CIN2+ was significantly higher for CC-DSI compared to CC for the entire group and in the subgroup of 675 women referred with ASCUS or LSIL. In women with HPV16/18 infections, the sensitivity of CC increased with the addition of DSI from 53% to 79% (p < 0.001). Using a multivariant Cox regression model, CC-DSI was an independent factor for progression of the cervical lesions (HR: 2.29, 95% CI 1.07-4.90). Other predictive factors were the number of sexual partners (HR: 1.05, 95% CI: 1.01-1.09) and anal intercourse (HR: 2.45, 95% CI 1.23-5.02). CONCLUSION: CC-DSI improves the ability to detect cervical lesions compared to CC and could help predict their potential to progress.

Resilience and psychological distress in pregnant women during quarantine due to the COVID-19 outbreak in Spain: a multicentre cross-sectional online survey.

PURPOSE: To examine the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women during the confinement due to the COVID-19 outbreak in Spain. MATERIALS AND METHODS: Between 15 April and 14 May 2020, a multicentre cross-sectional survey was performed to study depression, anxiety and resilience in a sample of Spanish pregnant women during the lockdown set up by the Government in response to COVID-19 pandemic outbreak. We designed an anonymous online self-administered questionnaire (https://bit.ly/34RRpq1) that included the Spanish validated versions of the Edinburgh Postpartum Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI) and the Connor-Davidson Resilience 10-items Scale (CD-RISC-10). RESULTS: A total of 514 pregnant women completed the survey. 72.8% had been confined < 40 days and 27.2% between 41 and 60 days. 182 (35.4%) participants scored over 10, with 21.3% scoring over 13 (75th Percentile) in depressive symptoms rates. We found high trait and anxiety scores, with 223 (43.4%) and 227 (44.2%) pregnant women scoring over the trait and state mean scores. Neither depression, anxiety or resilience levels showed any significant correlation with the length of confinement. We found low CD-RISC-10 scores. CONCLUSIONS: We found a high prevalence of depression and anxiety symptoms during the quarantine, although we did not find an increased prevalence of psychological distress according to length of home confinement. Resilience correlated negatively with depression and anxiety.

El ductus venoso es un buen marcador de rescate en los riesgos intermedios del cribado combinado / Ductus venosus is a good rescue marker in the intermediate riskcategory after combined screening

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La inmunosupresión es un factor mayor de riesgo en la recidiva de las lesiones del tracto genital inferior asociadas al virus del papiloma humano / Immunosuppression is a major prognostic factor in recurrence of human papillomavirus-associated lesions of the lower genital track

Objetivo: Analizar las características de las lesiones preneoplásicas del tracto genital inferior (TGI) y los factores asociados a su recidiva. Material y métodos: Se estudió a 376 mujeres tratadas de algún tipo de neoplasia intraepitelial del TGI, en la década de los 90. Las lesiones se agruparon en cervicales y vulvares, y estas en lesiones de alto (CIN II-III o VIN) y de bajo grado (CIN I o atipia vulvar por virus del papiloma humano [AV-VPH]). El tratamiento de las CIN se realizó con asa diatérmica y para las lesiones vulvares fue la resección con bisturí frío y/o láser CO2.ResultadosLa edad media de las mujeres fue 32 años. La multicentricidad fue identificada en el 57% de las CIN y en el 87% de las lesiones vulvares. Un 10% de las mujeres en ambos grupos presentó algún tipo de inmunosupresión. Se identificó VPH de riesgo alto en el 25% de los casos. Con un seguimiento medio de 21 meses, la recidiva global de la CIN fue del 17% y la acumulada a 5 años del 47%. En las lesiones vulvares fue del 15 y el 54%, respectivamente. En ambos grupos lesionales la recidiva apareció en los primeros 3 años en más del 90% de los casos y se asoció a la inmunosupresión y el genotipo viral de riesgo alto, aunque el único factor de riesgo independiente en el análisis multivariante fue la inmunosupresión. Ninguna paciente progresó a cáncer invasor. Conclusiones: La inmunosupresión es el factor riesgo predictivo más importante de recurrencia. Las conductas orientadas a estimular la inmunidad podrían ser eficaces en prevención de la recurrencia de la enfermedad por el VPH (AU)

