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Antecedentes: La elevada prevalencia de hipovitaminosis D en España es considerada una verdadera epidemia con importantes implicaciones para la salud por las múltiples funciones que ejerce la vitamina D tanto a nivel esquelético como extraesquelético. Para que las personas con insuficiencia o deficiencia en vitamina D alcancen los niveles séricos más adecuados, deben recibir suplementos de vitamina D. Este estudio se realizó con la finalidad de evaluar si en la práctica clínica habitual, el manejo de la hipovitaminosis D era llevada a cabo según las recomendaciones internacionales establecidas por las sociedades científicas. Métodos: Se realizaron dos rondas de circulación de un cuestionario Delphi entre un panel formado por médicos prescriptores habituales de vitamina D. Resultados: En general, los médicos del panel reconocieron la alta prevalencia de la hipovitaminosis D en España, la necesidad del cribado en los distintos grupos de riesgo y los beneficios de la suplementación en los pacientes con insuficiencia o déficit de vitamina D. Sin embargo, no se alcanzó el consenso en algunas de las aseveraciones relacionadas con los métodos de cuantificación de la vitamina D o con las recomendaciones para el manejo de la hipovitaminosis D. Conclusiones: La ausencia de acuerdo para algunos de los ítems reveló la necesidad de realizar acciones formativas destinadas a proporcionar un conocimiento adecuado y actualizado sobre las evidencias científicas y las recomendaciones para la práctica clínica de la suplementación de vitamina D.

Iñaki Lete,1 Jesus Novalbos,2 Esther de la Viuda,3 Felix Lugo,4 Mercedes Herrero,5 Marian Obiol,6 Josep Perelló,7 Rafael Sanchez-Borrego8 1Unit of Clinical Management of Obstetrics and Gynaecology, Araba University Hospital, Vitoria, Spain; 2Medical Department, Theramex SLU, Madrid, Spain; 3Gynaecology and Obstetrics Department, University Hospital of Guadalajara, Guadalajara, Spain; 4Intimate Health Unit Diatros Woman´s Clinic, Barcelona, Spain; 5Gynaecology Department Gine4, HM Hospitals, Madrid, Spain; 6Reproductive and Sexual Health Centre Fuente De San Luis, Valencia, Spain; 7Gynaecology and Obstetrics Department, Sant Pau Hospital, Barcelona, Spain; 8DIATROS, Woman’s Clinic, Barcelona, SpainCorrespondence: Iñaki LeteUnit of Clinical Management of Obstetrics and Gynaecology. Araba University Hospital, Jose Atxotegi s/n, Vitoria, 01009, SpainTel +34 945007204Email luisignacio.letelasa@osakidetza.netObjective: To know the contraceptive behaviour of Spanish women who use combined oral contraception (COC) during the period of lockdown due to COVID-19.Methods: Cross-sectional, descriptive study of a sample of Spanish women who use COC based on a survey conducted through social networks using the online platform Survey Monkey. The survey was conducted during the period of home confinement.Results: A total of 1407 women answered the survey and 937 were valid for the analysis. A total of 675 women (71.8%) were confined all day at home. During confinement 96,6% of women continued to use the COC, 53.5% responded that their sexual activity decreased during this time and 54% that their physical activity had decreased. A significant percentage of women (10.3%) recognized a worsening of premenstrual symptoms.Conclusion: Despite the lockdown and the decrease in the frequency of sexual intercourse, the Spanish women who use COC did not abandon its use during the period of time analysed.Keywords: COVID-19, confinement, combined oral contraception, discontinuation, premenstrual symptoms

This observational study compares the efficacy and incidence of side-effects between dl-norgestrel (2 mg) and levonorgestrel (1 mg) associated with ethinyl oestradiol (200 micrograms) given in two doses 12 h apart for emergency post-coital contraception. A total of 117 consecutive women were given dl-norgestrel in combination with the oestrogen (dl-norgestrel group) while 423 consecutive subjects received the combination ethinyl oestradiol/levonorgestrel (levonorgestrel group). Overall, four (0.8%) pregnancies occurred in the 540 treated women, one (0.9%) in the dl-norgestrel group and three (0.7%) in the levonorgestrel group. In addition to this similar high contraceptive efficacy between both study groups, women in the levonorgestrel group had a significantly lower incidence of side-effects (23.5%) and better timing of the next menstruation after treatment (75% had bleeding on time) than those in the dl-norgestrel group (corresponding figures were 50.5 and 62.6% respectively). It is concluded that levonorgestrel should be used in preference to dl-norgestrel for post-coital contraception in the Yuzpe regimen. [ABSTRACT FROM AUTHOR]

