Favorable outcome of SARS-CoV-2 infection in a patient with pituitary insufficiency.

BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outbreak originated in Wuhan (China) rapidly turned into a pandemic. Due to a national compulsive decree of quarantine, office visits for chronic disease control were delay. Hypopituitarism includes all clinical conditions that result in partial or complete failure of the pituitary gland's ability to secrete hormones. Pituitary insufficiency per se has been associated with an increase in both morbidity and mortality, particularly due to cardiovascular disease, which is an important risk factor for COVID-19 disease severity. OBJECTIVE: To report the first case of SARS-CoV-2 infection in a patient with hypopituitarism, discuss the implications of the treatments the patient was taking and grade up the value of telemedicine in the present scenario. METHODS: Report of the clinical record of a patient with hypopituitarism and infection with SARS-CoV-2. RESULTS: During the span of the infection, the patient remained on the same hormonal therapeutic scheme (thyroid, gonadal and adrenal axis). The dose of hydrocortisone was not changed during the course of the infection as she was asymptomatic. We use telemedicine to control and advise her on the treatment. CONCLUSION: Health care professionals should carefully follow up on the evolution of patients with hypopituitarism to provide them a safer outcome. The use of telemedicine as a methodology for selected patients acquires relevance in the present epidemiological context.

Pregnancy outcomes in women with polycystic ovary syndrome in two Latin American populations.

Pregnancy complications and obstetric outcomes were compared in 80 Chilean (PPCOSCh) and 70 Argentinian (PPCOSAr) pregnant women. Reference groups of Chilean and Argentinian normal pregnant women from the same antenatal care units were also compared. PPCOSCh showed a higher prevalence of gestational diabetes mellitus (GDM) (OR, 2.28, 95% CI: 1.08-4.77, p = .030) and a lower prevalence of pregnancy-induced hypertension (PIH) (OR, 0.20, 95% CI: 0.07-0.54, p = .001) compared to PPCOSAr. In the normal pregnant groups, the prevalence of PIH was lower in Chilean women compared to Argentinian women (OR, 0.24, 95% CI: 0.10-0.62, p = .001). Similar to the pattern observed in the normal populations, newborns from PPCOSCh had higher birth weight and length compared with the newborns of PPCOSAr (p = .006 and .014, respectively). In conclusion, differences in pregnancy complications and obstetric outcomes between Chilean and Argentinian pregnant women with PCOS could be determined by ethnic diversity together with environmental factors of both populations. Impact Statement What is already known on this subject: The reproductive and metabolic phenotypes of women with polycystic ovary syndrome vary between different populations, which could significantly influence the obstetric and neonatal outcomes in this syndrome. What the results of this study add: Pregnant women with PCOS from two Latin American countries (Chile and Argentina) exhibit differences in the prevalence of gestational diabetes and pregnancy-induced hypertension, and in the birth weight of their newborns. What the implications are of these findings for clinical practice and/or further research: Ethnic diversity together with environmental factors are fundamental elements that must be considered in the management of pregnant women with PCOS.

[Polycystic ovary sindrome: impact on reproductive and maternal fetal health]. / Síndrome de ovario poliquistico: impacto en la salud reproductiva y materno infantil.

UNLABELLED: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism (H), oligo-anovulation (O) and / or polycystic ovaries (P). There is currently little information on perinatal complications. OBJECTIVE: to investigate obstetric and neonatal characteristics of women with PCOS in our population. MATERIAL AND METHODS: we studied 87 pregnant women with PCOS (categorized in four phenotypes according Rotterdam Consensus: A (H + O + P) n = 53; B (H + O) n = 9; C (H + P) n = 16 and D (O + P) n = 9) and 96 without PCOS (control). We analyzed clinical and biochemical features (age, anthropometry hirsutism, acanthosis nigricans, OGTT, insulin, lipid profile, androgen and gonadotropins) during preconception, (weight gain, blood pressure, OGTT) through gestation and occurrence of perinatal complications. RESULTS: we found no differences in age (29.4 ± 4 and 28.7 ± 5 years) and body mass index (28.2 ± 6 and 27.8 ± 6 kg / m2) in both groups; while patients with PCOS had higher waist circumference, blood pressure and acanthosis nigricans versus control. Despite similar weight gain, patients with PCOS had higher percentage of perinatal complications. In the A phenotype RR for perinatal adverse outcomes was 2.37 (95%CI: 1.67-3.36, p <0.001). The HOMA-IR index preconception and fasting glucose during pregnancy were the predictors for these complications (p=0.01). CONCLUSION: patients with PCOS have a higher risk for complications during pregnancy and newborns more frequently have low weight or macrosomy. A careful history can recognize patients with higher perinatal risk to develop complications.

