Walking in pregnancy and prevention of insomnia in third trimester using pedometers: study protocol of Walking_Preg project (WPP). A randomized controlled trial.

BACKGROUND: Previous studies in pregnancy have not focused in evaluating the effect of walking during pregnancy and prevention of insomnia. Our general objective is to determine the effect of a walking program in preventing the appearance of insomnia in the third trimester of pregnancy, increasing sleep quality and improving quality of life throughout pregnancy. METHODS: Randomized Controlled trial in parallel in healthy sedentary pregnant women (n = 265), Walking_Preg Project (WPP), from university hospital in Granada, Spain. At 12th gestational week (GW), they will be invited to participate and randomly assigned to one of the three arms of study: the intervention group I1 (pedometer, goal of 11,000 steps/day), intervention group I2 (pedometer, no goal) and control (no pedometer). Duration of intervention: 13-32 GW. At 12th, 19th and 31st GW the average steps/day will be measured in groups I1 and I2. At 13th, 20th and 32nd GW, Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), Adherence to Mediterranean Diet (AMD), physical activity (short IPAQ), quality of life (PSI), and consumption of toxic substances (caffeine, illegal drugs, alcohol and tobacco) will be collected. Student t test or Mann-Whitney U will be used to compare 19th and 31st GW mean of daily steps between I1 and I2 groups. To compare differences between groups in terms of frequency of insomnia/quality of life for each trimester of pregnancy, Pearson's Chi-square test or Fisher's exact test will be used. To determine differences in hours of sleep and quality of sleep throughout each trimester of pregnancy, analysis of variance or Friedman test will be used. McNemar-Bowker test will be used to assess differences in life quality in pre-post analyses in the 3 arms. We will use Stata 15 statistical software. DISCUSSION: promoting walking in second half of pregnancy through use of pedometer and health pre-registration of a goal to be achieved -'10,000-11,000 steps a day'- should prevent appearance of insomnia in third trimester, will increase sleep quality and quality of life in pregnant women. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03735381 . Registered 8th November, 2018.

Dolor pélvico asociado a la colocación del dispositivo Essure ® y alergia al níquel. A propósito de 3 casos / Pelvic pain associated with an Essure ® device and nickel allergy. In relation to 3 cases

Essure(R) es el primer dispositivo intratubárico, colocado mediante histeroscopia, usado como método anticonceptivo definitivo en la mujer. Una complicación poco frecuente es el dolor pélvico que a veces se ha relacionado con alergia a alguno de sus componentes, principalmente al níquel. El níquel es el más frecuente alérgeno de contacto en el mundo desarrollado, por lo que podrían esperarse más problemas de los informados en pacientes portadoras de Essure(R). Se presentan 3 casos de dolor pélvico crónico en pacientes con alergia al níquel desconocida antes de la inserción. En 2 de ellas se resolvió poco después de la extracción del dispositivo Essure(R) mientras que la tercera paciente está asintomática tras haber adoptado una actitud expectante. Actualmente los estudios sobre este tema son escasos. En general, se acepta que, en caso de dolor abdominal más allá de 6 semanas tras la inserción del Essure(R), debe plantearse la retirada del mismo. Sería obligatorio en estos casos investigar si la paciente es alérgica a los metales

Essure(R) is the first intratubal device for permanent contraception inserted under hysteroscopic guidance. A rare complication of this device is pelvic pain, which can be related to allergy to one or more of its components, mainly nickel. Nickel is the most common contact allergen in the industrialized world, and consequently the number of published reports may not reflect the true extent of this complication in women with an Essure(R) device. We report 3 cases of pelvic pain in patients with nickel allergy that was not detected before Essure(R) insertion. The pain resolved after removal of the device in 2 women. An expectant attitude was adopted in the third woman.Currently, few cases have been reported on this topic. It is generally accepted that the device should be removed in women with pelvic pain lasting for more than 6 weeks. In addition, these women should also undergo testing for nickel allergy

Mastopatía fibroquística. Aspectos controvertidos / Fibrocystic breast disease. Controversial aspects

OBJETIVOS: Intentar dar una respuesta a los aspectos más controvertidos que se presentan en el estudio de esta patología mamaria tan prevalente.MétodosRevisión bibliográfica existente al respecto.ResultadosLa ecografía es el método diagnóstico de elección en la mastopatía fibroquística, pudiendo encontrar imágenes de similares características ecográficas que en las tumoraciones quísticas, diferenciándose en su número y en su diámetro máximo. En cuanto a su manejo, con nódulo dominante o separado, se hará ecografía para determinar si la lesión es quística o sólida. Si es quística, punción-aspiración con aguja fina; si es sólida, biopsia con aguja gruesa. Si existe mastalgia y nodularidad sin un nódulo dominante o con mamas difusamente nodulares que son indoloras, no necesitan ningún tratamiento activo.Conclusiones1. La mastopatía fibroquística simple no tiene riesgo de malignización; sí lo tiene la mastopatía proliferativa con atipia (RR de 4-5). 2. La ecografía es la técnica diagnóstica de primera elección, que permite diferenciar los quistes simples de los quistes complicados, pudiéndose también emplear como método de seguimiento y servir como guía para realizar la aspiración del quiste. 3. Ante un cuadro clínico-eco y radiológico dudoso (BI-RADS 3) o sugerente de malignidad (BI-RADS 4 y 5), hay que hacer una punción-aspiración con aguja fina y/o biopsia con aguja gruesa como primera medida. 4. La mastopatía fibroquística asintomática no requiere seguimiento; la sintomática se seguirá con ecografía y/o mamografía

OBJECTIVES: To elucidate the most controversial features of fibrocystic breast disease, which ishighly prevalent.METHODS: We reviewed the literature on the topic. RESULTS: In fibrocystic breast disease, the diagnostic method of choice is ultrasound, whichshows similar characteristics to those in cystic tumors but with differences in number andmaximum diameter. With dominant, or separate, nodules, ultrasound can be used to determinewhether the lesion is cystic or solid. In cystic lesions, fine-needle aspiration can be used; insolid lesions, core needle biopsy can be employed. No active treatment is required if there ismastalgia and nodularity without a dominant nodule, or if diffusely nodular breasts are painless. CONCLUSIONS: 1. There is no risk of malignancy in simple fibrocystic breast disease but proliferative mastopathy with atypical cells has a relative risk of 4-5. 2. The diagnostic technique of choice for differentiating simple from complex cysts is ultrasound, which can also be used for monitoring and as a guide when aspirating the cyst. 3. When there are clinical and radiologic signs suspicious for malignancy (BI-RADS 3) or suggestive of malignancy (BI-RADS 4 and 5), the first step is fine-needle aspiration or core needle biopsy, or both. 4. Asymptomatic fibrocystic breast disease does not require follow-up, while symptomatic disease can be monitored with ultrasound and/or mammography