Safety of prasterone in breast cancer survivors treated with aromatase inhibitors: the VIBRA pilot study.

BACKGROUND: Due to safety concerns on estrogen-based treatments for genitourinary syndrome of menopause (GSM) in breast cancer survivors (BCS), new options are appearing, such as androgen-based treatments, which according to proprieties would not be transformed systemically to estrogens in patients receiving aromatase inhibitors (AIs). OBJECTIVE: The aim of this pilot study is to assess the security and efficacy of vaginal prasterone (dehydroepiandrostenedione [DHEA]) in BCS treated with AIs. METHODS: This open, prospective, pilot study included 10 BCS treated with AIs. All participants complained of severe GSM. DHEA was administrated as a vaginal ovule. Participants were instructed to use one ovule every night during the first month, and one ovule every two nights for the entire five remaining months. The patients were requested to attend seriated visits after the beginning of the prasterone treatment to evaluate symptoms, physical improvement and serum estradiol. RESULTS: Mean serum estradiol remained low from 3.4 pg/ml to 4.3 pg/ml (p = 0.9136) after 6 months of follow-up. The visual analog scale of dyspareunia improved from 8.5 to mean values after treatment of 0.4 (p = 0.0178). The Vaginal Health Index (VHI) scale and Female Sexual Function Index improved from 9.75 to 15.8 (p = 0.0277) and from an initial score of 11.2 to 20.6 (p = 0.0277), respectively. Vaginal pH changed from basal 8.1 to final 6.5 (p = 0.0330). CONCLUSION: Symptoms and physical examination regarding sexuality and vaginal health improved significantly, while serum estradiol remained at low levels. Prasterone seems a safe and effective option to treat GSM in BCS receiving AIs.

Prevalence and Co-Occurrence of Different Types of Body Dysmorphic Disorder Among Men Having Sex with Men.

Body dysmorphic disorder (BDD) is a relatively common psychiatric condition of which the prevalence has not been fully investigated in the non-clinical population, and in particular among men having sex with men (MSM). MSM have proven to be more inclined to develop body dissatisfaction and body image disorders compared to non-MSM. Our study investigates the prevalence of BDD and the prevalence and co-occurrence of muscle dysmorphia (MD) and penile dysmorphic disorder (PDD) in a sample of 261 Italian MSM recruited online. From our data, gathered through self-report measures, the prevalence of BDD, MD, and PDD in our populations was 5.4%, 8.8%, and 4.2%, respectively. Compared to their elders, younger adults (ages 18-34) appear to be at higher risk of BDD and especially of MD. Non-significant differences have been observed for the prevalence of PDD depending on the age range. Our study shows that the risk of body image disorders among MSM is quite common, especially among young adults, and higher than what is found among heterosexual men.

Guía de actuación para el manejo de la infección por COVID-19 durante en el embarazo / A clinical management protocol for COVID-19 infection in pregnant women

La infección causada por el nuevo coronavirus SARS-CoV-2 (COVID-19) representa actualmente una de las mayores emergencias sanitarias a nivel mundial. La aparición de una nueva infección potencialmente grave y la situación de pandemia actual ha implicado importantes ajustes en la práctica clínica en medicina materno-fetal. Aunque no parece existir una mayor afectación o susceptibilidad al virus de las mujeres embarazadas respecto la población general, existen aspectos específicos ligados a la gestación que deben tenerse en cuenta de cara al diagnóstico y manejo de la COVID-19 en pacientes embarazadas. En el siguiente documento se exponen las recomendaciones y el protocolo de actuación ante la infección por COVID-19 durante el embarazo desarrollado en nuestro centro, basado en la evidencia científica disponible hasta la fecha y las principales recomendaciones internacionales

The severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) disease (COVID-19) has caused a large global outbreak and has had a major impact on health systems and societies worldwide. The generation of knowledge about the disease has occurred almost as fast as its global expansion. Very few studies have reported on the effects of the infection on maternal health, since its onset. The mother and foetus do not seem to be at particularly high risk. Nevertheless, obstetrics and maternal-foetal medicine practice have made profound changes in order to adapt to the pandemic. In addition, there are aspects specific to COVID-19 and gestation that should be known by specialists. In this review an evidenced-based protocol is presented for the management of COVID-19 in pregnancy

[A clinical management protocol for COVID-19 infection in pregnant women]. / Guía de actuación para el manejo de la infección por COVID-19 durante en el embarazo.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) has caused a large global outbreak and has had a major impact on health systems and societies worldwide. The generation of knowledge about the disease has occurred almost as fast as its global expansion. Very few studies have reported on the effects of the infection on maternal health, since its onset. The mother and foetus do not seem to be at particularly high risk. Nevertheless, obstetrics and maternal-foetal medicine practice have made profound changes in order to adapt to the pandemic. In addition, there are aspects specific to COVID-19 and gestation that should be known by specialists. In this review an evidenced-based protocol is presented for the management of COVID-19 in pregnancy.

Parent and peer attachment as predictors of facebook addiction symptoms in different developmental stages (early adolescents and adolescents).

Facebook Addiction (FA) is a problem that concerns minors all over the world. The attachment bond with peers and parents has been proven to be a risk factor for the onset of FA. However, the family and peer group can have a different importance depending on the developmental period of the minor. This study examined the influence of peer and parental attachment on the symptoms of FA in early adolescents and adolescents to verify whether attachment to peers and parents predicts FA symptoms in both categories respectively. The sample was composed of 598 participants (142 early adolescents) between the ages of 11 and 17 years (M age = 14.82, SD = 1.52) recruited in the school setting. Multivariate multiple regressions were performed. For early adolescents the relationships with their parents influenced the levels of FA the most (such as withdrawal, conflict, and relapse), whereas peer relationships (such as, peer alienation) were the most relevant for adolescents. Our study provides support to the role of attachment to peers and parents as a risk factor for symptoms of FA. In line with developmental theories, parents and peers acquire a different weight in predicting the relationship between attachment and FA for early adolescents and adolescents respectively. Clinical implications and future research directions are discussed.

Swimming pool attendance and risk of asthma and allergic symptoms in children.

Increased asthma risk has been associated with pool attendance in children but evidence is inconsistent and inconclusive. A survey was conducted of 3,223 9-12-yr-old children in Sabadell (Spain) to evaluate association between swimming pool attendance and prevalence of asthma and allergic conditions and symptoms. Parents completed a questionnaire on lifetime frequency of pool attendance and symptoms in the last 12 months (wheezing, asthma medication, rhinitis and allergic rhinitis), ever having asthma and eczema, and potential confounders. Indicators of indoor and outdoor swimming pool attendance early in life, cumulatively and currently were calculated. Swimming pool attendance before the age of 2 yrs was associated with slightly lower prevalence of current asthma (OR 0.79, 95% CI 0.43-1.46), rhinitis (OR 0.86, 95% CI 0.68-1.08) and allergic rhinitis symptoms (OR 0.72, 95% CI 0.54-0.96) compared to those who started attending swimming pools after 4 yrs of age. An increased prevalence of eczema was associated with duration of lifetime pool attendance (OR 1.71, 95%CI 1.38-2.12 for >5 yrs versus 0 yrs). Swimming pool attendance in Spanish children was associated with slightly less upper and lower respiratory tract symptoms and with more eczema. Longitudinal studies are required to confirm these findings and avoid potential reverse causation.

[Secondary amyloidosis (AA-type) due to localized cutaneous vasculitis]. / Amiloidosis secundaria asociada a vasculitis cutánea localizada.

We report a case of a 49 year old man, diagnosed soon after the outcome of casual proteinuria, of AA-type amyloidosis in relation to small and medium vessel cutaneous vasculitis without systemic involvement. This combination is a rare entity and only two cases of cutaneous hypersensibility vasculitis complicated with AA-type amyloidosis had been reported. We describe the results of the use of several immunosuppressive drugs during four years follow up with temporally total remission of the disease.