Metabolic profile of the different phenotypes of polycystic ovary syndrome in two Latin American populations.

OBJECTIVE: To evaluate the metabolic profile of Chilean and Argentinian women with polycystic ovary syndrome (PCOS) according to the Rotterdam criteria. DESIGN: Observational cross-sectional study. SETTING: Academic centers. PATIENT(S): Women with PCOS, aged 18-39 years: 220 Chilean (PCOSCh) and 206 Argentinian (PCOSAr). INTERVENTION(S): Physical examination, fasting blood samples for androgens, gonadotropins, metabolic parameters, and a transvaginal ultrasound. MAIN OUTCOME MEASURE(S): Comparative analysis of the metabolic profile in both populations divided into four phenotypes. RESULT(S): The distribution of the different phenotypes was different in both populations. PCOSCh women showed a higher body mass index and a higher percentage of metabolic syndrome in all phenotypes compared with the PCOSAr women. The PCOSAr women exhibited a statistically significantly higher diastolic blood pressure in phenotypes A, B, and C and a higher percentage of hypertension in phenotypes A and D compared with the PCOSCh women. CONCLUSION(S): The data show differences in the metabolic profile of both populations. PCOSCh women presented with greater metabolic alterations such as dysglycemia and dyslipidemia and a higher prevalence of metabolic syndrome, independent of the phenotype. The PCOSAr patients showed more elevated blood pressure. Ethnic diversity associated with environmental factors are fundamental elements in the analysis of the PCOS phenotypes.

Interacciones farmacológicas en ancianos hospitalizados utilizando programas informaticos en linea / Drug interactions in hospitalized elderly using computer programs online

Introducción: Se denominan interacciones farmacológicas (IF) a las relaciones que se establecen entre los fármacos dentro del organismo, que pueden resultar en cambios en la eficacia y seguridad de los mismos, a veces con efectos desfavorables. La polifarmacia genera una inmensa cantidad de combinaciones de drogas que aumenta el riesgo de IF. Este crecimiento es exponencial. Existen softwares que permiten conocer los pares de drogas capaces de generar IF. Estudiamos uno de ellos: Interdrugs® "http://www.medicamentos-rothlin.com.ar/” para conocer su desempeño y utilizarlo para estudiar el riesgo de IF en pacientes ancianos hospitalizados. Materiales y Métodos: Estudio transversal. Se ingresaron pacientes hospitalizados mayores de 65 años. Se consignaron datos demográficos, motivos de ingreso, patologías crónicas y medicación utilizada durante las primeras 24 hs de hospitalización. Las prescripciones se analizaron con el software "Interdrugs®” para pesquizar IF. Fueron clasificadas en leves, moderadas y severas. Se estimaron las frecuencias de: motivos de ingreso, drogas prescriptas y severidad de las IF. Se correlacionaron y compararon las frecuencias de IF moderadas a severas con los pacientes sin riesgo de IF o con IF leves. Se utilizaron los programas estadísticos SPSS 17 y EpiDat 3.

ABSTRACT: Introduction: Drug interactions (DI) are the relationships established between drugs inside the body, which can result in changes in the efficacy and safety of themselves, sometimes with adverse effects. Polypharmacy generates an immense amount of drug combinations that makes DI more frequent. There are software that allow to know the pairs of drugs capable of generating DI. We studied: Interdrugs® http://www.medicamentosrothlin.com.ar/" for their performance and use it to study the risk of DI in a group of hospitalized older patients. Materials and Methods: A cross-sectional study. We included patients 65 years old or older admitted to common room in three hospitals at Cordoba.We recorded demographic data, reason for admission, diagnoses of chronic diseases and medication used during the first 24 hours of hospitalization. The prescriptions were analyzed with the software "Interdrugs®" to search for DI. These were classified as mild, moderate, or severe. Frequencies were estimated for admission reasons, drugs prescription and severity of DI. Were correlated and compared moderate to severe DI frequencies with patients who had no risk of DI or mild DI. We used SPSS 17 and EpiDat 3 for statistical analysis.

