Levels of sCD163 in women rheumatoid arthritis: Relationship with cardiovascular risk markers.

AIM: The soluble scavenger receptor differentiation antigen 163 (sCD163), a monocyte/macrophage activation marker, is related to cardiovascular mortality in the general population. This study aimed to evaluate their relationship between serum levels of sCD163 with cardiovascular risk indicators in rheumatoid arthritis (RA). METHODS: A cross-sectional study was performed on 80 women diagnosed with RA. The cardiovascular risks were determined using the lipid profile, metabolic syndrome, and QRISK3 calculator. For the assessment of RA activity, we evaluated the DAS28 with erythrocyte sedimentation rate (DAS28-ESR). The serum levels of sCD163 were determined by the ELISA method. Logistic regression models and receiver operating characteristics (ROC) curve were used to assess the association and predictive value of sCD163 with cardiovascular risk in RA patients. RESULTS: Levels of sCD163 were significantly higher in RA patients with high sensitivity protein C-reactive to HDL-c ratio (CHR)≥0.121 (p=0.003), total cholesterol/HDL-c ratio>7% (p=0.004), LDL-c/HDL-c ratio>3% (p=0.035), atherogenic index of plasma>0.21 (p=0.004), cardiometabolic index (CMI)≥1.70 (p=0.005), and high DAS28-ESR (p=0.004). In multivariate analysis, levels of sCD163≥1107.3ng/mL were associated with CHR≥0.121 (OR=3.43, p=0.020), CMI≥1.70 (OR=4.25, p=0.005), total cholesterol/HDL-c ratio>7% (OR=6.63, p=0.044), as well as with DAS28-ESR>3.2 (OR=8.10, p=0.008). Moreover, levels of sCD163 predicted CHR≥0.121 (AUC=0.701), cholesterol total/HDL ratio>7% (AUC=0.764), and DAS28-ESR>3.2 (AUC=0.720). CONCLUSION: Serum levels of sCD163 could be considered a surrogate of cardiovascular risk and clinical activity in RA.

Anticoncepción posparto en grupos vulnerables. Cada mujer cuenta / Postpartum contraception in vulnerable populations. Every woman counts

Objetivo: conocer la tasa de continuación en anticoncepción, los embarazos deseados y no deseados en mujeres en riesgo de exclusión social incluidas en un programa posparto que potencia métodos anticonceptivos de larga duración. Material y método: estudiamos a 117 mujeres en riesgo de exclusión social citadas para revisión posparto; además, se recita a las que fallan y se facilitan métodos de larga duración el mismo día de la consulta. Analizamos los resultados a los 5 años. Resultados: el 72% eligió métodos de larga duración (47% DIU y 22% implante). A los 5 años continuaban con DIU el 63,6% y el 65,3% con implante. En 5 años hubo 36 embarazos en 29 mujeres (deseados 66%). Ninguna mujer tuvo 2 hijos en 5 años. Se produjeron 6 IVE (interrupción voluntaria del embarazo) en 5 años. El mismo grupo presentó 60 IVE en los años previos. Conclusión: facilitar métodos de larga duración en el posparto es una buena estrategia para distanciar las gestaciones y disminuir los IVE en grupos vulnerables. Disponer de métodos gratuitos en estos casos es fundamental (AU)

Objective: To determine the rates of contraception continuation, unwanted pregnancies and desired pregnancies in women from vulnerable populations in a postpartum program that provides long-acting reversible contraception. Material and method: We analysed 117 women at risk of social exclusion referred for a postpartum visit. Women who failed to attend were contacted. Long-acting reversible contraception was provided on the same day as the visit. The 5-year results were analysed. Results: A total of 72% chose long-acting reversible contraception (47% IUD and 22% implant). At 5 years, 63.6% continued with the IUD and 65.3% with the implant. In 5 years, there were 36 pregnancies in 29 women (66% desired). None of the women had 2 children in the 5-year period. There were 6 induced abortions in 5 years. The same women had 60 induced abortions in previous years. Conclusion: Providing long-term methods at the first postpartum visit has the potential to improve optimal interpregnancy intervals and reduce the number of induced abortions in vulnerable populations (AU)

Cribado de cáncer de cérvix: ¿merece la pena la búsqueda activa? / Cervical cancer screening: Is active recruitment worth the effort?

