Xenoestrogen concentration in women with endometriosis or leiomyomas: A case-control study.

BACKGROUND: Xenoestrogens are synthetic or naturally occurring chemicals capable of altering the endocrine system of humans and animals owing to their molecular similarity to endogenous hormones. There is limited data regarding their effects on women´s health. Chronic exposure to xenoestrogens can promote the development of estrogen-related diseases. OBJECTIVES: To examine xenoestrogen concentration (TEXB-α) differences between women with leiomyomas or endometriosis and control women, and to study the relationship between the clinical and sociodemographic characteristics of these patients and their xenoestrogen levels. METHODS: Prospective case-control study. We selected 221 women who underwent surgery at Quironsalud Madrid University Hospital between 2017 and 2021. The cases included 117 patients: 74 women who underwent surgery for uterine leiomyomas, 21 with endometriosis, and 22 with both pathologies. The control group comprised 104 healthy women who underwent surgical procedures for other reasons. TEXB-α was determined in the omental fat of all patients. Using a questionnaire and reviewing the patients' medical records, we collected sociodemographic data and other relevant variables. RESULTS: A significant majority of study participants (68.8%) had detectable levels of xenoestrogens. We found no association between TEXB-α levels in omental fat and the presence of myomas or endometriosis. In the case group, women living or working in Madrid Community exhibited, on average, 3.12 Eeq pM/g higher levels of TEXB-α compared to those working in other areas (p = 0.030). Women who referred to the use of estrogen-containing hormonal contraceptives had, on average, 3.02 Eeq pM/g higher levels of TEXB-α than those who had never used them (p = 0.022). CONCLUSIONS: This study found no association between omental xenoestrogen levels and leiomyomas or endometriosis. However, their presence in most participants and their association with highly polluted areas emphasizes the importance of limiting environmental exposure to these substances. We also identified an association between hormonal contraceptive use and xenoestrogen concentration.

Cyclosporine A in hospitalized COVID-19 pneumonia patients to prevent the development of interstitial lung disease: a pilot randomized clinical trial.

Post-COVID-19 interstitial lung disease (ILD) is a new entity that frequently causes pulmonary fibrosis and can become chronic. We performed a single-center parallel-group open-label pilot randomized clinical trial to investigate the efficacy and safety of cyclosporine A (CsA) in the development of ILD in the medium term among patients hospitalized with COVID-19 pneumonia. Patients were randomized 1:1 to receive CsA plus standard of care or standard of care alone. The primary composite outcome was the percentage of patients without ILD 3 months after diagnosis of pneumonia and not requiring invasive mechanical ventilation (IMV) (response without requiring IMV). The key secondary composite outcomes were the percentage of patients who achieve a response requiring IMV or irrespective of the need for IMV, and adverse events. A total of 33 patients received at least one dose of CsA plus standard of care (n = 17) or standard of care alone (n = 16). No differences were found between the groups in the percentage of patients who achieved a response without requiring IMV or a response requiring IMV. A higher percentage of patients achieved a response irrespective of the need for IMV in the CsA plus standard of care group although the RR was almost significant 2.833 (95% CI, 0.908-8.840; p = 0.057). No differences were found between the groups for adverse events. In hospitalized patients with COVID-19 pneumonia, we were unable to demonstrate that CsA achieved a significant effect in preventing the development of ILD. (EU Clinical Trials Register; EudraCT Number: 2020-002123-11; registration date: 08/05/2020).

Características de los pacientes con neoplasias hematológicas y con tumores sólidos atendidos por un equipo de soporte paliativo hospitalario / Characteristics of patients with hematological and solid tumors malignancies attended by a hospital palliative care service

