Hydroxychloroquine in obstetrics: New outlooks for therapy / La hidroxicloroquina en obstetricia. Nuevas perspectivas terapeuticas

Hydroxychloroquine is an antimalarial drug that is used to treat autoimmune diseases. It is safe in pregnancy and compatible with breastfeeding. Hydroxychloroquine is the drug of choice in pregnant women in need of treatment. Recently, it has proven useful for the treatment of refractory antiphospholipid syndrome and prevention of recurrence of congenital heart block in anti Ro/La-positive pregnant women. Two large prospective studies that will confirm the usefulness of this drug currently under way

La hidroxicloroquina es una droga antimalárica utilizada en enfermedades autoinmunes, segura en la gestación y en la lactancia, siendo la terapia de elección de mujeres gestantes que precisen tratamiento. Recientemente se ha visto su utilidad en el tratamiento del síndrome antifosfolipido refractario y en la prevención de la recurrencia del bloqueo cardiaco congénito en gestantes con anticuerpos antiRo/antiLa positivos. Están en marcha dos estudios prospectivos que confirmarán esta alternativa terapéutica

Embarazo en mujeres con cardiopatía estructural: experiencia de un centro / Pregnancy in women with structural heart disease: experience in a centre

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Macrocytic anemia and thrombocytopenia induced by orlistat.

INTRODUCTION: The overall incidence of obesity and its prevalence is increasing continuously. The obesity is a cardiovascular risk factor whose importance is increasing too. It is associated with many chronic conditions such as type II diabetes mellitus or cardiovascular diseases. The obesity is also implicated as a risk factor for several kinds of cancer such as esophagus, pancreas, colon, rectum, breast cancer in menopausal women. The treatment of the obesity may reduce the incidence of these diseases. The mainstray of the treatment of obesity is changing the lifestyles, but obesity´s treatment may need drug therapy or even though surgical treatment. Orlistat is a specific inhibitor of gastrointestinal lipases, which stops fat absortion. It is used along with a hypocaloric diet, for obesity´s treatment. The beneficial effects of orlistat include weight loss, the improvement of blood pressure´s control, it may delay the development of diabetes mellitus, and it may reduce HbA1c. CASE REPORT: Besides the interaction with other drugs (mainly warfarin and amiodarone). Orlistat´s mainly side effects are gastrointestinal disorders such as the existence of oily spotting from the rectum, abdominal pain or discomfort, fecal urgency. There are also side effects at other levels, like flu symptoms, hypoglycemia, heathache or upper respiratory infections. There are other side effects with very low incidence but clinically relevant like pancreatitis, subacute liver failure, severe liver disease, myopathy, or tubular necrosis secondary to oxalate nephropathy induced by Orlistat. DISCUSSION: IN THIS CASE REPORT APPEARS A NEW ADVERSE EFFECT OF ORLISTAT THAT HAS NOT BEEN DESCRIBED ABOVE: thrombopenia and macrocytic anemia.

Estimación ecográfica del peso fetal: ¿podemos mejorar nuestras predicciones? / Ultrasound estimation of fetal weight: can we improve our predictions?

Objetivos. a) Estudiar la validez de la estimación ecográfica del peso fetal y determinar qué fórmula permite mejores predicciones. B) Proponer una fórmula que se adapte mejor a nuestra población. Material y métodos. Estudio prospectivo en el que se incluyen 282 gestaciones únicas a término. Determinación del peso fetal mediante 17 fórmulas. Análisis de su validez mediante el error medio y el porcentaje de predicciones con un error menor del 10%. Resultados. Catorce fórmulas presentaron un error medio menor del 10%. Diez de ellas permiten más de un 65% de predicciones válidas, con un error inferior al 10%. Las que ofrecen mejores resultados son algunas de las propuestas por Hadlock y la de Aoki. La fórmula propuesta, usando 3 parámetros ecográficos, permite un 73,8% de predicciones válidas con un error inferior al 10% y un 87,9% con un error inferior al 15%. Conclusiones. La estimación por eco 2D tiene una validez limitada. La fórmula propuesta mejora las estimaciones en nuestra población (AU)

