Enfermedades tiroideas y embarazo en una unidad de cuidados intensivos. Experiencia 2014-2019 / Thyroid disease and pregnancy in an intensive care unit. Experience 2014-2019

Introducción: Las mujeres con enfermedad tiroidea y embarazo tienen alto riesgo de complicaciones graves. Los cuidados intensivos pueden mejorar los resultados. Objetivo: Conocer los resultados maternos y perinatales en pacientes con enfermedades tiroideas manejadas en la Unidad de Cuidados Intensivos (UCI). Material y métodos: Estudio transversal en 50 mujeres con enfermedades tiroideas y embarazo admitidas en la UCI entre los años 2014 y 2019. Se consultaron los expedientes clínicos para conocer sus características generales y los resultados maternos y perinatales. Análisis estadístico: estadística descriptiva, prueba t de Student. Resultados: Se identificaron dos grupos, pacientes con hipotiroidismo 66% (n=33) y con hipertiroidismo 34% (n=17). Cuando fueron admitidas a la UCI, el 33,33% (11 casos) tenían hipotiroidismo descontrolado y el 76,47% (13 casos) hipertiroidismo descontrolado, incluyendo un caso de tirotoxicosis. Las causas de admisión en el grupo con hipotiroidismo fueron preeclampsia (32%), tiroideopatía descontrolada (10%) e hipertensión crónica (8%), y en el grupo con hipertiroidismo fueron preeclampsia (10%), tiroideopatía descontrolada (10%) e hipertensión crónica (2%). Se encontraron diferencias en la edad gestacional (hipotiroidismo 31,07±7,47 vs. hipertiroidismo 24,52±9,42 semanas, p=0,015) y en el tiempo de la admisión al hospital hasta la interrupción gestacional (hipotiroidismo 2,30±1,45 vs. hipertiroidismo 12,97±3,39 días, p=0,033). Los recién nacidos hijos de pacientes con hipertiroidismo tuvieron edad gestacional más corta (p=0,015), bajo peso al nacer (p=0,011), elevada frecuencia de prematurez (30,76%), necesidad de cuidados intensivos (11,54%) y mayor mortalidad al nacimiento (11,54%). Conclusiones: Los resultados maternos y perinatales de las pacientes hipotiroideas fueron satisfactorios, no así en las enfermas con hipertiroidismo.(AU)

Introduction: Pregnant women with thyroid diseases have a high risk of severe complications. Intensive care may improve results. Objective: To determine maternal and perinatal outcomes in patients with thyroid diseases managed in the intensive care unit (ICU). Material and methods: Cross-sectional study in 50 pregnant women with thyroid diseases admitted into the ICU between the years 2014 and 2019. Clinical files were consulted for general characteristics, as well as maternal and perinatal outcomes. Statistical analysis: descriptive analysis, Student t test. Results: Two groups were identified: patients with hypothyroidism 66% (n=33) and with hyperthyroidism 34% (n=17). When admitted to ICU, 33.33% (11 cases) had uncontrolled hypothyroidism and 76.47% (13 cases) uncontrolled hyperthyroidism, including one case of thyrotoxicosis. The reasons for admission in the group with hypothyroidism were preeclampsia (32%), uncontrolled thyroid disease (10%), and chronic hypertension (8%). In the group with hyperthyroidism, it was preeclampsia (10%), uncontrolled thyroid disease (10%), and chronic hypertension (2%). Differences were found in gestational age (hypothyroidism 31.07±7.47 vs hyperthyroidism 24.52±9.42 weeks, P=.015), and in the time of hospital admission until termination of pregnancy (hypothyroidism 2.30±1.45 vs hyperthyroidism 12.97±3.39 days, P=.033). The children of patients with hyperthyroidism had lower gestational age (P=.015), lower birth weight (P=.011), higher frequency of prematurity (30.76%), need for intensive care (11.54%), and higher birth mortality (11.54%). Conclusions: Maternal and perinatal outcomes of patients with hypothyroidism were satisfactory, but not so in those with hyperthyroidism.(AU)

Cierre de un gran defecto de la pared torácica y abdominal usando omento y malla de polipropileno en un canino / Closure of a large thoracic and abdominal wall defect using omentum and a polypropylene mesh in a dog

RESUMEN Este reporte de caso describe la resección quirúrgica exitosa de un condroma de gran tamaño localizado en las dos últimas costillas y pared abdominal craneal izquierda de un canino, usando una malla de polipropileno, omento y avance del diafragma. Se discute la técnica quirúrgica y los materiales utilizados en el procedimiento, así como la evolución posquirúrgica del paciente.