Obesity is not a choice or a result of lack of willpower, but a multifactorial, chronic, progressive, and relapsing disease. During menopause, hormonal and body composition changes lead to greater visceral adiposity, that aggravates women's health at a cardiometabolic, mechanic and mental level. Adiposity has been identified as an important modifier of reproductive hormones. During female midlife, obesity has been associated with menstrual cycle alterations (anovulatory cycles ending with abnormal bleedings), menopausal symptoms including hot flashes, poor quality of sleep, aches and joint pain, genitourinary symptoms, and reduced quality of life. However, the relationships between weight, the menopausal process, aging, and hormone levels remain poorly understood. Women with obesity have an increased risk of thromboembolic disease when using menopause hormone therapy (MHT), and it is probably the main medical condition to prescribe or not MHT. However, this risk depends on the route and type of MHT. The use of estrogen-only or combined transdermal MHT does not increase the risk of a thrombotic event in women with obesity.

Background: The prevalence and severity of perimenopausal symptoms are typically associated with multiple factors, including demographic characteristics. The sociodemographic characteristics of women living in rural areas differ from those residing in urban areas, and it has been suggested that these differences could potentially influence the prevalence of symptoms experienced during perimenopause., Objectives: To evaluate if perimenopausal women living in Spanish rural areas have a higher prevalence of perimenopausal symptoms and assess their influence on health-related quality of life., Methods: A cross-sectional study was conducted in a sample of 270 perimenopausal women residing in rural and urban areas. The participants completed the Cervantes Scale Short Version and Beck Depression Inventory 2., Results: Perimenopausal women in rural areas reported a higher incidence of perimenopausal symptoms and a lower perception of health-related quality of life compared to those in urban areas, as evidenced by higher scores on the total Cervantes Scale Short Version scale (33.2 (±16.2) vs. 26.4 (±18.1), p  = .001). No differences in the Beck Depression Inventory 2 score were detected., Conclusions: Perimenopausal women residing in rural areas of Spain reported a higher prevalence of perimenopausal symptoms and experienced a poorer Health-Related Quality of Life compared to those living in urban areas of Spain.

This case report highlights a rare but significant complication of blunt trauma requiring preperitoneal packing and illustrates the intricate relationship between trauma surgery and urological emergencies. Testicular torsion is an acute urological emergency necessitating prompt surgical intervention to salvage testicular function. While commonly associated with intrinsic factors such as the "bell-clapper" deformity, extrinsic factors such as trauma and postoperative complications can also precipitate this condition. This case underscores the complexity of diagnosing and managing testicular torsion arising after surgical interventions for pelvic fractures, a scenario sparsely documented in medical literature. We present a 27-year-old male who sustained multiple injuries, including a pelvic fracture, from a motorcycle accident and subsequently underwent preperitoneal packing for significant pelvic hemorrhage. Five days post-operation, the patient developed acute right lower quadrant and unilateral testicular pain, leading to the diagnosis of testicular torsion via Doppler ultrasonography. An emergency bilateral orchiopexy was performed, revealing a 180° torsion of the right testis. This case illustrates the need for a heightened awareness of potential genitourinary complications following trauma surgery. The pathophysiological mechanisms possibly include increased intra-abdominal pressure and altered testicular mobility due to surgical interventions. The report emphasizes the importance of multidisciplinary care in trauma settings to ensure comprehensive evaluation and management of patients, including the consideration of urological complications. Testicular torsion following preperitoneal packing for pelvic fractures represents a critical intersection between trauma surgery complications and urological emergencies, necessitating vigilant postoperative care and multidisciplinary collaboration for timely diagnosis and intervention. This case contributes to the broader understanding of postoperative complications, advocating for an integrated approach to patient care in high-energy trauma scenarios., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Caussat et al.)

Background: Vaginal dryness (VD) represents a significant concern affecting women across diverse life stages, encompassing both pre- and postmenopausal women at any age. Dyspareunia, defined by genital pain that can be experienced before, during, or after intercourse, is often associated with vaginal dryness., Aim: This study aimed to evaluate the effectiveness and safety of a water-based vaginal lubricant with hyaluronic acid to reduce sexual discomfort associated with vaginal dryness., Methods: A prospective, multicenter, uncontrolled clinical investigation was conducted over a three-month period in women aged 18 years or older experiencing pain or difficulty during sexual intercourse for whom the use of a vaginal lubricant was recommended., Results: Significant improvements were observed in the FSFI scores, indicating enhanced sexual function ( p  < .001). Vaginal dryness symptoms, including irritation, dryness, itching, and dyspareunia, significantly decreased after product use ( p  < .001)., Clinical Implications: This study contributes to the limited scientific knowledge on the application of lubricants in the context of symptoms associated with VD., Strengths & Limitations: In addition to the short study period, inherent limitations of the study design, and lack of placebo control, it is pertinent to acknowledge that some of the pros used in this study were not based on validated questionnaires. However, as far as we know, this study is the only one that analyzes well-being and sexual pleasure as results using a lubricant formulated with hyaluronic acid., Conclusion: This tested vaginal lubricant with hyaluronic acid has demonstrated efficacy in improving vaginal dryness and female sexual function, particularly in reducing pain and improving lubrication during sexual intercourse, and showed a favorable safety profile, with minimal and transient adverse events.

