El papel de la Anatomía Patológica en la Prevención y Pronóstico del Cáncer de Cérvix.

INTRODUCCIÓN. El virus del papiloma humano es un virus ADN de la familia Papovaviridae responsable del cáncer de cuello de útero y de sus lesiones precursoras. La incorporación al cribado de las pruebas de detección de ADN viral, han supuesto una mayor detección de casos por su mayor sensibilidad. OBJETIVO. El objetivo primario es justificar, desde los puntos de vista estadístico y anatomopa-tológico, el protocolo actual para la prevención del cáncer de cérvix y, el secundario, es la eva-luación del papel de la inmunohistoquímica en el pronóstico y progresión de las lesiones pre-malignas epiteliales y del cáncer escamoso de cérvix avanzado. MATERIAL Y MÉTODOS. Se realizaron dos búsquedas; una en enero de 2017 en cuatro bases de datos en la que se encontraron 2819 artículos y, la segunda, se realizó en marzo de 2017, en Pubmed en busca de novedades en el campo de la inmunohistoquímica. Tras la eliminación, fueron incluidos en el trabajo 39 y 9 de las respectivas búsquedas. Para el análisis estadístico se utilizaron Review Manager 5.3 y calculadora Excel para conversión de datos. RESULTADOS. Se encontraron diferencias estadísticamente significativas en la sensibilidad de las pruebas ADN viral frente a la citología (p=0.0007) para la detección de CIN 2+, así como en la especificidad a favor de la citología (p=0.0003). No se encontraron diferencias significativas entre la citología convencional y en base líquida (p=0.06 y p=0.51). La inmunohistoquímica re-veló correlación significativa con el grado de lesión, así como con el pronóstico de la neoplasia. El marcador más utilizado y estudiado es la proteína p16INK4, cuya sensibilidad es equiparable a la de pruebas de detección viral y su especificidad significativamente superior. CONCLUSIONES. La mayor sensibilidad de los test de VPH justifica su utilización como primera línea de cribado, así como la mayor especificidad de la citología explica su uso en mujeres con mayor prevalencia de infección por VPH. La expresión de marcadores inmunohistoquímicos implica peor pronóstico y mayor probabilidad de progresión tumoral, aunque podrían utilizarse como dianas terapéuticas en el futuro

Effects of preeclampsia and eclampsia on maternal metabolic and biochemical outcomes in later life: a systematic review and meta-analysis

Objective: To evaluate the association between preeclampsia (PE) and eclampsia (E) on subsequent metabolic and biochemical outcomes. Methods: Systematic review and meta-analysis of observational studies. We searched five engines until November 2018 for studies evaluating the effects of PE/E on metabolic and biochemical outcomes after delivery. PE was defined as presence of hypertension and proteinuria at >20 weeks of pregnancy; controls did not have PE/E. Primary outcomes were blood pressure (BP), body mass index (BMI), metabolic syndrome (MetS), blood lipids and glucose levels. Random effects models were used for meta-analyses, and effects reported as risk difference (RD) or mean difference (MD) and their 95% confidence interval (CI). Subgroup analyses by time of follow up, publication year, and confounder adjustment were performed. Results: We evaluated 41 cohorts including 3300 PE/E and 13,967 normotensive controls. Women were followed up from 3 months after delivery up to 32 years postpartum. In comparison to controls, PE/E significantly increased systolic BP (MD = 8.3 mmHg, 95%CI 6.8 to 9.7), diastolic BP (MD = 6.8 mmHg, 95%CI 5.6 to 8.0), BMI (MD = 2.0 kg/m2; 95%CI 1.6 to 2.4), waist (MD = 4.3 cm, 95%CI 3.1 to 5.5), waist-to-hip ratio (MD = 0.02, 95%CI 0.01 to 0.03), weight (MD = 5.1 kg, 95%CI 2.2 to 7.9), total cholesterol (MD = 4.6 mg/dL, CI 1.5 to 7.7), LDL (MD = 4.6 mg/dL; 95%CI 0.2 to 8.9), triglycerides (MD = 7.7 mg/dL, 95%CI 3.6 to 11.7), glucose (MD = 2.6 mg/dL, 95%CI 1.2 to 4.0), insulin (MD = 19.1 pmol/L, 95%CI 11.9 to 26.2), HOMA-IR index (MD = 0.7, 95%CI 0.2 to 1.2), C reactive protein (MD = 0.05 mg/dL, 95%CI 0.01 to 0.09), and the risks of hypertension (RD = 0.24, 95%CI 0.15 to 0.33) and MetS (RD = 0.11, 95%CI 0.08 to 0.15). Also, PE/E reduced HDL levels (MD = –2.15 mg/dL, 95%CI –3.46 to −0.85). Heterogeneity of effects was high for most outcomes. Risk of bias was moderate across studies. Subgroup analyses showed similar effects as main analyses. Conclusion: Women who had PE/E have worse metabolic and biochemical profile than those without PE/E in an intermediate to long term follow up period. ©Revisión por pare