OBJETIVOS: Conocer el porcentaje de mujeres que han realizado una citología en los últimos 5 años y el ámbito de realización. Detectar alteraciones citológicas precursoras de cáncer de cérvix en mujeres sin cribado o con cribados inadecuados y conocer la prevalencia de determinaciones de VPH positivas. DISEÑO: Estudio descriptivo transversal. Emplazamiento: Centro de Salud de Natahoyo, Gijón. PARTICIPANTES: Mujeres de 40 a 50 años residentes en la zona básica y adscritas al centro de salud. MÉTODOS: Recogida de información en bases de datos, telefónicamente y por encuestas en domicilios. Captación activa, en atención primaria, de mujeres sin cribado o con cribado inadecuado para realizar citología y determinación de VPH. RESULTADOS: De las 1.420 mujeres de 40 a 50 años 1.236 (87%) habían realizado una citología en los últimos 5 años y 184 (13%) nunca habían hecho una citología o llevaban más de 5 años sin hacerla. De las 184 mujeres sin cribado o con cribados inadecuados 108 (el 58,7%) accedieron a realizar citología y determinación de VPH. En las citologías realizadas no se diagnosticó ninguna displasia de alto grado. El 8,3% de las determinaciones de VPH fueron positivas. CONCLUSIONES: En nuestra población existe una alta cobertura del cribado oportunista de cáncer de cérvix. La captación activa de mujeres que se encontraban fuera del programa de cribado no resultó rentable

OBJECTIVES: To determine the percentage of women who have had a Pap smear in the last 5 years, and the place where it was carried out. To detect cytological abnormalities and precursors of cervical cancer in un-screened or inadequately screened women and the prevalence of HPV-positive determinations. DESIGN: Cross sectional study. SETTING: Natahoyo Health Centre, Gijón (Spain). PARTICIPANTS: Women aged 40-50 years living in the area and assigned to the Health Centre. METHODS: The information was collected from databases, telephone and home surveys. There was active recruitment of unscreened women or inadequately screened in Primary Care as well as offering to perform cytology and HPV determination. RESULTS: Of the 1420 women aged 40 to 50 years, 1236 (87%) had cytology in the last 5 years, and 184 women (13%) had no screening or it was inadequate. Of these 184 women, 108 (58.7%) agreed to have cytology and HPV test performed. No high-grade cervical dysplasia was diagnosed. The prevalence of HPV-positive was 8.3%. CONCLUSIONS: In our population there is a high coverage of opportunistic screening for cervical cancer. The active recruitment of women who were not in the screening program was not useful

[Cervical cancer screening: Is active recruitment worth the effort?]. / Cribado de cáncer de cérvix: ¿merece la pena la búsqueda activa?

OBJECTIVES: To determine the percentage of women who have had a Pap smear in the last 5 years, and the place where it was carried out. To detect cytological abnormalities and precursors of cervical cancer in un-screened or inadequately screened women and the prevalence of HPV-positive determinations. DESIGN: Cross sectional study. SETTING: Natahoyo Health Centre, Gijón (Spain). PARTICIPANTS: Women aged 40-50 years living in the area and assigned to the Health Centre. METHODS: The information was collected from databases, telephone and home surveys. There was active recruitment of unscreened women or inadequately screened in Primary Care as well as offering to perform cytology and HPV determination. RESULTS: Of the 1420 women aged 40 to 50 years, 1236 (87%) had cytology in the last 5 years, and 184 women (13%) had no screening or it was inadequate. Of these 184 women, 108 (58.7%) agreed to have cytology and HPV test performed. No high-grade cervical dysplasia was diagnosed. The prevalence of HPV-positive was 8.3%. CONCLUSIONS: In our population there is a high coverage of opportunistic screening for cervical cancer. The active recruitment of women who were not in the screening program was not useful.