Obtaining adequate vascular access is imperative for effective resuscitative, therapeutic, and diagnostic interventions. The intraosseous (IO) route is indicated when immediate vascular access is needed, and standard central or peripheral intravenous (IV) access is unattainable or would delay therapy in a critical patient. We present a rare case of improper IO line placement in the right proximal tibia of a 30-year-old female involved in a motor vehicle collision, resulting in extravasation of blood products into the surrounding tissue and development of acute compartment syndrome. Emergency Medical Services was unable to obtain IV access in a timely manner, thus a right proximal tibia 45mm IO line was placed, and a unit of whole blood was given with a high-pressure infusor in the field. At the trauma center, the patient's right lower extremity was severely tense and edematous with no palpable right lower extremity pulses and no Doppler signals. Computed tomography revealed the IO catheter extending through both the proximal and distal cortices of the right tibia. Medial and lateral fasciotomy of the right lower extremity was performed in which all four compartments of the right lower leg were released and a significant hematoma was evacuated from the superficial posterior compartment. This case highlights the importance of IO access as a life-saving intervention while also underscoring the need to educate and familiarize pre-hospital and hospital healthcare personnel in delivering IO access so as to mitigate risks and improve outcomes for critically ill patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Desai et al.)

Objectives: The objective is to assess the perception of gynecologists regarding patients' adherence to vulvovaginal atrophy (VVA) treatments, to evaluate the gynecologists' opinions on what their patients think about treatment adherence, and to compare the gynecologists' opinions with the patients' own perceptions within the CRETA study., Methods: Spanish gynecologists who participated in the CRETA study were asked to fill out an online 41-item questionnaire to evaluate their views on VVA management., Results: From 29 centers across Spain, 44 gynecologists completed the survey. Their mean age was 47.2 years old, two-thirds of them were women, and the average professional experience was over 20 years. According to the gynecologists, the therapy most frequently used by VVA-diagnosed women was vaginal moisturizers (45.5%), followed by local estrogen therapy (36.4%) and ospemifene (18.2%). Nevertheless, ospemifene was viewed as the therapeutic option with the most efficacy, easiest route of administration, shorter time to symptom improvement, lower percentage of dropouts, and higher treatment adherence., Conclusions: Spanish gynecologists are in general agreement with their patients regarding VVA treatment preferences and the main issues for adherence and effectiveness. However, there is an opportunity for doctor-patient communication improvement. Among the three therapeutic options evaluated, ospemifene is regarded as offering some competitive advantages.

Agriculture currently confronts a multitude of challenges arising from the excessive utilization of chemical pesticides and the proliferation of phytopathogenic fungi strains that exhibit resistance to commonly employed active compounds in the field. Botrytis cinerea and Colletotrichum acutatum are phytopathogenic fungi that inflict substantial economic losses within agriculture and food due to their high impacts on crops both pre- and post-harvest. Furthermore, the emergence of fungal strains that are resistant to commercial fungicides has exacerbated this problem. To explore more environmentally sustainable alternatives for the control of these pathogens, an investigation into the endophytic bacteria associated with ginger ( Zingiber officinale Rosc.) was conducted. The primary focus of this study involved evaluating their inhibitory efficacy against the fungi and assessing their potential for promoting plant growth. The endophytic bacteria genera Lelliottia , Lysinibacillus , Kocuria , Agrococcus , Acinetobacter , Agrobacterium , Zymobacter , and Mycolicibacterium were identified. All isolates showed remarkable in vitro antagonistic ability against B. cinerea (>94%) and C. acutatum (>74%). Notably, the Lelliottia amnigena J29 strain exhibited a notable proficiency in producing extracellular enzymes and indole compounds (IAA), solubilizing phosphate and potassium, and forming biofilm. Furthermore, the Lysinibacillus capsici J26, Agrococcus citreus J28, and Mycolicibacterium sp. J5 strains displayed the capacity for atmospheric nitrogen fixation and siderophore production. These findings underscore the agricultural and biotechnological potential of endophytic bacteria derived from ginger plants and suggest the feasibility of developing alternative approaches to manage these two phytopathogenic fungi.