Antecedentes y objetivo: El interés por la atención paliativa en pacientes con neoplasias hematológicas está aumentando. Nuestro objetivo es describir las características de pacientes oncológicos valorados por un equipo de soporte paliativo en un hospital terciario y analizar las diferencias entre pacientes hematológicos y con tumores sólidos. Método: Estudio observacional descriptivo longitudinal retrospectivo con una cohorte de pacientes hospitalizados con enfermedad oncológica (hematológica o tumor sólido) valorados por equipo de soporte paliativo hospitalario. Comparamos variables clínicas, asistenciales y de supervivencia. El análisis de datos se realizó con la versión 15 del programa SPSS. Resultados: De enero de 2015 a diciembre de 2018 se valoraron 1025 pacientes oncológicos (10,8 % hematológicos, 89,2 % sólidos). No se encontraron diferencias en situación funcional medida por la Palliative Performance Scale, presentación de síntoma principal, porcentaje de pacientes con dolor, tiempo de seguimiento ni en porcentaje de fallecidos en el ingreso en que fueron valorados. El paciente hematológico, comparado con el oncológico, tiene menos tratamiento opioide pautado (43 vs. 53 %; p = 0,035), es seguido con más frecuencia por recurso paliativo hospitalario que domiciliario (46,55 vs. 29,44 % el primero; 15,5 vs. 33,06 % el segundo; p = 0,001 en distribución) y fallece más en hospital (82,9 vs. 65,5 %; p = 0,024). Conclusiones: Los pacientes con neoplasia hematológica presentan una carga sintomática similar a los pacientes con tumor sólido. Es importante identificar mejor sus necesidades para que puedan beneficiarse, como se ha demostrado con los pacientes oncológicos, de la atención integrada junto a los servicios de hematología con modelos de intervención acordes a sus necesidades y las trayectorias específicas de las enfermedades hematológicas. (AU)

Background and objective: Interest in palliative care for patients with hematologic malignancies is increasing. Our goal is to describe the features of cancer patients evaluated by a supportive and palliative care service in a tertiary referral hospital, and to analyze the differences between patients with hematological malignancies and solid tumors. Method: A retrospective longitudinal descriptive observational study was carried out in a cohort of hospitalized patients with oncological diseases (hematological or solid tumor) evaluated by a palliative care service. We compared clinical, healthcare and survival variables between both groups. The analysis was performed using the SPSS v.15 package. Results: From January 2015 to December 2018, 1025 cancer patients were evaluated (10.8 % hematological tumor, 89.2 % solid tumors). No differences were found in functional status as measured by the Palliative Performance Scale, presentation of main symptom, percentage of patients with pain, time of follow-up, or percentage of deaths on admission to the evaluation. The hematological patient, compared to the oncological one, has less prescribed opioid treatment (43 % vs 53 %, p = 0.035), received greater hospital palliative care rather than home-based care (46.55 % vs 29.44 % the former and 15.5 % vs 33.06 % the latter, p = 0.001), and dies more frequently in a hospital (82.9 % vs. 65.5 %, p = 0.024). Conclusions: Patients with hematological malignancies present a symptomatic burden similar to that of those with solid tumors. It is important to better identify their needs so that they can benefit, as has been demonstrated with cancer patients, from integrated care together with hematology services using intervention models according to their needs and specific disease trajectories. (AU)

Stress, subjective wellbeing and self-knowledge in higher education teachers: A pilot study through bodyfulness approaches.

Work-related stress is a major cause of health problems worldwide. Faculty in educational institutions, including universities, also face high levels of stress, which undoubtedly affects their performance, level of personal satisfaction and wellbeing, and the relationship with students. Training interventions based on embodied learning can promote self-knowledge, emotional regulation and stress reduction, thereby increasing levels of psychological well-being. The present pilot study analyzed the impact of body awareness training in 31 university teachers using a controlled, randomized pre-post experimental design, with two experimental groups and a control group (n = 10). The two interventions were: Hatha Yoga (n = 11) and Dance Movement Therapy/Body Mind Centering (n = 10), which we have termed Body Movement Awareness. Variables related to body awareness, mindfulness, wellbeing, life satisfaction and stress were measured using self-perception tests. Cortisol levels, heart rate variability and sleep quality were also analyzed. Finally, participants' reflections were analyzed according to a qualitative approach. The results showed significant differences between the control group and the Hatha Yoga group in terms of stress reduction and wellbeing. The Body Movement Awareness group exhibited evidence of contributions on self-knowledge, communication and kinesthetic empathy, key elements in the educational field. Despite the inherent limitations of the study, the conclusions are encouraging and open new lines of research from embodied approaches that introduce creative movement and group experience as part of the process of emotional regulation and self-knowledge.

Laparoscopic Single-Port versus Mini-Laparoscopic Hysterectomy: An International Study.