Amiloidosis secundaria asociada a vasculitis cutánea localizada / Secondary amyloidosis (AA-type) due to localized cutaneous vasculitis summary

Presentamos el caso de un paciente de 49 años de edad, diagnosticado a raíz del hallazgo de proteinuria aislada, de amiloidosis AA asociada a vasculitis de mediano y pequeño calibre con afectación exclusivamente cutánea. Esta asociación es muy poco frecuente y sólo se han descrito dos casos de vasculitis por hipersensibilidad y amiloidosis AA. Comentamos la evolución a lo largo de cuatro años en que ha sido tratado con distintos inmunosupresores, consiguiendo algún período de remisión completa de la enfermedad

We report a case of a 49 years old man, diagnosed soon after the outcome of casual proteinuria, of AA-type amyloidosis in relation to small and medium vessel cutaneous vasculitis without systemic involvement. This combination is a rare entity and only two cases of cutaneous hipersensiblility vasculitis complicated with AA-type amyloidosis had been reported. We describe the results of the use of several inmunossupressive drugs during four years follow up with temporally total remission of the disease

[Renal involvement in amyloidosis. Clinical outcomes, evolution and survival]. / Afectación renal en la amiloidosis. Características clínicas, evolución y supervivencia.

BACKGROUND: Systemic amyloidosis is a disease resulting from extracellular deposition of fibrillar protein in various organs. Main systemic amyloidosis are: primary (AL) and Secondary (AA). The kidney is usually involved, conferring and adverse prognosis. In the last decade there has been a change in the aetiology of AA amyloidosis. OBJECTIVES: To analyse the incidence of AL and AA amyloidosis in our current population as well as the aetiology of AA amyloidosis. To describe clinical outcomes, renal involvement and survival. PATIENTS AND METHODS: We performed a descriptive analysis of all cases of amyloidosis diagnosed from 1992 to 2004 in our hospital. Diagnosis was assessed on histological criteria: positivity Congo Red stain. Clinical data, renal involvement, dialysis treatment and survival were analysed. RESULTS: 76 cases, 44 women, mean age 70.7 +/- 12. Types: 55 AA (72%), 21 AL (28%) systemic amyloidosis. AA aetiology was: 66% rheumatic disorders, 28% infectious disease, 6% others. Incidence for AL was 4.6 and for AA 12.2 cases/million. Renal involvement was present in 75% at diagnosis (69% Creatinine clearance < 60 ml/min, 37% urinary protein > 3 g/24 hours). 21 cases (28%) progressed to renal disease stage V in the 8.1 +/- 9.8 months follow up period, and 14 cases started dialysis treatment (10 HD, 4 CAPD). In 7 cases (33%) dialysis was not indicated due to their poor clinical condition, short life expectancy and bad quality of life. Mean global survival at diagnosis was 55% and 40% at 12 and 24 months (AL 58% and 19%; AA 55% and 44%). Mean survival from the start of dialysis was 30% and 5% at 12 and 24 months. CONCLUSIONS: Although amyloidosis has a low incidence in our population, the kidney is usually involved. Rheumatological disorders are the principal aetiology of AA amyloidosis. Long term survival is poor, specially for AL.

Afectación renal en la amiloidosis. Características clínicas, evolución y supervivencia / Renal involvement in amyloidosis. Clinical outcomes, evolution and survival