Background: We present the case of a patient who presents with a high velocity thoracoabdominal gunshot wound requiring ultramassive transfusion who exhausted the county blood bank requiring adjunctive therapies to balanced blood product transfusion while additional blood products could be obtained., Summary: Thoracoabdominal gunshot wounds carry a high mortality of 14-37 % because of the risk to produce cardiopulmonary, solid organ as well as major vascular injuries (Mandal and Oparah (1989) [1]). Ultramassive transfusion (>20 units of blood product transfusion) also carries high morbidity and mortality and management has generally centered on balanced transfusion (Matthay et al. (2021) [2])., Conclusion: Balanced blood product transfusion reduces mortality for patients requiring ultramassive transfusion but when this is not possible utilization of adjuncts to blood products may temporize resuscitation until additional blood products can be obtained., Competing Interests: All authors have reviewed the manuscript in its entirety and declare that they have no significant financial conflicts of interest. The order of authorship has been reviewed and approved by all authors. Florida Atlantic University has provided funds for publication of this manuscript., (© 2023 The Authors. Published by Elsevier Ltd.)

Pediatric trauma surgeons frequently encounter severe injuries from animal bites, with dog bites being especially prevalent in children, often leading to facial injuries. This paper details the case of a six-year-old male who suffered a dog bite resulting in a rare proximal right brachial artery injury. The bite caused deep lacerations and avulsion injuries, prompting admission to the trauma center, where nonpalpable right radial and ulnar pulses and arm weakness were observed. Surgical intervention, including wound exploration and brachial artery repair using a saphenous vein graft, successfully restored vascular perfusion. This case underscores the urgency of addressing pediatric dog bite injuries through timely exploration, thorough irrigation, and antibiotic prophylaxis, while also highlighting the need for further research on preventive education and clinical guidelines for assessing vascular injuries in such cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Meknarit et al.)

A hepatic pseudoaneurysm (HPA) after blunt or penetrating liver injury is an unusual but potentially lethal complication that can develop from an injured hepatic artery branch [1-5]. Endovascular intervention with coil embolization to treat HPA is a safe and effective method and has become the standard first-line treatment, with a success rate achieving 70-100 % [13,14,15]. Infrequently the pseudoaneurysm is fed by collateral vessels and endovascular intervention may be unsuccessful. Other minimally invasive treatment options that can be considered include image guided percutaneous thrombin injection, endovascular placement of covered stents and injection of liquid agents such as fibrin glue [10,11]. We present a case of a young female who developed a post-traumatic persistent hepatic pseudoaneurysm requiring a total of nine interventions, including six endovascular interventions with angiography, three endoscopic procedures for bleeding, one percutaneous injection, and two re-admissions to the hospital. Although she avoided initial operative management, her three-month hospital course can be considered a failure of conservative management of blunt hepatic trauma due to the accrued health care costs and resources. The literature on the management of persistent pseudoaneurysm is limited. The decision to treat a persistent HPA that are found incidentally and stable in size needs further investigation., Competing Interests: None., (© 2023 The Authors.)

Introduction: Food and cooking skills (FCSks) are defined as a complex, interrelated, and person-centred set of skills, necessary to provide and prepare safe, nutritious, and culturally acceptable meals for all members of the household. Recent studies have associated higher FCSk with healthier eating habits and better health. This study aimed to validate a Portuguese version of a tool to assess and describe FCSk in young adults., Methods: A cross-sectional study used an online anonymous questionnaire that was disseminated to students from three Portuguese Higher Education Institutes. The questionnaire validation included Cronbach alpha and confirmatory factor analysis (CFA). The Mann-Whitney test was used for evaluating sample differences and Pearson correlation for association among variables., Results: Internal consistency reliability was 0.89 for cooking skills (CSks) and 0.87 for food skills (FSks). A moderate positive correlation was found between CSks and FSks confidence ( r = 0.658, p < 0.01). CFA presented a good adjustment model for most of the fit indices, indicating the adequacy of the questionnaire. The CSks score was 74.1 ± 21.2 (moderate) and the food Skills was 94.2 ± 20.8 (high). Cook pulses, steaming food, and planning meals ahead scored the lowest value, while boiling or simmering food, chopping, peeling vegetables, and reading the best-before date scored the highest value. No difference was found among sex ( p CSk = 0.576; p FSk = 0.158), age ( p CSk = 0.566; p FSk = 0.130), body mass index classes ( p CSk = 0.903; p FSk = 0.320), or course ( p CSk = 0.169; p FSk = 0.126). The greatest interest in gastronomy and frequency of meal preparation is associated with higher FCSk ( p < 0.05)., Conclusion: This research validated a Portuguese version of a tool to assess FCSk among young adults. Internal consistency reliability was adequate. Confirmatory factor analysis returned good psychometric properties for the questionnaire. Authors identified lower FCSk competencies in cooking pulses and vegetables, which are healthy and sustainable foods. This may compromise the adoption of healthy eating behaviours, so promoting FCSk in young adults may pose a strategy for nutrition and public health in reducing diet-related diseases. This tool may be used to identify opportunities for intervention in public health nutrition., Competing Interests: The authors have no conflicts of interest to declare., (© 2023 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health.)