Interacciones farmacológicas en ancianos hospitalizados utilizando programas informaticos en linea / Drug interactions in hospitalized elderly using computer programs online

Introducción: Se denominan interacciones farmacológicas (IF) a las relaciones que se establecen entre los fármacos dentro del organismo, que pueden resultar en cambios en la eficacia y seguridad de los mismos, a veces con efectos desfavorables. La polifarmacia genera una inmensa cantidad de combinaciones de drogas que aumenta el riesgo de IF. Este crecimiento es exponencial. Existen softwares que permiten conocer los pares de drogas capaces de generar IF. Estudiamos uno de ellos: Interdrugs« "http://www.medicamentos-rothlin.com.ar/ö para conocer su desempeño y utilizarlo para estudiar el riesgo de IF en pacientes ancianos hospitalizados. Materiales y Métodos: Estudio transversal. Se ingresaron pacientes hospitalizados mayores de 65 años. Se consignaron datos demográficos, motivos de ingreso, patologías crónicas y medicación utilizada durante las primeras 24 hs de hospitalización. Las prescripciones se analizaron con el software "Interdrugs«ö para pesquizar IF. Fueron clasificadas en leves, moderadas y severas. Se estimaron las frecuencias de: motivos de ingreso, drogas prescriptas y severidad de las IF. Se correlacionaron y compararon las frecuencias de IF moderadas a severas con los pacientes sin riesgo de IF o con IF leves. Se utilizaron los programas estadísticos SPSS 17 y EpiDat 3.(AU)

ABSTRACT: Introduction: Drug interactions (DI) are the relationships established between drugs inside the body, which can result in changes in the efficacy and safety of themselves, sometimes with adverse effects. Polypharmacy generates an immense amount of drug combinations that makes DI more frequent. There are software that allow to know the pairs of drugs capable of generating DI. We studied: Interdrugs« http://www.medicamentosrothlin.com.ar/" for their performance and use it to study the risk of DI in a group of hospitalized older patients. Materials and Methods: A cross-sectional study. We included patients 65 years old or older admitted to common room in three hospitals at Cordoba.We recorded demographic data, reason for admission, diagnoses of chronic diseases and medication used during the first 24 hours of hospitalization. The prescriptions were analyzed with the software "Interdrugs«" to search for DI. These were classified as mild, moderate, or severe. Frequencies were estimated for admission reasons, drugs prescription and severity of DI. Were correlated and compared moderate to severe DI frequencies with patients who had no risk of DI or mild DI. We used SPSS 17 and EpiDat 3 for statistical analysis.(AU)

Estudio de prevalencia de interacciones farmacológicas en pacientes ancianos hospitalizados utilizando programas informáticos en línea / Study of the prevalence of drug interactions in elderly hospitalized patients using online software

INTRODUCCION: Las interacciones farmacológicas son un fenómeno frecuente en la polifarmacia. La gran mayoría no representa un riesgo para la salud, pero un porcentaje de esas interacciones puede comprometer la vida de los pacientes.OBJETIVO: Investigar la prevalencia de interacciones farmacológicas en una muestra de pacientes ancianos hospitalizados.METODOS: Se analizó una muestra de ingresos hospitalarios de pacientes mayores de 65 años. Se consignó sexo, edad, cobertura social, motivo de ingreso, patologías crónicas y drogas prescriptas. La prevalencia de interacción farmacológica fue pesquisada con dos programa: InterDrugs« (ID«) y Drug Interaction Checker« (DIC«). Las interacciones se clasificaron en leves, moderadas o severas.RESULTADOS: Se analizaron 556 pacientes, con un 55,4% de mujeres y una media de 77 años. Se prescribieron 3.331 drogas con una moda de 6 por pacientes. Se registró un total de 196 monodrogas, y un 50,6% de lo prescripto correspondió a sólo 12 monodrogas. El 19,9% y 15,1% de las interacciones fueron moderadas y el 6,3% y 4,6% fueron severas, según ID« y DIC« respectivamente. Hubo una correlación positiva de las interacciones moderadas y severas con el número de drogas según DIC« (r=0,428: P=0,0001) e ID« (r=0,464; P=0,0001) con un riesgo relativo 5,2 veces mayor a partir de la quinta droga prescripta para ambos programas (P=0,0001).CONCLUSIONES: Las interacciones moderadas a severas tienen una prevalencia de 8 a 15%. El uso de cinco drogas o más incrementa el riesgo en 5,1 veces. La prescripción de digoxina, amiodarona y espirinolactona aumenta por sí misma la probabilidad de una interacción farmacológica.