Fundamento: La amiloidosis es una enfermedad sistémica caracterizada por eldepósito extracelular de material proteico fibrilar en disposición en lámina betaplegada. Las principales formas de amiloidosis sistémicas son la amiloidosis primaria(AL) y la secundaria (AA). La afectación renal es frecuente, confiriéndoleun pronóstico poco favorable. En los últimos años estamos asistiendo a un cambioen la etiología de las formas secundarias.Objetivo: Analizar la incidencia de AL y AA en nuestra área de referencia así comola etiología de AA. Describir la presentación clínica, la afectación renal y la evolución.Material y métodos: Análisis descriptivo de los casos de amiloidosis de nuestrohospital en el período 1992-2004. Criterio diagnóstico: histología positiva para RojoCongo. Se analizan las variables clínicas, afectación renal, inclusión en diálisis ysupervivencia.Resultados: Setenta y seis casos, 44 mujeres, edad media 70,7 ± 12. Tipos: 55AA (72%), 21 AL (28%), etiología AA: 66% reumatológicas, 28% infecciosas, 6%otras. La incidencia fue: AL 4,6 y AA 12,2 casos /millón. El 75% tenían afectaciónrenal al diagnóstico (69% ClCreat 3 g/24horas). 21 casos (28%) evolucionaron a insuficiencia renal grado V en un tiempomedio de 8,1 ± 9,8 meses, iniciando diálisis 14 pacientes (10 HD, 4 CAPD).En 7 casos (33%) no recibieron tratamiento dialítico por la importante afectacióndel estado general y la mala calidad de vida. La supervivencia actuarial globaldesde el momento del diagnóstico fue de 55% y 40% a los 12 y 24 meses (AL58% y 19%; AA 55% y 44%). La supervivencia actuarial desde el inicio de diálisisfue de 30% y 5% a los 12 y 24 meses.Conclusiones: Aunque la amiloidosis es una patología con escasa incidencia enla población general, la afectación renal es muy frecuente. Las enfermedades reumatológicasson la principal causa de AA. La supervivencia es limitada, especialmentepara las formas AL

Background: Systemic amyloidosis is a disease resulting from extracellular depositionof fibrillar protein in various organs. Main systemic amyloidosis are: primary (AL) and Secondary (AA). The kidney is usually involved, conferring and adverseprognosis. In the last decade there has been a change in the aetiology ofAA amyloidosis.Objectives: To analyse the incidence of AL and AA amyloidosis in our currentpopulation as well as the aetiology of AA amyloidosis. To describe clinical outcomes,renal involvement and survival.Patients and methods: We performed a descriptive analysis of all cases of amyloidosisdiagnosed from 1992 to 2004 in our hospital. Diagnosis was assessed onhistological criteria: positivity Congo Red stain. Clinical data, renal involvement,dialysis treatment and survival were analysed.Results: 76 cases, 44 women, mean age 70.7 ± 12. Types: 55 AA (72%), 21AL (28%) systemic amyloidosis. AA aetiology was: 66% rheumatic disorders, 28%infectious disease, 6% others. Incidence for AL was 4.6 and for AA 12.2 cases/million. Renal involvement was present in 75% at diagnosis (69% Creatinine clearance 3 g/24 hours). 21 cases (28%) progressedto renal disease stage V in the 8.1 ± 9.8 months follow up period, and14 cases started dialysis treatment (10 HD, 4 CAPD). In 7 cases (33%) dialysiswas not indicated due to their poor clinical condition, short life expectancy andbad quality of life. Mean global survival at diagnosis was 55% and 40% at 12and 24 months (AL 58% and 19%; AA 55% and 44%). Mean survival from thestart of dialysis was 30% and 5% at 12 and 24 months.Conclusions: Although amyloidosis has a low incidence in our population, thekidney is usually involved. Rheumatological disorders are the principal aetiologyof AA amyloidosis. Long term survival is poor, specially for AL

Afectación renal en la amiloidosis. Características clínicas, evolución y supervivencia / Renal involvement in amyloidosis. Clinical outcomes, evolution and survival