ABSTRACT This case report describes the successful surgical resection of a large chondroma located in the last two ribs and left cranial abdominal wall of a dog, using a polypropylene mesh, omentum and diaphragm advance. The surgical technique and the materials used in the procedure, as well as the postoperative outcome, are discussed.

Preoperative use of statins does not improve outcomes and development of acute renal failure after cardiac surgery. A propensity score analysis of ARIAM-Andalucía database.

BACKGROUND: Statin use prior to cardiac surgery has been reported to improve outcomes in the postoperative period because of other effects apart from decreasing lipid levels. Objective of the study was to analyse mortality and acute renal failure (ARF) during the cardiac surgery postoperative period in patients treated with or without statins. METHODS: This prospective cohort study comprised adult patients who underwent cardiac surgery at 11 institutions in the Andalusian community from March 2008 to July 2012 included in the ARIAM adult cardiac surgery project. We performed a first analysis in the whole cohort and in a second analysis statin users prior to surgery were pair matched with non-users according to their propensity score based on demographics, comorbidities, medication and surgical data. We analysed differences in outcomes, ARF, need for renal replacement therapy (RRT) and a composite end point with mortality or major morbidity in both groups. RESULTS: The study included 7276 patients, of whom 3749 were treated with statins. Overall, hospital mortality was 10.1%, 10.5% developed ARF and 2.5% required RRT. In the whole non-matched cohort, statins were associated with lower hospital mortality (OR 0.79; 95% CI, 0.67-0.93) and less ARF (OR 0.79; 95% CI, 0.68-0.93). However, after propensity score analysis in the matched cohort of 3056 patients (1528 in each group), statin use was not consistently associated with less ARF (OR 0.94; 95% CI, 0.74-1.19), hospital mortality (OR 0.83; 95% CI, 0.68-1.1) or composite outcome (OR 0.857; 95% CI, 0.723-1.015). CONCLUSION: Despite better outcomes for the statin users in the whole cohort, the matched analysis showed that statin use before cardiac surgery was not associated with a lower risk of ARF. Nor was presurgery statin use associated with lower hospital mortality.

What does weight stigma smell like? Cross-modal influence of visual weight cues on olfaction.

In a variety of personal and professional domains, heavy individuals face stigma associated with their body size. Here we investigate a new method for subtle detection of the negative perceptions consistent with that stigma. In two studies, participants were asked to view images of heavy and thin individuals while smelling substances that, unbeknownst to them, were odorless. Across both studies, the results showed that the substances were perceived to smell worse when they were paired with images of heavy individuals than when they were paired with images of thin individuals. These findings suggest that perceptions of stigmatized individuals can be assessed indirectly through olfactory responses. More generally, they suggest that the effects of weight stigma are broader than previously recognized.

[Conjunctival myeloid sarcoma in acute myeloblastic leukemia-M1]. / Sarcoma granulocítico conjuntival en leucemia mieloblástica aguda M1.

CLINICAL CASE: A 69-year-old man with a history of acute myeloblastic leukemia-M1 presented with bilateral conjunctival injection. Ophthalmological examination revealed lesions located at the upper tarsal conjunctiva of the right eye and lower tarsal conjunctiva of both eyes. Histological and immunohistochemical studies confirmed conjunctival myeloid sarcoma. The patient died due to multiorgan failure three months later. DISCUSSION: Extramedullary recurrence of leukemia can appear as an ocular manifestation that brings about a recurrence of the leukemia, leading to a poor prognosis.