OBJECTIVES: Laparoendoscopic single-site surgery (LESS) and mini-laparoscopic surgery (Mini-LPS) have been performed with comparable results to conventional laparoscopy. However, there are few data on the comparison between them. Our main objective was to compare LESS and Mini-LPS in terms of surgical time, postoperative pain, and hospital stay in patients who underwent hysterectomy for benign pathology. DESIGN: It is a retrospective international multicentric study carried out in 5 centers including 2 Spanish and 3 Italian. METHODS: Data from patients who underwent hysterectomy for benign pathology between January 1, 2010, and December 31, 2015, were reviewed. We collected the clinical-pathological characteristics of the patients and the perioperative results. The main variables of the study were surgical time, the switch to oral analgesia, and the hospital stay. The two comparison groups in the study included patients undergoing hysterectomy for benign pathology by LESS or by Mini-LPS. The decision to perform the type of procedure was left to the discretion of the surgeon, based primarily on the surgical skills and experience of the center. All data were collected retrospectively by an online encrypted platform. RESULTS: 161 patients were included in the study. 104 (64.6%) patients underwent LESS hysterectomy and 57 (35.4%) Mini-LPS. Median surgical time was significantly longer in the LESS group when compared to the Mini-LPS group (120 vs. 75 min, respectively; p < 0.001). Moreover, longer median hospital stay was observed in the LESS group compared to Mini-LPS (48 vs. 36 h, respectively; p < 0.001). Conversion of the technique to conventional LPS was performed in 4 (2.5%) patients, all of them in the Mini-LPS group (p = 0.015). LIMITATIONS: It is a retrospective study with the biases that this implies. Furthermore, some variables have been incompletely registered in the database, which implies loss of information. This is a nonrandomized study since the decision to intervene with one or another technique was made by the surgeon, which generated 2 nonhomogeneous groups in terms of the number of patients. On the other hand, all the patients who underwent Mini-LPS hysterectomy belonged to the same center, which may have made these results center dependent. CONCLUSIONS: Significant shorter surgical time and shorter hospital stay were observed in patients undergoing Mini-LPS hysterectomy compared to LESS technique; however, intraoperative complications related to instrumentation flaws were higher in the mini-LPS group that required conversion to standard laparoscopy in all cases. Both ultra-minimally invasive techniques seem safe to perform hysterectomies for benign pathology and emphasize the importance in surgical training to adapt them to our current practice.

Storage Proteins Are Driving Pediatric Hazelnut Allergy in a Lipid Transfer Protein-Rich Area.

Oral food challenge (OFC) remains the gold standard for the diagnosis of food allergies. However, this test is not without risks, given that severe allergic reactions can be triggered while it is conducted. The purpose of this study is to identify potential demographic variables, clinical characteristics of the patients and biomarkers that may be associated with severe reactions during the hazelnut oral challenge test. The sample included 22 children allergic to hazelnut who underwent a tree nut skin prick test (SPT), specific IgE (sIgE) to hazelnut, component-resolved diagnosis (CRD) with different hazelnut allergens (Cor a 1, Cor a 8, Cor a 9, Cor a 11, Cor a 14), and a single-blind placebo-controlled challenge with hazelnut. A statistically significant relationship was found between the severity of the reaction and the highest values of sIgE to hazelnut, Cor a 11 and Cor a 14, cumulative symptom-triggering dose and sunflower seed sensitization. The use of the CRD is a useful tool to identify patients at higher risk of developing a severe reaction. In this pediatric population sample from Spain, storage proteins were confirmed to be most involved in hazelnut allergy and the development of severe reactions.

Diseño de un cuestionario para conocer la satisfacción y percepción de los pacientes con el sistema de prescripción de receta electrónica / Design of a questionnaire to know the satisfaction and perception of the population with the electronic prescription system