Pseudoaneurisma y fístula aortocavitaria como complicaciones de endocarditis protésica tardía

Infective endocarditis is a disease associated with high mortality and serious complications. The perivalvular extension of infective endocarditis is associated with a worse prognosis and more frequently affects prosthetic valves. Diagnostic imaging is essential to be able to identify these complications and establish the best therapeutic strategy, usually combining intravenous antibiotic treatment and surgery.La endocarditis infecciosa es una enfermedad asociada a una elevada mortalidad y complicaciones graves. La extensión perivalvular de la endocarditis infecciosa se asocia con peor pronóstico y afecta más frecuentemente a válvulas protésicas. El diagnóstico por imagen es fundamental para poder identificar estas complicaciones y establecer la mejor estrategia terapéutica, combinando, habitualmente, tratamiento antibiótico endovenoso y cirugía

Infarto agudo de miocardio en paciente como forma de embolismo paradójico en paciente con foramen oval permeable: a propósito de un caso.

Patent foramen ovale (PFO) is a remnant of the embryological circulation present in 25% of the adult remnant found in 25% of adults that can cause intracardiac shunt and produce paradoxical embolisms. The clinical presentation as myocardial infartion is uncommon, and clinical suspicion should be raised in patients with a low burden of traditional cardiovascular risk factors, once other sources of embolism have been ruled out. Therapeutical approach should be individualized on a case-by-case basis.El foramen oval permeable (FOP) es un remanente de la circulación embriológica presente en el 25% de la población adulta que puede causar shunt intracardíaco y producir embolismos paradójicos. La presentación clínica como infarto agudo de miocardio es poco frecuente, debiendo sospecharse esta entidad en pacientes con baja carga de factores de riesgo cardiovascular tras descartar otras fuentes embolígenas. La decisión de cierre percutáneo debe individualizarse según cada caso

Insuficiencia mitral severa secundaria a rotura del músculo papilar posteromedial

The prevalence of mechanical complications of infarction has decreased in recent years, however, mortality remains high. Echocardiography plays a fundamental role for early diagnosis and management of these complications.  We present the case of a patient with ischemic rupture of the posteromedial papillary muscle and severe mitral regurgitation.La prevalencia de las complicaciones mecánicas del infarto se ha reducido en los últimos años, sin embargo, la mortalidad sigue siendo elevada. La ecocardiografía juega un papel fundamental para un diagnóstico y manejo precoz de estas complicaciones.  Presentamos el caso de una paciente con rotura isquémica del músculo papilar posteromedial e insuficiencia mitral severa

A cross-sectional study examining the parametric thyroid feedback quantile index and its relationship with metabolic and cardiovascular diseases

The usual inverse correlation between thyrotropin (TSH) and thyroid hormone disappears in syndromes of central resistance to thyroid hormone, where both are high. TSH and thyroid hormone are also simultaneously high when there is an elevation of the set point of the thyroid regulation axis. This can be estimated with indices, such as the Parametric Thyroid Feedback Quantile-based Index (PTFQI), which was designed for the general population. The PTFQI is positively associated with diabetes prevalence, but association with other pathologies has not been yet explored. The aim of this project was to explore the potential relationship of the PTFQI with metabolic and cardiovascular disease in a sample of ambulatory adult patients from Spain