Cribado de cáncer cervical con citología y test del virus del papiloma humano cada 5 años: una realidad / Cervical cancer screening with a combination of cytology and high risk human papilloma virus test every five years: a reality

Objetivo. Analizar si es posible aplicar un protocolo de cribado cervical con citología y detección de VPH a partir de los 35 años con repetición cada 5 años. Estudiamos si la aplicación de este protocolo retrasa el diagnóstico de cáncer cervical. Material y método. Desde el año 2005 aplicamos protocolos de cribado de cáncer cervical y en el año 2010 incluimos la detección del VPH a partir de los 35 años. Realizamos un estudio retrospectivo sobre 500 mujeres que acudieron a nuestra consulta. Estudiamos si se había aplicado correctamente el protocolo y el tiempo en que se recomendaba la siguiente revisión. Analizamos los cánceres de cérvix diagnosticados en nuestras consultas desde el año 2005. Resultados. Aplicamos el protocolo de manera correcta en el 100% de las mujeres estudiadas. Realizamos citología y determinación del VPH al 45,6%, solo citología a al 23,2% y no realizamos toma de cribado al 31,2%. Al 26% de nuestras pacientes les indicamos la siguiente revisión en 5 años. La aplicación del protocolo no retrasó el diagnóstico de cáncer. De los 27 casos diagnosticados desde 2005, solo una mujer con adenocarcinoma había realizado correctamente el cribado (antes de usar la determinación del VPH). Se diagnosticaron 4 cánceres microinfiltrantes con la aplicación del cribado. Conclusiones. Es posible la aplicación de un protocolo de cribado con doble test a partir de los 35 años con repetición cada 5 años en las consultas rutinarias de un hospital. No retrasa el diagnóstico de cáncer cervical y puede servir para optimizar los recursos al distanciar las revisiones en las mujeres sanas (AU)

Objective. To analyze screening for cervical cancer with a combination of cytology and HPV testing in women older than 35 years every 5 years and to determine whether the application of this protocol delays diagnosis of cervical cancer. Material and methods. Cervical cancer screening strategies have been applied in our hospital since 2005. HPV testing was introduced in 2010 for women older than 35 years. We performed a retrospective study of 500 women attended in our hospital. We studied whether we had correctly applied the strategy and the recommended time interval of the next review. We analyzed cervical cancers diagnosed in our hospital since 2005. Results. The strategy was correctly applied in 100% of the women. Screening was performed with both cytology and HPV testing in 45.6% and with cytology alone in 23.2%; no screening was performed in 31.2%. The recommended interval until the next review was 5 years in 26% of the patients. The implementation of the strategy did not delay the diagnosis of cancer. Cervical cancer was diagnosed in 27 women since 2005. Only one woman with adenocarcinoma had been correctly screened (before the introduction of HPV testing). In the last 2 years, four microinvasive carcinomas were diagnosed with this strategy. Conclusions. A combination of cytology and HPV testing can be applied in women older than 35 years and screening intervals can be increased to 5 years in routine clinical practice. This protocol does not delay the diagnosis of cervical cancer and optimizes resources by lengthening the interval between screening tests in healthy women (AU)

Anticoncepción posparto en mujeres con riesgo de exclusión social / Postpartum contraception in women at risk of social exclusion

Objetivo. Mejorar las tasas de anticoncepción posparto en mujeres en situación social desfavorable, espaciar los embarazos y disminuir las tasas de interrupción voluntaria del embarazo. Material y métodos. Realizamos un estudio prospectivo. Citamos a 90 mujeres embarazadas en riesgo de exclusión social para revisión posparto al mes y medio de la fecha probable de parto, con recuerdo SMS 48 horas antes de la cita y localización telefónica en caso de incomparecencia. Procuramos aplicar métodos de larga duración el mismo día de la consulta. Resultados. El 92% acudió a la revisión posparto. La tasa total de anticoncepción fue del 86%, el 68% fueron métodos de larga duración: fundamentalmente DIU e implantes. Conclusión. La consulta de posparto en mujeres de grupos sociales desfavorecidos puede ser muy útil para que accedan a métodos anticonceptivos seguros, eficaces y de larga duración. Flexibilidad y agilidad en la aplicación de los métodos son fundamentales(AU)

Objective. Improve birth control rates in women from vulnerable populations, space time out between pregnancies and reduce the rate of abortions. Material and methods. We gave 90 pregnant women at risk of social exclusion an appointment for a postpartum check- up a month and a half after their expected due date, with a SMS reminder 48hours before the appointment and a phone number in case they failed to make the appointment. We strive to implement long-term methods on the day of appointment. Results. 92% attended the postnatal visit. The overall rate of contraception was 86%, 68% were long-term methods: subdermal implants and IUDs. Conclusion. Consultation with postpartum women from disadvantaged social groups can be very useful to facilitate contraceptive methods which are safe, effective and long-lasting. Flexibility and agility in the implementation of the methods are essential(AU)