OBJETIVO: diseñar un cuestionario para conocer la satisfacción y percepciones de los pacientes con el sistema de prescripción de receta electrónica. MÉTODOS: el cuestionario se desarrolló en tres fases. Primera, búsqueda y selección de los atributos del cuestionario. Segunda, análisis del cuestionario por expertos mediante grupo focal multidisciplinar con farmacéuticos, médicos y enfermeros. Tercera, estudio piloto, observacional en 50 pacientes usuarios de receta electrónica durante al menos un año. Se valoró la consistencia interna del cuestionario, la fiabilidad intraobservador y la validez. RESULTADOS: de la primera y segunda fase resultó un cuestionario que incluye 5 atributos y 17 ítems. En el estudio psicométrico, el alfa de Cronbach fue de 0,77 (IC 95 %: 0,66-0,85), siendo el atributo de "satisfacción" el más valorado. La fiabilidad intraobservador tuvo un coeficiente de correlación de 0,96 (IC 95 %: 0,91-0,98). La validez de criterio quedó confirmada a través de la correlación de Spearman con una escala EVA. La validez convergente fue estadísticamente significativa (p = 0,04) para el nivel de estudios y no mostró relación con el número de tratamientos prescritos. CONCLUSIÓN: el cuestionario diseñado presenta adecuada fiabilidad y validez, y puede ser una herramienta útil para el trabajo en la farmacia comunitaria y para su uso en otras comunidades autónomas

OBJECTIVE: Design of a questionnaire to determine the satisfaction and perceptions of patients with electronic prescription system. METHODS: The questionnaire was developed in three phases. First, search and selection of questionnaire attributes. Second, analysis of the questionnaire by experts with a focus group methodology with pharmacists, doctors and nurses. Third, observational pilot study with 50 patients, users of electronic prescription system for at least one year. The internal consistency of the questionnaire, intraobserver reliability and validity were assessed. RESULTS: The first and second phase resulted in a questionnaire that includes 5 attributes and 17 items. In the psychometric study, Croncach's alpha was 0.77 (CI95%: 0.66-0.85), being the "satisfaction" attribute the one most valued. The intraobserver reliability had a correlation coefficient of 0.96 (CI95%: 0.91-0.98). The validity of criterion was confirmed through Spearman ́s correlation with a VAS scale. Convergent validity was statistically significant (p = 0.04) for the level of studies and did not show a relation with the number of prescribed treatments. CONCLUSIONS: The designed questionnaire has adequate reliability and validity and can be a useful tool for work in community pharmacy and for use in other autonomous communities

Real-Life Diagnostic Accuracy of MRI in Prenatal Diagnosis.

There is some controversy about the value of fetal MRI in prenatal diagnosis, and most of the studies examine its accuracy in central nervous system (CNS) pathology. The objective of this retrospective study was to assess the diagnostic accuracy and usefulness of fetal MRI in the prenatal diagnosis of central nervous system (CNS) pathology and non-CNS pathology. Patients referred to the Radiology Department between 2007 and 2018 for a fetal MRI after detection of an anomaly in the fetal ultrasound, a high-risk pregnancy, or an inconclusive fetal ultrasound (n = 623) were included in the study. Postnatal diagnosis was used to assess the diagnostic accuracy of MRI. Fetal MRI was considered to provide additional information over fetal ultrasound when findings of the fetal MRI were not detected in the fetal ultrasound or when established a pathological condition that was not detected in the fetal ultrasound. Fetal MRI provided useful information for the perinatal management and prognosis over fetal ultrasound when findings of the fetal MRI changed the postnatal prognosis, leaded to the decision to legally terminate the pregnancy, changed prenatal or postnatal follow-up, or helped in the planning of prenatal or postnatal treatment. Fetal MRI offered an accurate diagnosis in 97% of cases (compared to 90.4% of fetal ultrasound; p < 0.001). Concordance between fetal ultrasound and fetal MRI was 92.1%. Fetal MRI provided additional information over fetal ultrasound in 23.1% of cases. In 11.6% of cases, the information was useful for the perinatal management and prognosis. In 45 cases (7.2%), fetal MRI was the only accurate diagnosis. In conclusion, fetal MRI has a superior diagnostic accuracy, especially in CNS pathology, and provides additional useful information in CNS, thoracic, and abdominal pathology.