Fundamento: La amiloidosis es una enfermedad sistémica caracterizada por el depósito extracelular de material proteico fibrilar en disposición en lámina beta plegada. Las principales formas de amiloidosis sistémicas son la amiloidosis primaria (AL) y la secundaria (AA). La afectación renal es frecuente, confiriéndole un pronóstico poco favorable. En los últimos años estamos asistiendo a un cambio en la etiología de las formas secundarias. Objetivo: Analizar la incidencia de AL y AA en nuestra área de referencia así como la etiología de AA. Describir la presentación clínica, la afectación renal y la evolución. Material y métodos: Análisis descriptivo de los casos de amiloidosis de nuestro hospital en el período 1992-2004. Criterio diagnóstico: histología positiva para Rojo Congo. Se analizan las variables clínicas, afectación renal, inclusión en diálisis y supervivencia. Resultados: Setenta y seis casos, 44 mujeres, edad media 70,7 ± 12. Tipos: 55 AA (72%), 21 AL (28%), etiología AA: 66% reumatológicas, 28% infecciosas, 6% otras. La incidencia fue: AL 4,6 y AA 12,2 casos /millón. El 75% tenían afectación renal al diagnóstico (69% ClCreat 3 g/24 horas). 21 casos (28%) evolucionaron a insuficiencia renal grado V en un tiempo medio de 8,1 ± 9,8 meses, iniciando diálisis 14 pacientes (10 HD, 4 CAPD). En 7 casos (33%) no recibieron tratamiento dialítico por la importante afectación del estado general y la mala calidad de vida. La supervivencia actuarial global desde el momento del diagnóstico fue de 55% y 40% a los 12 y 24 meses (AL 58% y 19%; AA 55% y 44%). La supervivencia actuarial desde el inicio de diálisis fue de 30% y 5% a los 12 y 24 meses. Conclusiones: Aunque la amiloidosis es una patología con escasa incidencia en la población general, la afectación renal es muy frecuente. Las enfermedades reumatológicas son la principal causa de AA. La supervivencia es limitada, especialmente para las formas AL

Background: Systemic amyloidosis is a disease resulting from extracellular deposition of fibrillar protein in various organs. Main systemic amyloidosis are: primary (AL) and Secondary (AA). The kidney is usually involved, conferring and adverse prognosis. In the last decade there has been a change in the aetiology of AA amyloidosis. Objectives: To analyse the incidence of AL and AA amyloidosis in our current population as well as the aetiology of AA amyloidosis. To describe clinical outcomes, renal involvement and survival. Patients and methods: We performed a descriptive analysis of all cases of amyloidosis diagnosed from 1992 to 2004 in our hospital. Diagnosis was assessed on histological criteria: positivity Congo Red stain. Clinical data, renal involvement, dialysis treatment and survival were analysed. Results: 76 cases, 44 women, mean age 70.7 ± 12. Types: 55 AA (72%), 21 AL (28%) systemic amyloidosis. AA aetiology was: 66% rheumatic disorders, 28% infectious disease, 6% others. Incidence for AL was 4.6 and for AA 12.2 cases/ million. Renal involvement was present in 75% at diagnosis (69% Creatinine clearance 3 g/24 hours). 21 cases (28%) progressed to renal disease stage V in the 8.1 ± 9.8 months follow up period, and 14 cases started dialysis treatment (10 HD, 4 CAPD). In 7 cases (33%) dialysis was not indicated due to their poor clinical condition, short life expectancy and bad quality of life. Mean global survival at diagnosis was 55% and 40% at 12 and 24 months (AL 58% and 19%; AA 55% and 44%). Mean survival from the start of dialysis was 30% and 5% at 12 and 24 months. Conclusions: Although amyloidosis has a low incidence in our population, the kidney is usually involved. Rheumatological disorders are the principal aetiology of AA amyloidosis. Long term survival is poor, specially for AL

[Ischemic renal disease: revascularization or conservative treatment?]. / Nefropatía isquémica: revascularización o tratamiento médico conservador?

