Ustekinumab therapy for Crohn's disease during pregnancy: a case report and review of the literature.

WHAT IS KNOWN AND OBJECTIVES: The safety of continued ustekinumab (UST) therapy during pregnancy remains unclear in patients with Crohn's disease (CD). There are no meta-analysis reports of exposure to UST during pregnancy. The objective was to describe a case of a pregnant patient with CD who was successfully treated with UST maintenance therapy throughout the pregnancy and delivered a baby boy without any congenital malformations, neurological abnormalities or birth defects. CASE SUMMARY: A 37-year-old patient with CD treated with UST became pregnant. She had been receiving UST for 8 months at the time. After discussion with the patient and the obstetric team, the UST therapy was continued. The result of treatment was an uneventful pregnancy with delivery, at term, of a healthy boy and the maintenance of clinical, biological and endoscopic remission of CD during and after pregnancy. WHAT IS NEW AND CONCLUSION: To our knowledge, this is the first reported use of continued UST therapy for CD throughout a pregnancy. The result of treatment was an uncomplicated pregnancy with the mother giving birth to a healthy boy at term and the maintenance of clinical biological and endoscopic remission of CD during and after pregnancy.

[Clinical evaluation of the patient with a chronic snoring disease]. / Evaluación clínica del paciente con roncopatía.

INTRODUCTION: Sleep disordered breathing patients usually undergo an ENT clinical examination before any therapeutic decision is taker. This clinical examination should be predictive about the occurrence of OSAS, reproductible and should determine the sites of obstruction in the upper airways. We have evaluated the clinical ENT examination and compared it with the bibliography in order to standardize it. MATERIALS AND METHODS: We have done the same clinical ENT examination to 181 patients. 127 had a standar polysomnography. RESULTS: The patient's mean age was 49.6 years, the mean BMI was 29.3 kg/m2. 92.7% had an abnormal palate, 4.5% a tonsilar hipertrophy, 66.5% high Modified Mallampati scores, 60.8% were clasiffied as Fujita IIb type and 39.2% had nasal obstruction. CONCLUSIONS: Upper airway examination is important for the assessment of chronic snoring patients. Most of them have anatomical alterations that can be represented in visual scales to make it more reproductible. The obstruction area does not predict the severity of OSAS.

Evaluación clínica del paciente con roncopatía / Clinical evaluation of the patient with a chronic snoring disease

Introducción: Los pacientes con trastornos respiratorios relacionados con el sueño son sometidos habitualmente a un examen otorrinolaringológico antes de tomar una decisión terapéutica. Este examen debería ser predictivo sobre la existencia de síndrome de apnea obstructiva del sueño (SAOS), reproducible y debería determinar las zonas de obstrucción de la vía aérea. Hemos evaluado el examen clínico ORL y comparado con la literatura con el ánimo de estandarizar el mismo. Material y métodos: Hemos realizado el mismo protocolo de anamnesis y exploración a 181 pacientes, de los cuales 127 tienen realizada también una polisomnografía (PSG). Resultados: La edad media de los pacientes fue de 49,6 años, con un IMC de 29,3 kg/m2. El 92,7% presentaron un paladar patológico, el 4,5% presentaron una hipertrofia amigdalar importante y el 66,5% índices de Mallampati modificados elevados. El 68,8% se estadió como Fujita IIb y un 39,2% presentó obstrucción nasal. Conclusiones: La exploración de la vía aérea superior (VAS) es muy importante para el diagnóstico de la roncopatía crónica. La mayoría de los pacientes presentan alteraciones morfológicas que se pueden representar mediante escalas visuales para hacerla más reproducible. La zona de obstrucción no predice la severidad del síndrome de apnea del sueño

Introduction: Sleep disordered breathing patients usually undergo an ENT clinical examination before any therapeutic decision is taker. This clinical examination should be predictive about the occurrence of OSAS, reproductible and should determine the sites of obstruction in the upper airways. We have evaluated the clinical ENT examination and compared it with the bibliography in order to standardize it. Materials and methods: We have done the same clinical ENT examination to 181 patients. 127 had a standar polysomnography. Results: The patient’s mean age was 49.6 years, the mean BMI was 29.3 kg/m2. 92.7% had an abnormal palate, 4.5% a tonsilar hipertrophy, 66.5% high Modified Mallampati scores, 60.8% were clasiffied as Fujita IIb type and 39.2% had nasal obstruction. Conclusions: Upper airway examination is important for the assessment of chronic snoring patients. Most of them have anatomical alterations that can be represented in visual scales to make it more reproductible. The obstruction area does not predict the severity of OSAS

[Our findings in the sleep endoscopy exams]. / Nuestros hallazgos en la videofibrosomnoscopia.