Sarcoma granulocítico conjuntival en leucemia mieloblástica aguda M1 / Conjunctival myeloid sarcoma in acute myeloblastic leukemia-M1

Caso clínico: Varón de 69 años diagnosticado de leucemia mieloblástica aguda M1 en remisión completa, remitido a Oftalmología por cuadro de ojo rojo no doloroso. Biomicroscópicamente se observan lesiones sobreelevadas asalmonadas en conjuntiva tarsal superior de ojo derecho e inferior de ambos ojos. Mediante estudios histológicos e inmunohistoquímicos se confirma recidiva extramedular en forma de sarcoma mieloide en conjuntiva. El paciente fallece a los 3 meses de un fallo multiorgánico. Discusión: La recidiva extramedular de una leucemia puede presentarse como una manifestación ocular que conlleva una recurrencia de la leucemia, siendo esta de mal pronóstico(AU)

Clinical case: A 69-year-old man with a history of acute myeloblastic leukemia-M1 presented with bilateral conjunctival injection. Ophthalmological examination revealed lesions located at the upper tarsal conjunctiva of the right eye and lower tarsal conjunctiva of both eyes. Histological and immunohistochemical studies confirmed conjunctival myeloid sarcoma. The patient died due to multiorgan failure three months later. Discussion: Extramedullary recurrence of leukemia can appear as an ocular manifestation that brings about a recurrence of the leukemia, leading to a poor prognosis(AU)

[Intermediate uveitis due to human T-cell lymphotropic virus type 1]. / Uveítis intermedia por virus linfotropo humano de células T Tipo 1.

CASE REPORT: The case of a 66-year-old woman with intermediate uveitis in both eyes and progressive weakness of lower limbs is reported. A human T-lymphotropic virus type 1 (HTLV-1) infection was detected in the serological study, with the patient being diagnosed with tropical spastic paraparesis and HTLV-1 intermediate uveitis. The patient made good progress with oral steroid treatment. DISCUSSION: The clinical and epidemiological aspects of HTLV-1 infection are discussed. We recommend a serological determination of the virus in intermediate uveitis of unknown origin in people from endemic areas or with neurological symptoms.

Uveítis intermedia por virus linfotropo humano de células T Tipo 1 / Intermediate uveitis due to human T-cell lymphotropic virus type 1

Caso Clínico: Se presenta el caso de una mujer de 66 años con uveítis intermedia bilateral y debilidad progresiva de miembros inferiores. En estudio serológico se detecta infección por virus linfotropo humano de células T tipo 1 (VLHT-1), siendo diagnosticada la paciente de paraparesia espástica tropical y uveítis intermedia por VLHT-1. La paciente evolucionó favorablemente con tratamiento corticoideo oral. Discusión: Se comenta la clínica y la epidemiología de la infección por VLHT-1. Se recomienda la realización de serología para el virus en uveítis intermedias no filiadas en inmigrantes de áreas endémicas o con síntomas neurológicos(AU)

Case Report: The case of a 66-year-old woman with intermediate uveitis in both eyes and progressive weakness of lower limbs is reported. A human T-lymphotropic virus type 1 (HTLV-1) infection was detected in the serological study, with the patient being diagnosed with tropical spastic paraparesis and HTLV-1 intermediate uveitis. The patient made good progress with oral steroid treatment. Discussion: The clinical and epidemiological aspects of HTLV-1 infection are discussed. We recommend a serological determination of the virus in intermediate uveitis of unknown origin in people from endemic areas or with neurological symptoms(AU)

[Descemet's membrane detachment as a complication of cataract surgery]. / Desprendimiento postquirúrgico de la membrana de Descemet (a propósito de un caso).

CASE: A case of Descemet's membrane detachment after cataract surgery successfully treated with an injection of sulphur hexafluoride 20% is presented. DISCUSSION: Possible pathogenic mechanisms and available therapeutic options are discussed. We highlight the need for prophylactic measures and the importance of an early detection to prevent further damage.

[Visual acuity loss, the initial sympton of a spinal cord neoplasm]. / Disminución de agudeza visual, primer síntoma de un tumor medular.

CASE REPORT: A 46-year-old woman, who presented with right visual acuity loss, was found to have papilledema, and subsequently shown to have ventricular dilatation in a cerebral Magnetic Resonance Imaging (MRI) assessment. Elevated protein levels were found in the cerebrospinal fluid. Spinal MRI revealed the presence of a spinal cord neoplasm. After surgical removal of the tumor, which turned out to be a neurilemmoma, the patient's visual acuity was restored. DISCUSSION: The ocular presentation and the relationship between intracranial hypertension and spinal tumors are discussed. Likewise, the importance of considering the various causes of papilledema is emphasized.

Determinants of human papillomavirus 16 serological conversion and persistence in a population-based cohort of 10 000 women in Costa Rica.