Ischemic nephropathy is recognized as a distinct cause of renal insufficiency and it is defined as a significant reduction in glomerular filtration rate in patients with hemodynamically significant renovascular occlusive disease. We argue the epidemiologic and clinical manifestations of atherosclerotic renovascular disease, and we evaluate the pronostic agents. Published studies of the outcome of revascularization for renal-artery stenosis have been excellent, offering a durable patency and functional improvement but they have had numerous limitations. The atherosclerosis is a systemic disease and it provides the general prognosis of patients. We conclude that ischemic renal disease is a nephropathy of smoker men, with proteinuria excretion similar to nephropathy with unilateral stenosis. The age of patients is the clinical feature that decide the treatment: surgery, angioplasty/stent or medical management. Comparative analysis of percutaneous transluminal angioplasty and operation for renal revascularization and medically treated patients have proved that the advanced chronic renal insufficiency is associated with an unfavourable response of treatment of the ischemic nephropathy. But, in this nephropathy the revascularization can be the better therapy for selected patients. The revascularization with angioplasty/stent for patients with unilateral renal stenosis and chronic renal insufficiency has a doubtful effectiveness, as the chronic renal failure is result of nephroangiosclerosis.

Nefropatía isquémica: ¿revascularización o tratamiento médico conservador? / Ischemic renal disease: revascularization or conservative treatment?

La nefropatía isquémica es la enfermedad renal que origina insuficiencia renala través de la reducción de filtrado glomerular, a consecuencia de la alteraciónsignificativa del flujo arterial renal principal.Se valoran los factores etiopatogénicos de la nefropatía isquémica y de otrasnefropatías vasculares como la nefroangiosclerosis. Se revisan también sus factorespronósticos.La revascularización tendría que ser el mejor tratamiento de la nefropatía isquémica.Sin embargo, cuando las estenosis de las arterias renales son consecuenciade lesiones arteriosclerosas, al incidir esta enfermedad de manera generalen todo el organismo, no está tan claro que la revascularización sea la mejoropción terapéutica.Partiendo de poblaciones seleccionadas, no equiparables entre sí, nos proponemosestablecer el mejor tratamiento para cada una de ellas. Hemos podidocomprobar que la afectación arteriosclerosa de las arterias renales en nuestro contextoes una enfermedad predominante en pacientes varones con hábito tabáquico,y que el daño parenquimatoso renal atendiendo a la determinación de proteinuriaes parecido entre la verdadera nefropatía isquémica y la nefropatía vascularcon afectación arterial unilateral.Nuestros datos muestran que la edad es el único factor determinante de la opciónterapéutica a seguir y que el grado de insuficiencia renal crónica en el momentodel diagnóstico es índice pronóstico independiente de la nefropatía isquémica.La revascularización renal tiende a ser la mejor opción terapéutica enpoblación seleccionada afecta de nefropatía isquémica. La revascularización renalendovascular, en casos de afectación renal unilateral con insuficiencia renal, ofreceresultados más dudosos de efectividad, ya que dicha insuficiencia renal crónicasería atribuible a la afectación renal intraparenquimatosa

Ischemic nephropathy is recognized as a distinct cause of renal insufficiencyand it is defined as a significant reduction in glomerular filtration rate in patientswith hemodynamically significant renovascular occlusive disease.We argue the epidemiologic and clínical manifestations of atherosclerotic renovasculardisease, and we evaluate the pronostic agents.Published studies of the outcome of revascularization for renal-artery stenosishave been excellent, offering a durable patency and functional improvement butthey have had numerous limitations. The atherosclerosis is a systemic disease andit provides the general prognosis of patients.We conclude that ischemic renal disease is a nephropathy of smoker men, withproteinuria excretion similar to nephropathy with unilateral stenosis. The age ofpatients is the clinical feature that decide the treatment: surgery, angioplasty/stentor medical management.Comparative analysis of percutaneous transluminal angioplasty and operation forrenal revascularization and medically treated patients have proved that the advancedchronic renal insufficiency is associated with an unfavourable response oftreatment of the ischemic nephropathy. But, in this nephropathy the revascularizationcan be the better therapy for selected patients. The revascularization withangioplasty/stent for patients with unilateral renal stenosis and chronic renal insufficiencyhas a doubtful effectiveness, as the chronic renal failure is result ofnephroangiosclerosis

[Arteriovenous fistula: complication of renal biopsy. Superselective embolization]. / Fístula arteriovenosa: complicación de biopsia renal. Embolización supraselectiva.