INTRODUCTION: Drug interactions are a prequent event within polypharmacy. The great majority does not represent any risk for health, but a percentage of them can compromise the life of patients.OBJECTIVE: To investigate the prevalence of drug interactions in a sample of hospitalized elderly patients.METHODS: Analysis of a sample of hospital admissions for patients older than 65 years, considerin sex, age, social service, reason for admission, chronic pathologies and prescribed drugs. The prevalence of drug interaction was addressed with two software programs: InterDrugs« (ID«) and Drug Interaction Checker« (DIC«). The interactions were classified as mild, moderate or severe.RESULTS: 556 patients were analyzed, with 55.4% of women and an average age of 77 years. The prescribed drugs totaled 3.331, with a mode of 6 per patient. There were only 196 single drugs, and 50.6% of the prescriptions were for onle 12 single drugs. 19.9% and 15.1% of drug interactions were moderate and 6.3% and 4.6% were severe according to ID« and DIC«, respectively. There was a positive correlation of moderate and severe drug interactions with the number of drugs according to DIC« (r=0.428; P=0.0001) and ID« (r=0.464; P=0.0001) with a 5.2 fold increase in the relative risk starting from the fifth drug prescribed (P=0.0001)-CONCLUSIONS: Moderate to severe interactions have a prevalence of 8 to 15%. Using 5 or more drugs increases the risk 5.2 times. The prescription of digoxine, amiodarone and spirinolactone increases the risk of drug interaction.

Estudio de prevalencia de interacciones farmacológicas en pacientes ancianos hospitalizados utilizando programas informáticos en línea / Study of the prevalence of drug interactions in elderly hospitalized patients using online software

INTRODUCCION: Las interacciones farmacológicas son un fenómeno frecuente en la polifarmacia. La gran mayoría no representa un riesgo para la salud, pero un porcentaje de esas interacciones puede comprometer la vida de los pacientes.OBJETIVO: Investigar la prevalencia de interacciones farmacológicas en una muestra de pacientes ancianos hospitalizados.METODOS: Se analizó una muestra de ingresos hospitalarios de pacientes mayores de 65 años. Se consignó sexo, edad, cobertura social, motivo de ingreso, patologías crónicas y drogas prescriptas. La prevalencia de interacción farmacológica fue pesquisada con dos programa: InterDrugs« (ID«) y Drug Interaction Checker« (DIC«). Las interacciones se clasificaron en leves, moderadas o severas.RESULTADOS: Se analizaron 556 pacientes, con un 55,4% de mujeres y una media de 77 años. Se prescribieron 3.331 drogas con una moda de 6 por pacientes. Se registró un total de 196 monodrogas, y un 50,6% de lo prescripto correspondió a sólo 12 monodrogas. El 19,9% y 15,1% de las interacciones fueron moderadas y el 6,3% y 4,6% fueron severas, según ID« y DIC« respectivamente. Hubo una correlación positiva de las interacciones moderadas y severas con el número de drogas según DIC« (r=0,428: P=0,0001) e ID« (r=0,464; P=0,0001) con un riesgo relativo 5,2 veces mayor a partir de la quinta droga prescripta para ambos programas (P=0,0001).CONCLUSIONES: Las interacciones moderadas a severas tienen una prevalencia de 8 a 15%. El uso de cinco drogas o más incrementa el riesgo en 5,1 veces. La prescripción de digoxina, amiodarona y espirinolactona aumenta por sí misma la probabilidad de una interacción farmacológica.