Determinants of human papillomavirus (HPV)-16 serological conversion and persistence were assessed in a population-based cohort of 10 049 women in Guanacaste, Costa Rica. Serologic responses to HPV-16 were measured in 7986 women by VLP-based enzyme-linked immunosorbent assay at both study enrollment (1993/94) and at 5-7 years of follow-up. Seropositive women were defined as >/=5 standard deviations above the mean optical density obtained for studied virgins at enrollment (n=573). Seroconnversion (n=409), persistence (n=675), and clearance (n=541) were defined based on enrollment and follow-up serology measurements. Age-specific distributions revealed that HPV-16 seroconversion was highest among 18- to 24-year-old women, steadily declining with age; HPV-16 seropersistence was lowest in women 65+ years. In age-adjusted multivariate logistic regression models, a 10-fold risk increase for HPV-16 seroconversion was associated with HPV-16 DNA detection at enrollment and follow-up; two-fold risk of seroconversion to HPV-16 was associated with increased numbers of lifetime and recent sexual partners and smoking status. Determinants of HPV-16 seropersistence included a 1.5-fold risk increase associated with having one sexual partner during follow-up, former oral contraceptive use, and a 3-fold risk increase associated with HPV-16 DNA detection at both enrollment and follow-up. Higher HPV-16 viral load at enrollment was associated with seroconversion, and higher antibody titres at enrollment were associated with seropersistence.

A case-control study of endogenous hormones and cervical cancer.

Both parity and oral contraceptive use are associated with elevated circulating levels of sex hormones, at least transiently, and with increased risk of cervical cancer in human papillomavirus (HPV)-infected women. We directly evaluated whether elevations in the physiologic levels of these hormones predispose to the development of cervical neoplasia. We identified 67 premenopausal and 43 postmenopausal women with cervical intraepithelial neoplasia 2, 3, or cervical cancer (>/=CIN2) diagnosed during enrollment of a population-based cohort of 10 077 women. Four controls, two chosen randomly and two chosen from women testing positive for cancer-associated HPV, were matched to each case on menopausal status, age, days since last menses (pre), or years since menopause (post). Sex hormone-binding globulin, oestradiol, oestrone, oestrone-sulphate, dehydroepiandrosterone sulphate, and progesterone were measured in enrollment plasma. There was no consistent association between the sex hormones and risk of >/=CIN2. Excluding cases with invasive disease had a minimal impact on results. Though this case-control study was based on a well-defined population, it was limited by reliance on a single measure of hormone levels taken at the time of diagnosis. Nonetheless, our results do not support the hypothesis that plasma levels of sex hormones have an important bearing on the risk of cervical neoplasia in HPV-infected women.

A population based study of herpes simplex virus 2 seroprevalence in rural Costa Rica.

OBJECTIVES: To determine seroprevalence and determinants of herpes simplex virus 2 (HSV-2) seropositivity, in a random sample of a population based cohort of 10 049 women of Guanacaste, Costa Rica, using a highly sensitive and specific serological assay. METHODS: Seroprevalence was determined by a type specific HSV-2 ELISA assay in an age stratified random sample of 1100 women. Univariate and multivariate logistic regression was used to calculate odds ratios and 95% confidence intervals for risk factors of seropositivity. RESULTS: Overall age adjusted HSV-2 seroprevalence was 38.5% (95% CI, 37.5 to 39.5), and it was strongly associated with increasing age (p(Trend<0.0001)), both among monogamous women and women with multiple sexual partners. A greater number of lifetime sexual partners increased the risk of seropositivity, with a 28.2% (95% CI, 24.4 to 32.2) seroprevalence among monogamous women and 75% (95% CI, 65.6 to 83.0) seroprevalence for those with four or more partners (OR = 7.6 95% CI, 4.7 to 12.4 p(Trend<0.0001)). Barrier contraceptive use was negatively associated with HSV-2 seropositivity (OR 0.54, 95% CI, 0.31 to 0.94). Women with antibodies against HPV 16, 18, or 31 were 1.6 times more likely to be HSV-2 seropositive (OR 1.6, 95% CI, 1.2 to 2.1). CONCLUSIONS: HSV-2 infection is highly endemic in Guanacaste, even among lifetime monogamous women, suggesting a role of male behaviour in the transmission of the infection. Until vaccination against HSV-2 is available, education to prevent high risk sexual behaviour and the use of condoms appear as preventive measures against HSV-2.