The arteriovenous fistula can be a major and late complication of percutaneous renal biopsies of native kidneys. The incidence of arteriovenous fistulas appears to be low and has been infrequently mentioned in large series of biopsies although there are a number of individual reports. In most part of cases, no systemic effects of the arteriovenous fistulas were observed, so they close by themselves. Optimization of renal biopsy techniques aims not only at obtaining kidney tissue technically adequate for diagnosis, but at reducing biopsy-induced complications. When these complications are done, the new transvascular techniques can get the healing of fistula with the embolism by catheters. We describe the case of a 37-year-old woman who had chronic renal failure by a possible chronic glomerulonephritis. She developed deterioration of renal function after the percutaneous renal biopsy. An arteriovenous fistula of high flow was detected by Doppler ultrasound. Then, it was confirmed angiographically and closed by embolism's catheter without damage of renal tissue.

[Primary antiphospholipid syndrome associated with malignant hypertension]. / Síndrome antifosfolipídico primario e HTA maligna.

The antiphospholipid syndrome is defined by the presence of antiphospholipid antibodies and recurrent thrombosis, affecting the venous system more frequently than the arterial one. Renal involvement is only observed in approximately 20-25% of cases, main renal artery thrombosis has been exceptionally described. We report a 39-year-old woman with previous history of recurrent thrombosis diagnosed as primary antiphospholipid syndrome, who presented malignant hypertension in the context of a renal artery thrombosis. She had a high IgG anticardiolipin antibody titre and positive lupus anticoagulant. An isotopic renogram demonstrated asymmetrical activity (60% right vs 40% left kidney). Renal arteriography demonstrated preoclusive thrombosis in the left renal artery. Blood pressure was well controlled by the use of ACE-inhibitor and alpha blockers.

Material educativo en la diabetes gestacional / Educational material in gestational diabetes

Este artículo presenta el material didáctico elaborado para facilitar la tarea educativa en las mujeres diagnosticadas de diabetes gestacional (AU)

Síndrome antifosfolipídico primario e HTA maligna / Antiphospholipid síndrome associated to malignat hypertension

El síndrome antifosfolipídico viene definido por la presencia de anticuerpos antifosfolípidos y trombosis de repetición, siendo más prevalentes las trombosis venosas que las arteriales. La afectación renal en el síndrome antifosfolipídico primario es poco frecuente, oscilando entre un 20-25% de los casos y siendo la trombosis de la arteria renal principal un acontecimiento raramente descrito. Presentamos el caso de una mujer de 39 años, con historia previa de trombosis de repetición y diagnosticada de síndrome antifosfolipídico primario, que desarrolló hipertensión arterial maligna en el contexto de una oclusión de la arteria renal. Presentaba anticuerpos anticardiolipina IgG positivos a títulos elevados, anticoagulante lúpico positivo. El renograma isotópico objetivó una asimetría en la captación renal (60% a nivel del riñón derecho y un 40% a nivel del riñón izquierdo). La arteriografía renal detectó una trombosis pre-oclusiva de la arteria renal izquierda. Se consiguió un control óptimo de la presión arterial mediante el tratamiento con inhibidores de la ECA y alfa-bloqueantes (AU)

The antiphospholipid syndrome is defined by the presence of antiphospholipid antibodies and recurrent thrombosis, affecting the venous system more frequently than the arterial one. Renal involvement is only observed in approximatelly 20- 25% of cases, main renal artery thrombosis has been exceptionally described. We report a 39 year old woman with previous history of recurrent thrombosis diagnosed as primary antiphospholipid syndrome, who presented malignant hypertension in the context of a renal artery thrombosis. She had a high IgG anticardiolipin antibodies title and positive lupic anticoagulant. An isotopic renogram demonstrated assymetrical activity (60% right vs 40% left kidney). Renal arteriography demonstrated preoclusive thrombosis in the left renal artery. Blood pressure was well controlled by the use of ACE-inhibitor and alfablockers (AU)

