Pituitary stalk dysgenesis-induced hypopituitarism in adult patients: prevalence, evolution of hormone dysfunction and genetic analysis.

OBJECTIVES: To investigate the prevalence of pituitary stalk dysgenesis (PSD) in adult hypopituitary patients by describing the chronology of hormone deficiencies and their potential correlation with traumatic delivery, mutations in genes required for pituitary development and function and pituitary stalk visibility on MRI. DESIGN: Retrospective and prospective study involving 231 hypopituitary patients, including 26 diagnosed with PSD. Clinical, biochemical and radiological studies were reviewed. Molecular analyses of HESX1, LHX4,PROP1 and POU1F1 genes were performed prospectively. RESULTS: PSD was present in 11.2% of hypopituitary patients. PSD was diagnosed before 14 years of age in 46.2% of cases, between 14 and 18 years of age in 23%, and in adulthood in 30.8%. Perinatal complications or gene mutations were present in 26.9 and 4.3% of patients, respectively. At first assessment, 92.3% of patients had growth hormone (GH) deficiency. 26.9% presented as combined pituitary deficiencies and 7.6% as panhypopituitarism. Hormone deficiencies were progressive during follow-up in 84.6%. 96% progressed to multiple deficiencies and 46% to panhypopituitarism. No significant association was found between hormonal dysfunction and previous perinatal damage or breech delivery (p = 0.17), PROP1 mutations (p = 0.26) or pituitary stalk visibility on MRI (p = 0.52). No mutations in POU1F1, HESX1 and LHX-4 genes were detected. CONCLUSION: In this study, PSD prevalence in adult hypopituitary patients was 11.2%. Typical clinical presentation includes isolated or combined pituitary hormone deficiencies during the pediatric age, which usually progress to combined or complete hypopituitarism in adulthood. Phenotype is highly variable depending on hormone profile and age at onset.

Gender influence in the quantity of drugs used in primary care.

OBJECTIVE: To analyze whether for an equal health problem there are gender differences in the drugs used in an adult population attended in the Health Care Centers of the Valencian Community (Spain). METHODS: A cross-sectional analytical study was carried out between February-August 1997. The independent variables were: socio-economic parameters, frequency of visits, and self-perceived or diagnosed health problems, and the dependent one the number of drugs consumed. RESULTS: Of the 812 patients considered, 801 consumed medication. Eighty percent of the health problems for which drugs were used involved 5 apparatuses and systems (mean: 3.3 health problems/patient). The 5 most consumed therapeutic groups accounted for 81% of the total (mean: 4.5 drugs/patient). Significant differences were recorded, with greater female consumption in the central nervous system and genitourinary tract therapeutic groups, and with greater male consumption in relation to the respiratory system and systemic anti-infectious therapy. Drug use increased with age, lowest educational level, lowest professional categories, and with the highest frequency of visits to the physician. Significant differences were also recorded in drug use by occupational status, marital status and family structure. The multivariate analysis showed the number of health problems and the frequency of visits accounted for 82.2% of the variability of the variable <>. The variability accounted for by gender was explained by the variable health problems, the main factor underlying drug consumption among women and men. CONCLUSION: The main finding is probably that women do not use larger numbers of drugs than men if health problems and frequency of visits are controlled.

Gender influence in the quantity of drugs used in primary care

Objective: To analyze whether for an equal health problem there are gender differences in the drugs used in an adult population attended in the Health Care Centers of the Valencian Community (Spain). Methods: A cross-sectional analytical study was carried out between February-August 1997. The independent variables were: socio-economic parameters, frequency of visits, and self-perceived or diagnosed health problems, and the dependent one the number of drugs consumed. Results: Of the 812 patients considered, 801 consumed medication. Eighty percent of the health problems for which drugs were used involved 5 apparatuses and systems (mean: 3.3 health problems/patient). The 5 most consumed therapeutic groups accounted for 81% of the total (mean: 4.5 drugs/patient). Significant differences were recorded, with greater female consumption in the central nervous system and genitourinary tract therapeutic groups, and with greater male consumption in relation to the respiratory system and systemic anti-infectious therapy. Drug use increased with age, lowest educational level, lowest professional categories, and with the highest frequency of visits to the physician. Significant differences were also recorded in drug use by occupational status, marital status and family structure. The multivariate analysis showed the number of health problems and the frequency of visits accounted for 82.2% of the variability of the variable «number of drugs consumed». The variability accounted for by gender was explained by the variable health problems, the main factor underlying drug consumption among women and men. Conclusion: The main finding is probably that women do not use larger numbers of drugs than men if health problems and frequency of visits are controlled (AU)