INTRODUCTION: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. MATERIALS AND METHODS: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. RESULTS: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. CONCLUSIONS: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient's obstruction.

Nuestros hallazgos en la videofibrosomnoscopia / Our findings in the sleep endoscopy exams

Introducción: La videofibrosomnoscopia es una técnica que permite la visualización de la faringe de un paciente al que se le ha inducido el sueño farmacológicamente. De este modo se puede diagnosticar la o las zonas causantes de la vibración y colapso de los pacientes con roncopatía crónica. Material y métodos: La prueba se realizó a un total de 51 pacientes. A todos se les realizó una anamnesis estándar y una exploración otorrinolaringológica como parte del diagnóstico habitual. Resultados: La zona de obstrucción más frecuentemente encontrada fue el velo del paladar en el 90,4%, seguido de la base de la lengua en el 38,5%. El colapso multinivel se dio en el 60,7%. No se han hallado correlaciones entre la obstrucción hallada en la consulta y la vista durante la VFS. Conclusiones: La VFS es una técnica útil en el diagnóstico del paciente con roncopatía y es aconsejable su utilización para saber con certeza el tipo de obstrucción del paciente

Introduction: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. Materials and methods: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. Results: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. Conclusions: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient´s obstruction

[Hemodialysis with 2.5 mEq/L of calcium in relative hypoparathyroidism: long-term effects on bone mass]. / Hemodiálisis con 2,5 mEq/L de calcio en el hipoparatiroidismo relativo: efectos a largo plazo en la masa ósea.

Low PTH secretion is known to be associated with Adynamic Bone Disease (ABD). Positive balance calcium by CaCO3 or dialysate calcium (DCa) might play a role in the parathyroid gland suppression and a decrease in DCa to 2.5 mEq-l or lower has been proposed. The long-term effect of this procedure on bone mineral density (BMD) has not been established. The aim was to evaluate the effect of lowering dialysate calcium on bone mass in patients with relative hypoparathyroidism. We studied 20 patients with intact PTH below 120 pg/ml, using 3 mEq/l DCa and CaCO3 as sole phosphate binder. Sex: 10M/10F. Age: 57 +/- 13 yrs. Months on dialysis: 40 +/- 29. None of them had previous renal transplantation, parathyroidectomy nor aluminic toxicity. BMD of the lumbar spine was assessed by Quantitative Computed Tomography (QCT). They were randomized in two groups (GI and GII), with similar age, sex, and time on dialysis. There were no difference in BMD, levels of intact PTH, serum calcium, phosphate and AP (Alkaline Phosphatase) GI (n = 11; 5M/6F) was transferred to 2.5 mEq/l DCa and GII (n = 9; 5M/4F) continued using 3 mEq/l. BMD was measured one year later. Calcium, phosphate and AP were measured monthly and PTH every three months. After one year of hemodialysis with 2.5 mEq/l of calcium dialysate, BMD showed a significant reduction. BMD mg/cc Baseline (B): 146.09 +/- 54; Final (F): 125.42 +/- 54 (p < 0.01). Z-score B: 0.13 +/- 1.89; F: -0.68 +/- 1.89 (p < 0.05). GII did no show change. The mean change: GI: -15 +/- 13%, GII: 1.28 +/- 17% (p < 0.05); Z-Score GI: -0.81 +/- 0.92, GII: 0.27 +/- 0.67 (p < 0.01). A separate analysis of BMD in both sexes (GI) revealed a tendency for females to lose more bone mineral than males: F: = 17.12 +/- 7.1%. M: -12.23 +/- 18.6% (ns). GI: PTH and AP increased: PTH B: 38.75 +/- 41; F: 99 +/- 69 (p < 0.01); AP: B: 118.4 +/- 47; F: 152 +/- 38 (p < 0.01). GII: PTH B: 53.8 +/- 28; F: 79 +/- 5 (ns). AP: B: 125.1 +/- 36; F: 138 +/- 38 (ns). The rate of BMD loss inversely correlated with the increase of PTH (r = -0.61, p < 0.01). Serum calcium and phosphate did not change. In GI CaCO3 doses were: B: 332 +/- 261; F: 537 +/- 260 (as grams of element calcium, every three months, p < 0.01). By multiple lineal regression only delta PTH and DCa were predictors of greater BMD loss. In conclusion, the use of 2.5 mEq/l dialysate calcium resulted in: 1) Loss of trabecular vertebral bone mass. 2) Increase in PTH secretion and biochemical markers of bone formation. 3) A greater CaCO3 dose.