An elevated parametric thyroid feedback quantile-based index is associated with atrial fibrillation

Atrial fibrillation is associated with hyperthyroidism. Within the euthyroid range, it is also associated with high thyroxine (fT4), but not with thyrotropin (TSH). We aim to describe differences in thyroid regulation, measured by the Parametric Thyroid Feedback Quantile-Based Index (PTFQI), between patients with atrial fibrillation and the general population. Materials and methods: Thyroid parameters (PTFQI, TSH, and fT4) of a sample of 84 euthyroid subjects with atrial fibrillation (cases) were compared to a reference sample of euthyroid healthcare patients (controls). We calculated age and sex adjusted ORs for atrial fibrillation across tertiles of these parameters. Also, within cases, we studied thyroid parameters association with clinical characteristics of the atrial fibrillation. Results: After adjusting for age and sex, fT4 and PTFQI were higher in subjects with atrial fibrillation when compared to the general sample (p<0.01 and p=0.01, respectively). Atrial fibrillation ORs of the third versus the first PTFQI tertile was 1.88(95%CI 1.07,3.42), and there was a gradient across tertiles (p trend=0.02). Among atrial fibrillation patients, we observed that higher PTFQI was associated with sleep apnea/hypopnea syndrome (OSAS) (p=0.03), higher fT4 was associated with the presence of an arrhythmogenic trigger (p=0.02) and with heart failure (p<0.01), and higher TSH was also associated with OSAS (p<0.01). Conclusions: Euthyroid subjects with atrial fibrillation have an elevation of the pituitary TSH-inhibition threshold, measured by PTFQI, with respect to the general population. Within atrial fibrillation patients, high PTFQI was associated with OSAS, and high fT4 with heart failure. These results hint of the existence of a relationship between thyroid regulation and atrial fibrillation

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Effect of programmed exercise on insulin sensitivity in postmenopausal women

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.OBJECTIVE:: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effect of programmed exercise for at least 12 weeks, in postmenopausal women on insulin sensitivity-related outcomes (ISROs), including fasting insulin, C-peptide, insulin growth factor (IGF-1) and IGF-binding protein (IGFBP-3), Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), and anthropometric variables. METHODS:: Searches were conducted in PubMed-Medline, Embase, Scopus, Web of Science, and Cochrane Library from inception through May 3, 2016, for studies published in all languages. Extracted data included characteristics of the study design, study participants, intervention, and outcome measures. Types of exercise were classified into “mid-term exercise intervention” (MTEI, 3-4 months exercise duration) and a “long-term exercise intervention” (LTEI, 6-12 months exercise duration). Risk of bias in RCTs was evaluated with the Cochrane tool. We used random-effects models for meta-analyses. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS:: Seven RCTS (n?=?580) evaluating the effects of programmed exercise on ISROs were included. In three RCTs, MTEI significantly lowered insulin levels (mean difference [MD] −6.50?pmol/L, 95% confidence interval [CI] −11.19, −1.82, P?=?0.006) and HOMA-IR values (MD −0.18, 95% CI −0.34, −0.03, P?=?0.02) when compared with controls. LTEI had no significant effect on insulin levels (P?=?0.19) or HOMA-IR values (P?=?0.68) in four and three RCTs, respectively. There were no significant differences between exercise intervention versus controls in circulating IGF-1, glucose, triglycerides with both MTEI and LTEI, and in IGFBP-3 with LTEI. There were significant reductions in body mass index (BMI, kg/m) (MD −1.48, 95% CI −2.48, −0.48, P?=?0.004) and in body fat percentage (MD −2.99, 95% CI −4.85, −1.14, P?=?0.01) after MTEI; and in waist circumference after both MTEI (MD −1.87, 95% CI −3.02, −0.72, P?=?0.001) and LTEI (MD −3.74, 95% CI −6.68, −0.79). Heterogeneity of effects among studies was moderate to low. CONCLUSION:: Exercising for 3 to 4 months significantly lowered insulin levels and HOMA-IR values, BMI waist circumference, and percentage body fat mass; exercising for 6 to 12 months lowered waist circumference in postmenopausal women.Revisión por pare