Objetivo: Analizar si para el mismo problema de salud hay diferencias de género en los medicamentos utilizados en una población adulta atendida en centros de salud de la Comunidad Valenciana. Métodos: Estudio observacional transversal analítico realizado entre febrero y agosto de 1997. Variables independientes: parámetros socioeconómicos, frecuentación de los servicios de salud y problemas de salud autopercibidos o diagnosticados. Variable independiente: número de medicamentos consumidos. Resultados: De los 812 pacientes, 801 tomaban medicamentos. El 80% de los problemas de salud por los que se medicaban pertenece a 5 aparatos y sistemas (media: 3,3 problemas de salud por paciente). Los 5 grupos terapéuticos más consumidos suponen el 81% del total (media: 4,5 medicamentos por paciente). Se evidenció un mayor consumo significativo por la mujer de medicamentos de los grupos terapéuticos del sistema nervioso central e infecciones genitourinarias, y mayor consumo por los varones de medicamentos de los grupos terapéuticos del sistema respiratorio y terapia antiinfecciosa sistémica. El uso de los medicamentos incrementó con la edad, el menor nivel educativo, menor categoría profesional y con la mayor frecuencia de visitas. También se encontraron diferencias significativas en el uso de medicamentos según la situación laboral, estado marital y la estructura familiar. El análisis multivariante mostró que el número de problemas de salud y la frecuencia de visitas explicaban el 82,2% de la variabilidad de la variable «número de medicamentos consumidos». La variabilidad representada por el género se explicó por la variable de problemas de salud, el principal factor subyacente del consumo de medicamentos entre mujeres y hombres. Conclusiones: El hallazgo principal es, probablemente, que las mujeres no utilizan mayor número de medicamentos que los hombres al ajustar por problemas de salud y la frecuencia de las visitas (AU)

Acute spinal epidural hematoma and systemic mastocytosis.

BACKGROUND: Systemic mastocytosis is a mast cell proliferative disorder affecting many organs that is rarely associated with internal bleeding. OBJECTIVE: To describe a case of spinal epidural hematoma in a patient with past medical history of urticaria pigmentosa and osteoporosis diagnosed with systemic mastocytosis. CASE REPORT: A 63-year-old woman with urticaria pigmentosa was admitted to hospital for severe back pain after minor trauma. Physical examination showed pain on pressing T12 and L1 spinous processes, bilateral Lasègue sign, absent ankle jerk, and extensor plantar response. Computed tomography disclosed L3 fracture, and magnetic resonance imaging revealed spinal epidural hematoma and T2 hyperintensive scattered vertebral foci that suggested malignancy. The 24-hour urine histamine was very high. Mast cell infiltration was found in bone marrow biopsy. Because power was normal and there was no clinical sphincter disorder, the patient was successfully treated with conservative care. CONCLUSIONS: To our knowledge, acute intraspinal epidural hematoma has never been associated with mastocytosis. The hematoma was likely related to the vertebral fracture as well as a hemorrhagic diathesis due to anticoagulants released by local mast cells.

Risk factors for invasive disease among children in Spain.

OBJECTIVE: To identify the risk factors related to invasive disease caused by Haemophilus influenzae type b (Hib), Neisseria meningitidis, and Streptococcus pneumoniae. METHODS: Case-control study. All hospitals of the region of Valencia in Spain (covering 95% of the population of Valencia). The patients are children aged less than 15 years in whom Hib, N. meningitidis or S. pneumoniae are isolated from normally sterile sites. RESULTS: From 1995 to 1998, 275 cases of invasive disease were analysed, and 243 hospital controls were selected in the month after the onset of the case. The paediatrician completed a survey administered to the relatives at the time of admission. The risk factors related to invasive disease by Hib were exposure to tobacco smoke (number of smokers, adjusted OR (aOR) 1.74, 95% confidence interval (CI) 1.02-2.96) and living with more than four people (aOR 3.72, 95% CI 1.3-3.7). For N. meningitidis, there is a dose-response relationship; if more than 60 cigarettes are smoked daily at home, the aOR is 3.61 (95% CI 1.04-12.57). If there are more than four people living in the household, aOR 1.69 (95% CI 1.01-2.85). In children under two years of age, having siblings less than 15 years of age (OR 1.76, 95% CI 0.75-4.17) and attending a day nursery represents a risk for suffering invasive pneumococcal disease (aOR 4.21, 95% CI 1.28-13.83). CONCLUSIONS: Among the variables tested, the modifiable risk factor is smoking; if smoking was reduced at home, the number of cases of invasive disease could be reduced in children, mainly in those under 5 years of age. Identification and vaccination of these risk groups would significantly reduce these diseases.

Accuracy of pharmaceutical advertisements in medical journals.

BACKGROUND: Because of the effect of the ever-growing evidence-based medicine movement on prescribing behaviour of doctors, the pharmaceutical industry incorporates bibliographical references to clinical trials that endorse their products in their advertisements. We aimed to assess whether the references about efficacy, safety, convenience, or cost of antihypertensive and lipid-lowering drugs included in advertisements supported the promotional claims. METHODS: We assessed all advertisements for antihypertensive and lipid-lowering drugs published in six Spanish medical journals in 1997 that had at least one bibliographical reference. Two pairs of investigators independently reviewed the advertisements to see whether the studies quoted to endorse the advertising messages supported the corresponding claims. FINDINGS: We identified 264 different advertisements for antihypertensive drugs and 23 different advertisements for lipid-lowering drugs. We recorded at least one reference in 31 advertisements in the antihypertensive group and at least one reference in every seven advertisements in the lipid-lowering group, providing a total of 125 promotional claims with references. We could not retrieve 23 (18%) references from monographic works and non-published data on file. 79 (63%) of the 125 references were from journals with a high impact factor; 84 (82%) of the 102 references retrieved were from randomised clinical trials. In 45 claims (44.1%; 95% CI 34.3-54.3) the promotional statement was not supported by the reference, most frequently because the slogan recommended the drug in a patient group other than that assessed in the study. INTERPRETATION: Doctors should be cautious in assessment of advertisements that claim a drug has greater efficacy, safety, or convenience, even though these claims are accompanied by bibliographical references to randomised clinical trials published in reputable medical journals and seem to be evidence-based.