Objective: To analyze the characteristics of preneoplastic lesions of the lower genital tract (LGT) and the factors associated with their recurrence. Material and methods: A total of 376 women treated for some type of intraepithelial neoplasm of the LGT between 1990 and 1999 were studied. The lesions were classified into cervical intraepithelial neoplasms (CIN) and vulvar intraepithelial neoplasms (VIN) and were further classified into high-grade lesions (CIN 2-3 or VIN) and low-grade lesions (CIN 1 or human papillomavirus vulvar atypia [HPV-VA]). Treatment of cervical lesions consisted of CO2 laser and / or loop electrosurgical excision while that of vulvar lesions consisted of cold-knife local excision and / or CO2 laser. Results: The mean age of women was 32 years. Multicentric disease was found in 57% of CIN lesions and in 87% of vulvar lesions. Ten percent of women in both groups had some type of immunosuppression. High-risk HPV was identified in 25% of patients. With a mean follow-up of 21 months, the overall CIN recurrence was 17% and accumulated recurrence rate at 5 years was 47%. In vulvar lesions, these values were 15% and 54%, respectively. In both groups, more than 90% of recurrences occurred in the first 3 years, and relapse was associated with immunosuppression and high-risk viral genotype. In multivariate analysis, the only independent risk factor was immunosuppression. None of the lesions progressed to invasive cancer. Conclusions: The most important risk factor predictive of recurrence is immunosuppression. Measures to stimulate immunity could be effective in preventing HPV-related disease (AU)

[Overexpression and prognostic value of p53 and HER2/neu proteins in benign ovarian tissue and in ovarian cancer]. / Grado de expresión y valor pronóstico de las proteínas p53 y HER2/neu en el tejido ovárico benigno y en el cáncer de ovario.

BACKGROUND AND OBJECTIVE: To investigate the prognostic value of p53 and HER2/neu overexpression in epithelial ovarian cancer (EOC). PATIENTS AND METHOD: p53 and HER2/neu immunostaining were performed in 198 tissue samples, 124 EOC, 44 benign ovarian tumors and 30 normal ovaries. Nuclear p53 and membranous HER2/neu immunostaining were evaluated. RESULTS: Neither p53 nor HER2/neu overexpression was seen in the benign ovarian tumors. HER2/neu immunostaining was observed in one normal ovary. P53 overexpression was found in 25% EOC and was related with advanced stage, endometrioid, clear cell and undifferentiated types, grade G3, and sub-optimal surgery. HER2/neu immunostaining was observed in 24.2% and it was associated with advanced stage, clear cell and undifferentiated types, and suboptimal surgery. Both, p53 and HER2/neu overexpression decreased overall and progression-free survival, but in the multivariant analysis, only HER2/neu overexpression was an independent prognostic factor of overall survival (RR = 2.8; 95% confidence interval [CI], 1.2-5.6) and recurrence (RR = 2.8; 95% CI, 1.1-7.1). Simultaneous p53 and HER2/neu overexpression made the prognosis worse (p < 0.01). CONCLUSIONS: HER2/neu overexpression (but not p53 overexpression) is a major prognostic factor in EOC.

Grado de expresión y valor pronóstico de las proteínas p53 y HER2/neu en el tejido ovárico benigno y en el cáncer de ovario / Overexpression and prognostic value of p53 and HER2/neu proteins in benign ovarian tissue and in ovarian cancer

Fundamento y objetivo: Determinar la expresión de las proteínas p53 y HER2/neu en el tejido ovárico y analizar su valor pronóstico en el cáncer de ovario. Pacientes y método: Se estudió a un total de 198 pacientes, 124 con cáncer epitelial de ovario (CEO), 44 con tumores benignos y 30 con ovarios normales. Se midió la expresión nuclear de p53 y en membrana de HER2/neu mediante técnicas inmunohistoquímicas. Resultados: No se observó sobreexpresión de p53 o HER2/neu en los tumores benignos de ovario. Sólo hubo sobreexpresión de HER2/neu en un ovario normal. El 25% de los casos de CEO mostró sobreexpresión de p53 y ésta se relacionó con los estadios avanzados, con los tipos histológicos endometrioides, de células claras e indiferenciados, con el grado G3 y con la citorreducción subóptima. El 24,2% de los CEO sobreexpresó HER2/neu y se relacionó con los tumores en estadio avanzado, con los tipos histológicos de células claras e indiferenciado y con una citorreducción subóptima. Tanto la sobreexpresión de p53 como la de HER2/neu se asociaron a una reducción de la supervivencia global y libre de enfermedad de las pacientes con CEO; sin embargo, en el estudio multivariable sólo la sobreexpresión de HER2/neu fue un factor independiente predictivo de menor supervivencia, tanto global (riesgo relativo [RR] = 2,8; intervalo de confianza [IC] del 95%, 1,2-5,6) como libre de enfermedad (RR = 2,8; IC del 95%, 1,1-7,1). La sobreexpresión conjunta de ambas proteínas empeoró aún más el pronóstico de estas pacientes (p < 0,01). Conclusiones: La sobreexpresión de HER2/neu es un factor pronóstico importante en el CEO, no así la sobreexpresión de p53

