Population-based survey on menopausal symptoms and treatment use

OBJECTIVE

This article aimed to study the use of menopausal hormone therapy (MHT) among Spanish perimenopausal and postmenopausal women, the presence of menopausal symptoms and the sources of information.

METHODS

The epidemiological study using a survey included Spanish perimenopausal or postmenopausal women aged between 40 and 70 years in August 2021.

RESULTS

A total of 1254 women were included. In the postmenopausal group, 86% reported one or more menopausal symptoms; the most frequent was vulvovaginal dryness (57%). Among the symptomatic women, 15.2% used some treatment. Vasomotor symptoms (p = 0.001), vulvovaginal atrophy (p < 0.001) and symptoms related to sexuality (p < 0.001) were associated with greater use of treatments; 2.5% of postmenopausal women used MHT. In the perimenopausal group, 75.1% were symptomatic, hot flashes being the most frequent. Only insomnia was related to greater use of some treatment (p = 0.021); 1.6% of perimenopausal women used MHT. The most common reason for women's rejection of MHT was the fear of side effects, especially cancer. The gynecologist was the most frequently used source of information.

CONCLUSIONS

Although there is a high prevalence of symptoms, the use of MHT in Spanish perimenopausal and postmenopausal women is very low.

Resource use in patients with Crohn's disease treated with infliximab

AIM

To estimate the impact of infliximab (IFX) on hospital resources for patients with Crohn's disease.

METHODS

Resource use data for at least 1 year before (B-IFX) and after (A-IFX) infliximab administration were retrospectively collected for all patients treated with IFX at the Hospital Cabueñes (Spain). Direct costs calculated were: hospital-stays, surgeries, out-patient visits, diagnostic and laboratory tests, pharmacological treatments, and day-care hospitalization for IFX administration.

RESULTS

Patients (n = 34; mean age at treatment: 43.6 years) with 9.8 and 4.3 years (B-IFX and A-IFX, respectively) had their costs estimated. Partial or complete response was achieved in 82% of patients. Total annual B-IFX costs per patient were Euro 4,464, of which 62.4% was for hospitalization, 3.1% for surgery, 8.7% for consultation visits, 16.2% for diagnostic and laboratory tests, and 9.6% for other treatments. Total annual A-IFX costs per patient were Euro 10,594; of which 6.4% was for hospitalization, 0.8% for surgery, 4.2% for consultation visits, 7.6% for diagnostic and laboratory tests, 5.5% for other treatments, and 75.5% for IFX and its administration. The primary cost item was hospitalization (Euro 2,783) during the B-IFX period as opposed to IFX itself (Euro 7,996) during the subsequent A-IFX period.

CONCLUSIONS

In routine practice, IFX appears to be an effective treatment by reducing hospital-stays, but increases overall budgetary cost for patients with Crohn's disease.

[Capillary blood flow as an index of the therapeutic effect of folinic acid in ischemia-reperfusion syndrome]

OBJECTIVE

An intestinal reperfusion study with two aims: a) to assess the usefulness of intestinal capillary blood flow measurement by laser-Doppler for intestinal reperfusion studies; and b) to compare the effects of racemic and levo forms of folinic acid in treating the syndrome.

EXPERIMENTAL DESIGN

A murine model of intestinal ischemia by completely clamping the superior mesenteric artery for 90 minutes. A comparison was made of three treatment groups: saline, folinic acid, and levo-folinic acid. The following factors were analyzed: changes in biochemical parameters (levels of creatine kinase, lactic dehydrogenase, and alkaline phosphatase at 60 minutes, and at two and seven days after restoring blood flow), capillary flow in the jejunum and ileum by laser-Doppler (during ischemia and after the first hour of reperfusion), intestinal mucosa injury, and survival curve.

RESULTS

Laser-Doppler provided reliable data on how the different treatments affected capillary flow during intestinal reperfusion. Levo-folinic acid improved capillary flow in the ileum after 25 minutes of reperfusion, and also reduced mucosal injury in the same stretch of intestine by the seventh day post-reperfusion (p<0.05). On the other hand, it produced an initial increase in serum enzymes during reperfusion, and did not modify survival.