INTRODUCTION: Drug interactions are a prequent event within polypharmacy. The great majority does not represent any risk for health, but a percentage of them can compromise the life of patients.OBJECTIVE: To investigate the prevalence of drug interactions in a sample of hospitalized elderly patients.METHODS: Analysis of a sample of hospital admissions for patients older than 65 years, considerin sex, age, social service, reason for admission, chronic pathologies and prescribed drugs. The prevalence of drug interaction was addressed with two software programs: InterDrugs« (ID«) and Drug Interaction Checker« (DIC«). The interactions were classified as mild, moderate or severe.RESULTS: 556 patients were analyzed, with 55.4% of women and an average age of 77 years. The prescribed drugs totaled 3.331, with a mode of 6 per patient. There were only 196 single drugs, and 50.6% of the prescriptions were for onle 12 single drugs. 19.9% and 15.1% of drug interactions were moderate and 6.3% and 4.6% were severe according to ID« and DIC«, respectively. There was a positive correlation of moderate and severe drug interactions with the number of drugs according to DIC« (r=0.428; P=0.0001) and ID« (r=0.464; P=0.0001) with a 5.2 fold increase in the relative risk starting from the fifth drug prescribed (P=0.0001)-CONCLUSIONS: Moderate to severe interactions have a prevalence of 8 to 15%. Using 5 or more drugs increases the risk 5.2 times. The prescription of digoxine, amiodarone and spirinolactone increases the risk of drug interaction.

Clinical, metabolic, and endocrine parameters in response to metformin and lifestyle intervention in women with polycystic ovary syndrome: a randomized, double-blind, and placebo control trial.

The aim of this study was to evaluate the effects of metformin in addition to diet and exercise on endocrine and metabolic disturbances in women with polycystic ovary syndrome (PCOS) in a prospective, double-blind, randomized, placebo (PBO) control trial. Thirty women with insulin resistance and PCOS received lifestyle modification and 1500 mg of metformin or placebo for 4 months. Before and after treatment, body mass index, waist/hip ratio, blood pressure, hirsutism, and menstrual patterns were evaluated. Serum concentrations of gonadotropins, androgens, progesterone, glucose, insulin, and lipids were measured. Lifestyle interventions resulted in similar weight and menstrual cycle's improvements in both groups. A significant reduction in serum fasting insulin, HOMA index, waist and testosterone levels was only observed with metformin. There were no significant changes in androstenedione, dehydroepiandrosterone sulfate, gonadotropins, and lipids levels. No other changes were observed in hirsutism or blood pressure. These findings suggest that metformin has an additive effect to diet and exercise to improve parameters of hyperandrogenism and insulin resistance. Although, a small decrease in body weight trough lifestyle changes could be enough to improve menstrual cycles in insulin-resistant women with PCOS.

Pregnancies associated with primary adrenal insufficiency.

OBJECTIVE: To provide a framework for the clinical presentation, evolution, treatment, and outcome of the unusual association between primary adrenal insufficiency (AI) during pregnancy and life-threatening complications for the mother and fetus. DESIGN: Case reports. SETTING: Pregnant women with AI treated in the Endocrine and Diabetes Department, Hospital Universitario de Maternidad y Neonatología, Córdoba, Argentina. PATIENT(S): Three pregnant women with AI. INTERVENTION(S): Review of hospital records. MAIN OUTCOME MEASURE(S): Clinical, laboratory features, treatment, and outcome. RESULT(S): Two women with AI were diagnosed before conception, and one was diagnosed during gestation. Two of the cases were associated with other autoimmune diseases. Two newborns were born with signs of fetal distress, and one passed away hours later. Poor outcome was related to low compliance with treatment. CONCLUSION(S): AI is often overlooked during pregnancy because of its rarity and pregnancy-like symptoms. Nevertheless, other autoimmune diseases, hyponatremia, metabolic acidosis, nausea and vomiting, and orthostatic hypotension that does not improve with usual treatment or persists after first trimester should evoke a diagnosis of AI. If diagnosis and treatment are properly managed, pregnancy, labor, and delivery may occur without complications. If not, AI is associated with high maternal and fetal morbidity and mortality.