Background and objetive: To investigate the prognostic value of p53 and HER2/neu overexpression in epithelial ovarian cancer (EOC). Patients and method: p53 and HER2/neu immunostaining were performed in 198 tissue samples, 124 EOC, 44 benign ovarian tumors and 30 normal ovaries. Nuclear p53 and membranous HER2/neu immunostaining were evaluated. Results: Neither p53 nor HER2/neu overexpression was seen in the benign ovarian tumors. HER2/neu immunostaining was observed in one normal ovary. P53 overexpression was found in 25% EOC and was related with advanced stage, endometrioid, clear cell and undifferentiated types, grade G3, and sub-optimal surgery. HER2/neu immunostaining was observed in 24.2% and it was associated with advanced stage, clear cell and undifferentiated types, and suboptimal surgery. Both, p53 and HER2/neu overexpression decreased overall and progression-free survival, but in the multivariant analysis, only HER2/neu overexpression was an independent prognostic factor of overall survival (RR = 2.8; 95% confidence interval [CI], 1.2-5.6) and recurrence (RR = 2.8; 95% CI, 1.1-7.1). Simultaneous p53 and HER2/neu overexpression made the prognosis worse (p < 0.01). Conclusions: HER2/neu overexpression (but not p53 overexpression) is a major prognostic factor in EOC

Evaluación de la seguridad y la eficacia de la endometrectomía histeroscópica en la menometrorragia / Safety and efficacy of hysteroscopic endometrectomy in patients with menometrorrhagia

Objetivo: Analizar la eficacia y la seguridad de la endometrectomía histeroscópica en pacientes con hemorragia uterina disfuncional. Material y métodos: Estudio retrospectivo de 119 pacientes con menometrorragias. Se evaluó la histología prequirúrgica y posquirúrgica, las complicaciones inmediatas y tardías, la recidiva de la sintomatología y la necesidad de reintervención. Resultados: La edad media de las pacientes fue de 45 años (rango, 25-72). Tras una mediana de seguimiento de 14 meses (rango, 9-54), el 92,8% de las mujeres mejoró de su metropatía. En el 30,9% persistió la amenorrea; en el 26,3%, la hipomenorrea; y en el 35,4%, la eumenorrea. Las complicaciones globales fueron del 5,9% (7 casos), 6 casos a corto plazo (3 perforaciones y 3 hemorragias intraoperatorias) y un caso de hematometra a largo plazo. Un 7,2% (8 casos) mantuvo menometrorragias tras la ablación. El fallo del tratamiento se asoció con la resección incompleta del endometrio y la presencia de complicaciones intraoperatorias. La tasa de respuesta se redujo con el tiempo: el 96% a los 6 meses y el 87% a los 3 años. Se realizó un 7,3% (8 casos) de reintervenciones, 3 de ellas histerectomías. Conclusiones: La ablación/resección endometrial o endometrectomía histeroscópica es un tratamiento seguro y efectivo en el manejo quirúrgico de la menometrorragia

Objective: To analyze the safety and efficacy of hysteroscopic endometrectomy in patients with menometrorrhagia. Material and methods: We performed a retrospective study of 119 patients with menometrorrhagia. Histology, early and late complications, symptom recurrence, and reinterventions were evaluated. Results: The mean age of the patients was 45 years (range, 25-72). With a median follow-up of 14 months (range, 9-54), menometrorrhagia was improved in 92.8%. A total of 30.9% showed amenorrhea, 26.3% hypomenorrhea, and 35.4% eumenorrhea. Complications occurred in seven patients (5.9%), early complications in six (three uterine perforations and three intraoperative hemorrhages), and there was one late complication (hematometra). Symptom recurrence was observed at the end of follow-up in eight patients (7.2%). Treatment failure was associated with incomplete endometrial resection and the presence of intraoperative complications. Treatment efficacy decreased during follow-up and was 96% at 6 months and 87% at 3 years. Reinterventions were performed in 7.3% (eight patients); of these, hysterectomy was performed in three patients. Conclusions: Hysteroscopic endometrectomy is a safe and effective surgical treatment for menometrorrhagia