CONCLUSIONS

The changes observed in intestinal capillary blood flow measurement by laser-Doppler have similarities with the effects of drugs on pathological mucosal changes. We could not prove that the levo form of folinic acid has a stronger protective effect versus racemic folinic acid in intestinal ischemia-reperfusion syndrome.

[The efficacy of the valproic acid-ethosuximide combination in the continuous slow point wave syndrome during sleep]

Continuous spikes and waves during slow sleep (CSWS) is a syndrome with a serious prognosis due to the frequent association with neuropsychological dysfunction. It is mandatory to consider this syndrome if an epileptic child suffers from behavioral changes, dysarthria or learning difficulties. We report on two patients with CSWS syndrome with focal abnormalities on the nondominant hemisphere and a proportion of generalized spike-waves discharges in more than 85% of their NREM sleep on the EEG. Both had a good response to the treatment with sodium valproate and ethosuximide at high doses. Both suffered a relapse of their clinical and EEG semiology after withdrawal of their treatment. After restarting treatment they became clinically normal with a normal sleep EEG recording. We propose the association of sodium valproate and ethosuximide for CSWS; this treatment should be maintained until adolescence.

Comparative study of propofol versus midazolam in the sedation of critically ill patients: results of a prospective, randomized, multicenter trial

OBJECTIVES

To compare the effectiveness, characteristics, duration of action, hemodynamic and biochemical effects, and side effects of propofol and midazolam used for continuous intravenous sedation of ventilated critically ill patients.

DESIGN

Multicenter, prospective, randomized, nonblinded study.

SETTING

Nine Spanish general intensive care units (ICUs).

PATIENTS

Ninety-eight patients admitted to the ICU who were mechanically ventilated and required sedation for a minimum of 48 hrs.

INTERVENTIONS

Propofol or midazolam was used for induction and maintenance of continuous intravenous sedation for a maximum of 5 days. The effectiveness of those two regimens was assessed according to their effects on ventilatory management and the presence of agitation.

MEASUREMENTS AND MAIN RESULTS

In 93% of the patients studied, there was a medical cause necessitating mechanical ventilation. The mean (+/-SD) duration of sedation was 81 +/- 25 hrs and 88 +/- 27 hrs for the propofol and midazolam groups, respectively. The induction dose was 2.24 +/- 0.43 mg/kg over 318 +/- 363 secs for propofol, and 0.22 +/-0.07 mg/kg over 33 +/-29 secs for midazolam. The maintenance dose was 2.8 +/-1.1 mg/kg/hr for propofol and 0.14 +/- 0.10 mg/kg/hr for midazolam. There was no difference regarding the opiate and muscle relaxant requirements between the two groups. Sedation with propofol was more effective in achieving patient-ventilator synchrony than that with midazolam after the first hour of treatment (p < .01). Patients sedated with propofol awoke more rapidly and with less variability that those patients sedated with midazolam (23 +/- 16 mins vs. 137 +/- 185 mins, respectively, p < .05), particularly in those patients requiring deep sedation (27 +/- 16 mins vs. 237 +/- 222 mins, respectively, p < .01). No hemodynamic or biochemical changes were detected in any of the treatment groups. During induction, five patients in the propofol group and two patients in the midazolam group had hypotension.

CONCLUSIONS

In this population of critically ill patients, propofol is an effective and safe alternative for sedation, with some advantages, such as short duration of action and high effectiveness over the conventional regimen with benzodiazepines and opiates.

[Anal extrusion: a complication of ventriculo-peritoneal shunt for hydrocephalus (author's transl)]

The authors report a case of rectal perforation eight months after the placement of a ventriculo-peritoneal shunt. There was no peritonitis, but an "E. coli" meningitis was found. The patient died two hours after surgical removal of the shunt. At autopsy, a perforation by the tip of the catheter was found in the anterior face of the rectosigmoid.