Déficit de yodo durante la gestación / No disponible

El déficit de yodo (DY) durante la gestación puede tener importantes repercusiones en la función tiroidea tanto materna como fetal, pudiendo llegar a desencadenar un hipotiroidismo materno y neonatal. En mujeres en edad fértil, el hipotiroidismo puede reducir la fertilidad e incrementar el número de abortos espontáneos. Además, cuando consiguen un embarazo se altera la adaptación de la glándula tiroides a los cambios que se producen durante la gestación, y pueden presentar una hiperplasia tiroidea en forma de bocio. En el feto, el déficit materno de yodo constituye una de las principales causas de lesiones cerebrales y de retraso mental de carácter irreversible. Es importante que las matronas conozcan estas repercusiones e incluyan en el programa de educación sanitaria a la mujer embarazada recomendaciones para garantizar el aporte adecuado de yodo, como puede ser el consumo de pescado y la utilización de sal yodada para la condimentación de los alimentos. Además, deberán derivar al médico a aquellas mujeres que presenten una deficiencia de yodo para que realicen una suplementación si fuera necesario (AU)

The iodine deficiency (ID) during pregnancy can have serious repercussions on the mother´s and foetus´ thyroid function which can lead to a maternal and neona tal hypothyroidism. Among women in fertile age, hypotyroidism can reduce fertility and increase the number of miscarriages. Moreover, when they get pregnancy , the thyroid gland don’t adapt to the changes that are produced during the pregnancy and goiter thyroid hyperplasia can appear. As for the foetus, the maternal iodine deficit is one of the main causes for brain-damage and irreversible mental deficiency. It is very important that midwives know these repercussions and that they include in the health care education to the pregnancy woman, the following recommendations in order to assure the sufficient iodine contribution: Intake of fish and use of iodized salt. Furthermore, they must refer to the doctor those women with iodine deficiency, for iodine supplementation if it is necessary (AU)

Long-acting lacidipine versus short-acting nifedipine in the treatment of asymptomatic acute blood pressure increase.

We compared antihypertensive efficacy and safety of a single administration of equipotent doses of lacidipine versus nifedipine in the hypertensive urgencies. Twenty-nine asymptomatic essential hypertensive patients (nine men, 20 women) with a mean age of 55.03+/-11.19 years and baseline diastolic blood pressure (DBP) of > or =120 mm Hg after resting 30 min, not taking antihypertensive drugs for the last 24 h, were randomized in a single-blind fashion to receive lacidipine, 4 mg (LCD, 15 patients) or short-acting nifedipine, 20 mg (NFD, 14 patients) in a single dose. Blood pressure (BP) and heart rate (HR) were taken every 30 min during the first 8 h and every 2 h until 24 h of follow-up. Baseline BP values were similar in the two groups (LCD, 222.5+/-32.8/124.6+/-8.4 mm Hg vs. NFD, 215.9+/-20.6/128+/-7.7 mm Hg; p = NS). Both drugs promoted a significant reduction of systolic blood pressure (SBP; 169.6+/-27.8 vs. 170.6+/-25.3 mm Hg) and diastolic blood pressure (DBP; 104.1+/-16 vs. 102.9+/-12.4 mm Hg) after 8 h. However, either SBP (165+/-27.3 vs. 190.6+/-18.2 mm Hg; p = 0.008) and DBP (99.9+/-12.3 vs. 117.2+/-11.4 mm Hg; p = 0.001) were significantly higher in the NFD group after 24-h dosing. Eleven patients in the LCD group had a decrease in BP >25% of the baseline value both 8 and 24 h after the dose. Although 10 patients showed the same response in the NFD group 8 h after the dose, only four patients maintained these values at 24 h. One patient treated with NFD had a transient cerebrovascular ischemic attack. No adverse effects were observed in the LCD group. We conclude that the long-acting calcium antagonist lacidipine was more effective than the short-acting nifedipine in both controlling BP and maintaining this BP reduction over 8 h in essential hypertensive patients with acute asymptomatic BP increase.