Current practices and perceptions of misoprostol use for cervical preparation prior to outpatient hysteroscopy: a nationwide survey among gynecologists in Spain.

BACKGROUND: Although misoprostol has been used as a potential option for cervical priming prior to hysteroscopy, the available scientific evidence regarding its use is not always conclusive. The purpose of this article is to assess the different practices and criteria applied for the use of misoprostol use for cervical preparation in outpatient hysteroscopy without anesthesia among gynecologists across Spain, exploring the need for the corresponding evidence-based guidelines. METHODS: We carried out a cross-sectional study in which a two-step approach survey was conducted. Firstly, an online pilot survey was conducted with a limited sample of 10 professionals from 10 centers to identify initial patterns and gather feedback. Subsequently, a comprehensive online survey was carried out over a larger sample of respondents. The comprehensive survey covered aspects of misoprostol usage, including dosage, timing, indications, safety concerns, and overall perception. The survey design allowed for a thorough examination of existing practices and provided valuable insights to help address the disparities noted in misoprostol use for cervical preparation in outpatient hysteroscopies. RESULTS: Through the comprehensive online survey, we received response of 102 gynecologists from 54 centers across Spain. The overall results show a considerable variation in misoprostol use prior to hysteroscopy, with 21.57% of respondents not using misoprostol in any case, while a substantial majority (78.43%) use it selectively (68.83%) or consistently (9.8%). When asked about the type of patients, the vast majority (72.55%) use it in postmenopausal nulliparous patients, while its was used considerably less in premenopausal nulliparous patients (35.29%), postmenopausal multiparous patients (22.55%), and premenopausal multiparous patients (3.92%), whereas some choose not to use it in any patients (26.47%). Furthermore, 89.22% of respondents felt that there is a lack of clear criteria on misoprostol use, while 79.41% believed that it is necessary to establish such criteria. CONCLUSIONS: There was a diverse landscape of misoprostol use which underscores the complexity and individual approach to cervical preparation for an outpatient hysteroscopy. Indeed, the findings regarding its application, notably more prevalent among postmenopausal patients, contravene the prevailing body of published evidence. Moreover, a considerable proportion of respondents expressed the need for clear criteria, which emphasizes the importance of evidence-based protocols to guide the optimal use of misoprostol.

Hiperparatiroidismo neonatal: una rara afección de pronóstico infausto / Neonatal hyperparathyroidism: a rare condition of untimely prognosis

El hiperparatiroidismo neonatal severo es una entidad grave y poco frecuente causada por la inactivación del receptor sensible al calcio. Las manifestaciones clínicas suelen ser precoces. Incluyen: dificultad respiratoria debido a la hipotonía y deformidades de la caja torácica, huesos con mineralización baja y múltiples fracturas. La tasa de mortalidad es elevada. La mayoría de los pacientes mueren durante el periodo neonatal. Se presenta el caso de un recién nacido que presenta signos clínicos y analíticos sospechosos de hiperparatiroidismo neonatal severo. Finalmente tras recuperación espontánea se realiza el diagnóstico de hiperparatiroidismo transitorio secundario a hipoparatiroidismo materno desconocido (AU)

The severe neonatal hyperparathyroidism is a serious institution, and rare caused by the inactivation of receiver sensitive to calcium. The clinical manifestations are usually early. Include: difficulty breathing due to the hypotonia and deformities of the chest, bones with low mineralization, and multiple fractures. The mortality rate is high. Most patients die by during the neonatal period. We present the case of a newborn with clinical signs and analytical suspects of severe neonatal hyperparathyroidism. Finally after spontaneous recovery is performed the diagnosis of hyperparathyroidism secondary to transient hypoparathyroidism unknown maternal (AU)

Determinación del sexo fetal en ecografía del primer trimestre / Fetal gender determination by first-trimester ultrasound

Objetivo: Valorar la precisión de la determinación ecográfica del sexo fetal entre las 11 y 14 semanas de gestación como parte de la ecografía rutinaria del primer trimestre. Material y métodos: El sexo fetal fue evaluado por ecografía de forma prospectiva en 534 embarazadas entre las semanas 11 y 14 de gestación que acudieron a su ecografía de rutina. La región genital fue examinada en un plano mediosagital con el fin de determinar la dirección del tubérculo genital respecto a una línea horizontal definida por la piel del área lumbosacra, considerando sexo masculino si el ángulo es superior a 30° y femenino si el tubérculo es paralelo o convergente (ángulo inferior a 30°). La confirmación clínica del sexo fetal se hizo por ecografía en semana 20, 32 y al nacimiento. Resultados: El sexo fetal fue asignado correctamente en el 85,13% de los casos. Se asignó de forma correcta en el 78,32% de los casos en la semana de gestación 11, en el 84,49% de los casos en semana 12 y en el 93,7% de los casos en la semana 13. El 82,5% de los varones fueron asignados correctamente y el 87,84% de las mujeres. Conclusión: El sexo fetal se puede determinar con una eficacia aceptable entre las 12-14 semanas de gestación en la ecografía de rutina (AU)

Objective: To assess the accuracy of fetal gender determination by ultrasound at 11-14 weeks’ gestation as part of first-trimester ultrasound screening. Material and methods: Fetal gender assessment by ultrasound was prospectively carried out in 534 women at 11-14 weeks of gestation attending first-trimester ultrasound screening. The genital region was examined in a midsagittal plane to determinate the direction of the genital tubercle to a horizontal line through the lumbosacral skin surface. Fetal gender was assigned as male if the angle was greater than 30 degrees and as female if the tubercle was parallel or convergent (less than 30 degrees). Clinical confirmation of fetal gender was obtained by 20- and 32-week ultrasound and after delivery. Results: Fetal gender was correctly determined in 85.13% of cases. The accuracy of sex assignment was 78.32% at 11 weeks, 84.49% at 12 weeks, and 93.7% at 13 weeks. Gender was correctly determined in 82.8% of the male fetuses and in 88% of the female fetuses. Conclusion: Fetal gender can be determined with an acceptable efficiency at 12-14 weeks of gestation on routine ultrasound (AU)

Assessment of mammographic density in postmenopausal women during long term hormone replacement therapy.

OBJECTIVE: To assess long-term effects of different hormone replacement therapy (HRT) regimens on mammographic density. METHODS: One hundred sixty-five postmenopausal women were treated with the same HRT during 5 years: 38 received transdermal estradiol, 78 cyclic combined therapy and 49 continuous combined therapy. Mammograms were obtained at baseline, at 1-year and 5-year treatment. Breast density changes were categorized as slight focal increased density, considerable focal increased density, slight diffuse increased density and considerable diffuse increased density. RESULTS: Mammographic density increased in 7.9% of women receiving estrogen alone versus 25.2% of women receiving combined therapy (p < 0.022) during 1 year, and in 7.9% of women versus 28.3% of women (p < 0.009) after 5 years of therapy, respectively. There were significant statistical differences in women treated with estrogen alone versus those treated with combined HRT after 1 and 5 years. After 5 years of HRT, breast density increased 21.8% in women receiving cyclic combined therapy versus 38.8% in those under continuous combined therapy (p < 0.039). CONCLUSION: An increase in breast density is significantly more frequent in women receiving combined estrogen-progestin therapy than in women receiving estrogen alone. There are differences between cyclic and continuous combined therapy at 5 years of treatment.