Hemodiálisis con 2,5 mEq/l de calcio en el hipoparatiroidismo relativo: efectos a largo plazo en la masa ósea / Long-term hemodialysis with 2,5 mEq/l dialysate calcium concentration in relative hypoparathyroidism: effects on bone mass

Los niveles de PTH < 120 pg/ml en pacientes en diálisis están relacionados con bajo remodelado y defecto de formación ósea y tienen gran valor predictivo de enfermedad ósea adinámica no relacionada con el aluminio. Este hipoparatiroidismo relativo se ve favorecido por los balances positivos de calcio producidos por los compuestos cálcicos y el concentrado para diálisis habiéndose propuesto la reducción del calcio en PI dializante a 2,5 mEg/l. Se desconoce la repercusión de esta medida sobre la masa ósea. Nuestro objetivo fue valorar el efecto de un concentrado de 2,5 mEg/l de calcio sobre la masa ósea en los pacientes con PTH suprimida. Estudiamos 20 pacientes con PTH intacta < 120 pg/ml, sin intoxicación alumínica, trasplante o paratiroidectomía, en hemodiálisis con 3 mEg/l de calcio y CO3Ca como captor del fósforo. Sexo: 10 hombres/10 mujeres, edad: 57 ñ 13 años, meses en diálisis: 40 ñ 29. Se valoró la masa ósea trabecular en columna vertebral mediante tomografía axial computerizada cuantitativa. Se dividieron en grupo 1 (11 pacientes) y grupo II (9 pacientes) similares en sexo, edad y tiempo en diálisis. Sin diferencias en densidad ósea, PTH, calcio, fósforo y fosatasa alcalina. El grupo I fue transferido a 2,5 mEg/I y el II continuó con 3 mEq/l. Se midieron calcio, fósforo (mg/dl) y fosfatasa alcalina (Ul/1) mensualmente. PTH (pg/ml) cada tres meses y la densidad ósea (mg/cc) al término del estudio. Tras un año de hemodiálisis con 2,5 mEg/I de calcio hubo una reducción de la masa ósea: basa] 149,09 ñ 54; final: 125 ñ 42 (p < 0,01), Z-Score basa]: 0,13 ñ 1,89; final: -0,68 ñ 1,89 (p < 0,05), sin cambios en grupo control. Pérdida ósea en unidades Z-Score: Grupo l: -0,81 ñ 0,92; grupo ll: 0,27 ñ 0,67 (p < 0,01). Cambio porcentual: grupo l: -15 ñ 1_3 por ciento; grupo II: 1,28 ñ 17 por ciento (p < 0,05). En grupo I hubo tendencia a mayor pérdida en mujeres: -17,12 ñ 7,1 por ciento que en hombres: - 12,33 ñ 18,6 por ciento (ns). En grupo I aumentaron PTH (basa]: 38,75 ñ 41, final: 99 ñ 69, p < 0,01) y fosfatasa alcalina (basa]: 118,4 ñ 47, final: 152 ñ 38, p < 0,01), sin cambios en grupo II. La pérdida ósea se relacionó inversamente con incremento de PTH (r = -0,61, p < 0,01). Calcio y fósforo no se modificaron. En grupo I la dosis acumulativa de CO3Ca se incrementó: 1.°' trimestre: 332 ñ 261; 4. ' trimestre: 537 ñ 260 (expresado como calcio elemento; p < 0,01). En análisis de regresión lineal múltiple, un mayor incremento de PTH y el tipo de concentrado utilizado se comportaron como únicos predictores de pérdida ósea (r = 0,74, p < 0,01). En conclusión, el uso de un concentrado de 2,5 mEg/l de calcio resultó en: 1.=' Pérdida de masa ósea. 2.=' Au mento de PTH y marcadores bioquímicos de formación ósea. 3.=' Mayor dosificación de CO,Ca. (AU)