Objective. (a) To assess the validity of ultrasound estimation of fetal weight and to compare the accuracy of 17 sonographic formulae to predict fetal birth weight. (b) To propose a new formula that improves predictions in our population. Methods. We performed a prospective study that included 282 pregnant women at term. Seventeen formulae were used to predict fetal weight. To assess the accuracy of the predictions, the mean error and the percentage of estimations with a mean error of less than 10% were used. Results. Fourteen formulae provided a mean error lower than 10%. Ten of these formulae allowed estimations within ±10% of the actual birth weight in more that 65% of predictions. The most accurate formulae in predicting fetal weight were those of Hadlock and Aoki. With our formula, which employs three ultrasound parameters, 73.8% of estimations were valid with a mean error of 10% and 87.9% had an error of less than 15%. Conclusions. The accuracy of fetal weight estimation by ultrasound is limited and may improve with the new formula adjusted to our population (AU)

Osteoporosis transitoria de cadera y gestación / Transient osteoporosis of the hip and pregnancy

La osteoporosis transitoria de cadera es una entidad rara, de etiología desconocida. Afecta a varones de mediana edad y a mujeres en el tercer trimestre del embarazo. Se caracteriza por dolor inguinal agudo, progresivo e incapacitante sin antecedente de traumatismo.Las pruebas de laboratorio son normales, a excepción de la velocidad de sedimentación globular y los valores urinarios de hidroxiprolina, que pueden estar elevados. Los hallazgos radiológicos consisten en una desmineralización de la cabeza femoral, pero se manifiestan después de un periodo de ventana de 4-6 semanas. La resonancia magnética es la prueba más sensible y específica para su diagnóstico temprano, lo cual es importante para evitar potenciales complicaciones como fracturas patológicas.La resolución suele ser espontánea a los 6-8 meses, tanto clínica como radiológica. El tratamiento consiste en analgesia y descarga del miembro afectado. La calcitonina se utiliza como analgésico y parece disminuir la duración del proceso. Los bifosfonatos pueden también mejorar el pronóstico del mismo modo.Se describe un caso de osteoporosis transitoria de cadera bilateral en una gestante (AU)

Transient osteoporosis of the hip (TOH) is a rare disorder of unknown etiology, characterized by acute, progressive disabling pain in the hip without prior trauma. This disease is more common among middle-aged men and during the third trimester of pregnancy.Laboratory values are normal, except for erythrocyte sedimentation rate and urinary hydroxyproline levels, which can be elevated. Radiologic findings consist of demineralization of the femoral head, but are only apparent after a window of 4-6 weeks. Magnetic resonance imaging has been proven to be the most accurate test for an early diagnosis, which can be important to avoid potential complications such as pathological fractures.Both clinical and radiological signs of TOH usually resolve spontaneously at 6-8 months. Treatment consists of analgesics and restricted weight bearing of the affected limb. Calcitonin may be used as an analgesic and to shorten disease duration. Bisphosphonates are another alternative. We report a case of severe bilateral TOH in a pregnant woman (AU)

Epidermólisis ampollosa distrófica recesiva y gestación / Recessive dystrophic epidermolysis bullosa and pregnancy

La epidermólisis ampollosa distrófica recesiva noHallopeau-Siemens (EADR no-HS) es unaenfermedad hereditaria de la piel, infrecuente,caracterizada por una falta de adhesión cutánea quepuede involucrar también a mucosas, cuyo cursono se ve afectado por la gestación. Se debe ofrecerconsejo genético a las parejas que hayan tenido unniño con esta afección, ya que un 25% de los hijosde dichas parejas pueden tener la enfermedad. Sinembargo, en el caso de las pacientes, al tratarse deuna forma recesiva, el riesgo de tener un niñoafectado es menor de un 1%, recomendándose enestos casos el diagnóstico prenatal únicamente siexisten antecedentes familiares en su pareja oconsanguinidad o sospecha de consanguinidad(p. ej., ambas familias oriundas de una mismaregión geográfica). El parto por vía vaginal y lalactancia no están contraindicados, pero son difícilesy requieren una valoración individualizada y unoscuidados especiales (AU)

Recessive non-Hallopeau-Siemens dystrophicepidermolysis bullosa is a rare and severe inheritedskin disease characterized by increased skinfragility that can also involve the mucosa. Thisentity is not associated with pregnancycomplications. Genetic counselling must be offered,because the risk of recurrence in parents with anaffected child is 25%. However, becausetransmission is recessive, the risk of having affectedoffspring in individuals with the disease is lessthan 1%. Therefore prenatal diagnosis is onlyrequired if the partner has a familial history of thedisease or if there is consanguinity or suspectedconsanguinity (for example, if both families arefrom the same geographical area). Vaginal deliveryand breast feeding are not contraindicated, but aredifficult and require individual assessment andclose monitoring (AU)