Decision-making for the treatment of climacteric symptoms using the Menopause Rating Scale.

OBJECTIVE: The Menopause Rating Scale (MRS) is one of the most frequently used instruments to evaluate menopausal symptoms; however, no cut-off score is given that would indicate the need for treatment. Our goal was to determine such a cut-off score on the MRS, using as a standard a woman's own perception of her need for treatment in relation to the severity of her symptoms. MATERIAL AND METHODS: The sample comprised 427 healthy women aged 40-59 years who were not taking hormonal treatment. Based on the concept of quality of life, we considered that the patient required treatment if she herself believed that she required it, on the basis of the severity of at least one of her menopausal symptoms. To obtain an optimal MRS cut-off score associated with the need for treatment, an ROC curve analysis was performed. RESULTS: The symptoms rated "very severe" on the MRS (i.e. that most require treatment) were physical and mental exhaustion (95.8% of women) and muscle and joint discomfort (95.1%). In total, 378 women (88.5%) considered that their symptoms required treatment. The ROC curve analysis determined that the optimal cut-off score on the MRS to indicate the need for treatment would be 14 (area under the curve 0.86, p < 0.0001). This score achieved 76.5% sensitivity and 83.6% specificity. With this cut-off score, 97.1% of the women who considered that they required treatment for at least one of their symptoms would be treated. There was concordance of more than 90% between this cut-off score and a score of 4 (i.e. a rating of "very severe") for any of the symptoms on the scale. CONCLUSIONS: An MRS score ≥14 indicates the need for treatment for climacteric symptoms. In clinical practice, a score of 4 for any of the MRS items could be taken to indicate the need for treatment.

Manejo terapéutico de la sintomatología climatérica

La menopausia ha sido definida por la Sociedad Internacional de Menopausia como el cese permanente de la menstruación en la mujer, suceso determinado por la disminución de la producción hormonal. Trae consigo, por una parte, una sintomatología que interfiere en la calidad de vida de la mujer, la cual incluye síntomas vasomotores, psíquicos, atrofia urogenital; y, por otra, cambios metabólicos que implican aumento del riesgo de enfermedades crónicas como las enfermedades cardiovasculares y la osteoporosis. Con el progresivo aumento de la esperanza de vida, los grupos de mayor edad comienzan a ser parte importante de la población mundial. Por lo tanto, el manejo clínico de la posmenopausia pasa a ser un problema relevante de salud pública. Tiene como objetivo mejorar la calidad de vida y disminuir el riesgo de enfermedades crónicas. Para medir la existencia de síntomas y signos asociados a la menopausia se puede utilizar la Menopause Rating Scale (MRS), escala que permite evaluar la intensidad de la sintomatología. Se debe valorar además el riesgo cardiovascular y de osteoporosis. El tratamiento incluye mejorar los estilos de vida, el uso de terapia hormonal y de terapias para las comorbilidades. Estas orientaciones tienen como objetivo ser una ayuda para el médico al momento de evaluar a una mujer en este periodo de la vida. Se han basado principalmente en las 'Orientaciones Técnicas para la atención integral de la mujer en edad de climaterio en el nivel primario de red de salud' del Programa de Salud de la Mujer, Ministerio de Salud, Chile. Sin embargo, son solo orientaciones; cada decisión terapéutica debe ser siempre individualizada acorde a las características particulares de cada paciente.

Menopause has been defined by the International Menopause Society as the permanent cessation of menstruation in women, an event determined by the decrease in hormonal production. On one hand, the associated symptomatology interferes with the quality of life of the woman, and includes vasomotor and psychic symptoms and urogenital atrophy; on the other hand, metabolic changes that imply an increase in the risk of chronic diseases such as cardiovascular disease and osteoporosis. With the progressive increase in life expectancy, the older groups begin to be an important part of the world population. Therefore, the clinical management of the postmenopause becomes a relevant public health problem. Its objective is to improve the quality of life and reduce the risk of chronic diseases. The Menopause Rating Scale (MRS) is a scale to assess the existence and intensity of symptoms. Cardiovascular risk and osteoporosis should also be assessed. Treatment includes improving lifestyle, the use of hormonal therapy and therapies for comorbidities. These guidelines are intended to be an aid to the physician when evaluating a woman in this period of life. They have been based mainly on the "Technical Guidelines for the comprehensive care of women of climacteric age at the primary level of the health network" of the Women's Health Program, Ministry of Health, Chile. However, they are only orientations. Every therapeutic decision should be individualized according to the particular characteristics of each patient.

MicroRNA Profiling of B Cell Subsets from Systemic Lupus Erythematosus Patients Reveals Promising Novel Biomarkers.

MicroRNAs control the differentiation and function of B cells, which are considered key elements in the pathogenesis of systemic lupus erythematosus (SLE). However, a common micro(mi)RNA signature has not emerged since published data includes patients of variable ethnic background, type of disease, and organ involvement, as well as heterogeneous cell populations. Here, we aimed at identifying a miRNA signature of purified B cells from renal and non-renal severe SLE patients of Latin American background, a population known to express severe disease. Genome-wide miRNA expression analyses were performed on naive and memory B cells and revealed two categories of miRNA signatures. The first signature represents B cell subset-specific miRNAs deregulated in SLE: 11 and six miRNAs discriminating naive and memory B cells of SLE patients from healthy controls (HC), respectively. Whether the miRNA was up or down-regulated in memory B cells as compared with naive B cells in HC, this difference was abolished in SLE patients, and vice versa. The second signature identifies six miRNAs associated with specific pathologic features affecting renal outcome, providing a further understanding for SLE pathogenesis. Overall, the present work provided promising biomarkers in molecular diagnostics for disease severity as well as potential new targets for therapeutic intervention in SLE.