Estilo de vida y riesgo de trastorno alimentario atípico en estudiantes universitarios: realidad versus percepción / Life style and risk of atypical eating disorders in university students: Reality versus perception

Objetivo: Los objetivos de este trabajo han sido determinar el estado ponderal y los hábitos de alimentación y de consumo de alcohol y tabaco en estudiantes universitarios, determinar la asociación de estas variables con la autopercepción negativa de sus hábitos alimentarios, así como analizar el riesgo de desarrollar algún tipo de trastorno de la conducta alimentaria (TCA). Método: Se llevó a cabo un estudio transversal en 422 estudiantes universitarios. Los parámetros analizados fueron: estado nutricional, hábitos alimentarios, consumo alcohol/tabaco y conductas de TCA. Se aplicó regresión logística para identificar factores asociados a una percepción negativa de los hábitos alimentarios. Resultados: El 5% de la población presentaba peso insuficiente, el 16% sobrepeso y el 4% obesidad. El 55% no realizaba las cinco comidas/día. Los alimentos recomendados de ingesta diaria se consumían por debajo de las recomendaciones, mientras que embutidos/carnes grasas, bollería industrial, carnes magras y pescados se consumían en exceso. Percibieron sus hábitos alimentarios como buenos/muy buenos el 63%. El consumo de alcohol/tabaco predominaba los fines de semana. Las chicas mostraron mayor preocupación por su imagen (80,6% vs. 33%) y miedo a engordar (52,5% vs. 23,9%). Casi el 30% presentó una percepción distorsionada de su imagen corporal. Encontramos un riesgo del 12,8% de anorexia nerviosa atípica y del 4,7% de bulimia nerviosa atípica. Conclusiones: Los estudiantes universitarios presentan un estilo de vida poco saludable, principalmente debido a hábitos alimentarios alejados de las recomendaciones. Más del 17% presentan riesgo de desarrollar TCA atípico. Esta información puede resultar de interés para desarrollar acciones preventivas

Objective: The objectives of this paper were to determine weight status, eating, and alcohol drinking and smoking habits of university students, to determine the association between these variables with negative self-perception of their eating habits and to assess the risk of developing eating disorders. Method: A cross-sectional study was carried out on 422 university students. The parameters analyzed were: nutritional status, eating habits, alcohol/ tobacco consumption, and risk of eating disorder. Logistic regression was applied to identify factors associated with a negative perception of eating habits. Results: Out of the whole population that was analyzed, 5% were underweight, 16% overweight and 4% obese. Fifty-five percent of the sample analyzed did not consume five meals a day. The recommended foods for daily consumption were consumed below recommendations, while sausages/fatty meats, industrial pastries, lean meats, and fish were over-consumed. Overall, the population perceived their eating habits as good/very good (63%). Alcohol and tobacco consumption predominated at weekends. The girls were more image-conscious (80.6% vs. 66%) and fearful of gaining weight (52.5% vs. 23.9%). Almost 30% had a distorted perception of body image. There was a 12.8% risk of atypical anorexia nervosa and 4.7% of atypical bulimia nervosa. Conclusions: College students led unhealthy lifestyles, mainly due to eating habits that do not conform to the establish recommendations. More than 17% are at risk of developing an atypical eating disorder. This information may be of interest in developing preventive actions

Life style and risk of atypical eating disorders in university students: Reality versus perception. / Estilo de vida y riesgo de trastorno alimentario atípico en estudiantes universitarios: realidad versus percepción.

OBJECTIVE: The objectives of this paper were to determine weight status, eating, and alcohol drinking and smoking habits of university students, to determine the association between these variables with negative self-perception of their eating habits and to assess the risk of developing eating disorders. METHOD: A cross-sectional study was carried out on 422 university students. The parameters analyzed were: nutritional status, eating habits, alcohol/ tobacco consumption, and risk of eating disorder. Logistic regression was applied to identify factors associated with a negative perception of eating habits. RESULTS: Out of the whole population that was analyzed, 5% were underweight, 16% overweight and 4% obese. Fifty-five percent of the sample analyzed did not consume five meals a day. The recommended foods for daily consumption were consumed below recommendations, while sausages/fatty meats, industrial pastries, lean meats, and fish were over-consumed. Overall, the population perceived their eating habits as good/very good (63%). Alcohol and tobacco consumption predominated at weekends. The girls were more image-conscious (80.6% vs. 66%) and fearful of gaining weight (52.5% vs. 23.9%). Almost 30% had a distorted perception of body image. There was a 12.8% risk of atypical anorexia nervosa and 4.7% of atypical bulimia nervosa. CONCLUSIONS: College students led unhealthy lifestyles, mainly due to eating habits that do not conform to the establish recommendations. More than 17% are at risk of developing an atypical eating disorder. This information may be of interest in developing preventive actions.