Seroprevalence of human papillomavirus-16, -18, -31, and -45 in a population-based cohort of 10000 women in Costa Rica.

Human papillomavirus (HPV) seroprevalence and determinants of seropositivity were assessed in a 10049-woman population-based cohort in Guanacaste, Costa Rica. Serologic responses based on VLP-based ELISA were obtained from the plasma collected at study enrollment in 1993/1994 for HPV-16 (n=9949), HPV-18 (n=9928), HPV-31 (n=9932), and HPV-45 (n=3019). Seropositivity was defined as five standard deviations above the mean optical density obtained for studied virgins (n=573). HPV-16, -18, -31, and -45 seroprevalence was 15, 15, 16, and 11%, respectively. Of women DNA-positive for HPV-16, -18, -31, or -45, seropositivity was 45, 34, 51, and 28%, respectively. Peak HPV seroprevalence occurred a decade after DNA prevalence; lifetime number of sexual partners was the key determinant of seropositivity independent of DNA status and age. DNA- and sero-positive women showed the highest risk for concurrent CIN3/cancer, followed by DNA-positive, sero-negative women.

La investigación en necesidades de formación de los gestores de enfermería / Search in nursing managers training necessities

En este artículo se hace un análisis sobre la producción científica relacionada con las necesidades de formación de los profesionales de enfermería que se dedican a la gestión, en las publicaciones enfermeras de nuestro país. El estudio que se ha llevado a cabo ha sido de carácter descriptivo/observacional. Las unidades de análisis han sido los materiales publicados tanto en revistas como en libros, así como algunos estudios relacionados el tema objeto de estudio. Para conocer la naturaleza de dichas publicaciones y situarnos ante el panorama de la producción científica sobre necesidades de formación en gestión enfermera, realizamos un barrido de artículos en revistas de enfermería de publicación periódica en el ámbito nacional, desde la década de los setenta hasta diciembre de 2001.Los resultados obtenidos nos dan una visión de los temas más tratados en las revistas de enfermería y de la naturaleza de éstos, que por lo general son los relacionados con la actividad enfermera, como atención y cuidados; sobre gestión y formación sanitaria en enfermería y más concretamente en necesidades de formación de gestores enfermeros, se detecta una gran carencia (AU)

An association of cervical inflammation with high-grade cervical neoplasia in women infected with oncogenic human papillomavirus (HPV).

Previous reports of genital conditions, such as nonspecific genital infection/sore or vaginal discharge associated with cervical cancer (L. A. Brinton et al., J. Natl. Cancer Inst. (Bethesda), 79: 23-30, 1987; C. J. Jones et al., Cancer Res., 50: 3657-3662, 1990), suggest a possible link between either genital tract inflammation or changes in bacteria flora consistent with bacterial vaginosis (BV) and cervical cancer. To test whether changes in vaginal bacterial flora or the degree of cervical inflammation are associated with women having a human papillomavirus (HPV) infection or with women infected with oncogenic HPV having high-grade cervical lesions (high-grade squamous intraepithelial lesions or cancer), we conducted a case-control study of women <50 years old enrolled in the Costa Rican natural history study of HPV and cervical neoplasia. To test whether BV and inflammation were associated with HPV DNA positivity, Analysis 1 was restricted to women with no or mild (low-grade or equivocal) cytological abnormalities, and the degree of inflammation and Nugent score (a measure of BV) were compared between women infected (n = 220) and not infected (n = 130) with HPV. To test whether BV and inflammation were associated with high-grade lesions, Analysis 2 was restricted to women infected with oncogenic HPV, and the degree of inflammation and Nugent score were compared between women with (n = 95) and without (n = 158) high-grade cervical lesions. In Analysis 1, BV and cervical inflammation were not associated with HPV infection. In Analysis 2, BV was not associated with high-grade lesions. However, we found a marginally significant positive trend of increasing cervical inflammation associated with high-grade lesions in oncogenic HPV-infected women, (P(trend) = 0.05). Overt cervicitis was associated with a 1.9-fold increase in risk of high-grade lesions (95% confidence interval, 0.90-4.1). The results of this study suggest that cervical inflammation may be associated with high-grade lesions and may be a cofactor for high-grade cervical lesions in women infected with oncogenic HPV.