Ictus paradójico asociado a histersalpingografía / Paradoxical embolism associated with hysterosalpingography

La histerosalpingografía (HSG) es un procedimiento utilizado en el estudio de la infertilidad. La embolia del medio de contraste es una complicación infrecuente y está favorecida por ciertos factores. La persistencia del foramen oval permeable (FOP) complica el pronóstico, ya que puede producir embolias paradójicas. Presentamos el caso de una mujer de 32 años, derivada de un hospital comarcal por accidente cerebrovascular isquémico tras realizarse una HSG informada como dificultosa, precisando una dosis mayor de contraste (ácido diazitroico) que la habitual. Se realizó una tomografía computarizada craneal que mostró infarto cerebral hemisférico derecho. La ecocardiografía posterior al acontecimiento reveló la existencia de un FOP. Tras 8 días de evolución, la paciente presentó mejoría progresiva del déficit, con capacidad para deambular autónomamente, por lo que se procedió al alta hospitalaria con tratamiento antiagregante domiciliario. La clínica acontecida en esta paciente y los hallazgos encontrados en las pruebas diagnósticas son altamente sugestivos de ictus isquémico de la arteria cerebral media secundario a embolismo paradójico del medio de contraste a través del FOP, por lo que resulta interesante realizar una revisión del tema (AU)

Hysterosalpingography is a procedure used in the study of infertility. Embolism of contrast dye is a rare complication and is facilitated by certain factors. Persistence of permeable foramen ovale (PFO) complicates the prognosis and may produce paradoxical embolisms. We present the case of a 32-year-old woman who was referred from a district hospital due to an ischemic stroke following a hysterosalpingography reported as difficult, requiring a higher dose of contrast medium (diatrizoic acid) than usual. A cranial computed tomography scan was performed, which showed a right hemispheric stroke. Post-event echocardiography revealed a PFO. Eight days after the event, the patient showed progressive improvement and was able to walk without assistance. Consequently, she was discharged from hospital with antiplatelet therapy. The symptomology in this patient, as well as the findings of the diagnostic tests, are highly suggestive of ischemic stroke of the middle cerebral artery secondary to paradoxical embolism of the contrast medium through the PFO. A review of the topic is provided (AU)

Assessment of sexual function and related factors in mid-aged sexually active Spanish women with the six-item Female Sex Function Index.

OBJECTIVE: The aim of this study was to assess sexual function and related factors (menopause-related quality of life and mood included) in mid-aged Spanish women. METHODS: This was a cross-sectional study in which 179 sexually active women (40-65 y old) completed the six-item Female Sexual Function Index (FSFI-6), the Menopause Rating Scale (MRS), the Hospital Anxiety and Depression Scale (HADS), and a sociodemographic questionnaire containing personal and partner data. RESULTS: Median age was 51 years; 55.3% of the women were naturally postmenopausal, 47.5% had increased body mass index, and 6.7% had hypertension. Currently, 4.5% and 19.6% of the women used hormone therapy and psychotropic drugs, respectively. A total of 87.7% had a stable partner; 1.3% of partners abused alcohol and 8.3% had erectile dysfunction. Of the surveyed women, 36.9% displayed total FSFI-6 scores of 19 or less (lower sexual function); 40.2%, mood morbidity (total HADS scores ≥11); and 23.5%, impaired quality of life (severe total MRS scores ≥17). Cronbach α for the FSFI-6 was 0.91. Total FSFI-6 scores positively correlated with female and partner education and inversely with female age and scores on the MRS and the HADS (total and subscale values). Multiple linear regression analysis found that total FSFI-6 scores positively correlated with partner educational level and inversely (worse sexual function) with female age, partner issues (alcohol abuse and erectile dysfunction), and total HADS and urogenital and somatic MRS scores. CONCLUSIONS: In this mid-aged Spanish sample, as assessed with a short and consistent tool, lower sexual function was related to menopausal and mood symptoms and several women and partner factors. Further research using this instrument is warranted.

Life satisfaction, loneliness and related factors during female midlife.

BACKGROUND: Studies assessing life satisfaction and feelings of loneliness in mid-aged women are scarce. OBJECTIVE: To assess loneliness, life satisfaction and related factors in mid-aged Spanish women. METHOD: This was a cross sectional study in which 182 women aged 40 to 65 completed the menopause rating scale (MRS), the University of California at Los Angeles loneliness scale (UCLA-LS), the life satisfaction index A (LSI-A), and a general socio-demographic questionnaire containing personal/partner data. Internal consistency of each tool was also computed. RESULTS: Median [interquartile range] age of the sample was 51 [9.0] years. A 55.5% were postmenopausal, 47.3% had increased body mass index (BMI) values, 57.7% were abdominally obese, 1.6% had hypertension and 86.3% had a stable partner. In addition, 4.9% used hormone therapy and 19.2% psychotropic drugs. Multiple linear regression analysis found that higher UCLA-LS scores (more loneliness) correlated with MRS psychological scores, partner alcohol abuse, living in urban areas, lower LSI-A scores (less life satisfaction) and not having a stable partner. Lower LSI-A scores (worse life satisfaction) correlated with severe female economical problems, BMI values and UCLA-LS and MRS psychological scores. CONCLUSION: Loneliness and life satisfaction in this mid-aged female sample was influenced by personal and partner issues which seem to play a much more relevant role than biological aspects. More research is warranted in this regard.

Factors related to insomnia and sleepiness in the late third trimester of pregnancy.

OBJECTIVE: To assess the presence of insomnia and sleepiness and related factors in the late third trimester of pregnancy. METHODS: A total of 370 singleton gravids completed a general questionnaire containing personal data, the Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS). In addition, maternal anthropometry was recorded upon survey. RESULTS: Median [interquartile range] maternal age and gestational age upon survey was of 31 [7.0] years and 39 [1.8] weeks, respectively. A 73.5% of women displayed some degree of insomnia (Total ISI score 8-28) and 22.2% sleepiness (Total ESS score ≥10). Determined rho Spearman coefficients showed significant correlations between ISI scores and gestational age at survey and survey to birth interval (weeks) and between ESS scores and maternal weight and arm circumference at survey and neonatal birth weight. Multiple linear regression analysis found that smoking habit, higher blood pressure and shorter survey to birth interval (weeks) significantly predicted higher ISI scores, and hence a higher risk of insomnia. Employed status, increased arm circumference and neonatal weight predicted higher ESS scores (sleepiness). CONCLUSION: Insomnia and sleepiness were prevalent in the late third trimester of pregnancy in which lifestyle factors and maternal and neonatal body composition were significant predictors.