Anti-inflammatory effect as a mechanism of effectiveness underlying the clinical benefits of pelotherapy in osteoarthritis patients: regulation of the altered inflammatory and stress feedback response.

The purpose of the present investigation was to evaluate whether an anti-inflammatory effect together with an improvement of the regulation of the interaction between the inflammatory and stress responses underlies the clinical benefits of pelotherapy in osteoarthritis (OA) patients. This study evaluated the effects of a 10-day cycle of pelotherapy at the spa centre 'El Raposo' (Spain) in a group of 21 OA patients diagnosed with primary knee OA. Clinical assessments included pain intensity using a visual analog scale; pain, stiffness and physical function using the Western Ontario and McMaster Universities Arthritis Index; and health-related quality of life using the EuroQol-5D questionnaire. Serum inflammatory cytokine levels (IL-1ß, TNF-α, IL-8, IL-6, IL-10 and TGF-ß) were evaluated using the Bio-Plex® Luminex® system. Circulating neuroendocrine-stress biomarkers, such as cortisol and extracellular 72 kDa heat shock protein (eHsp72), were measured by ELISA. After the cycle of mud therapy, OA patients improved the knee flexion angle and OA-related pain, stiffness and physical function, and they reported a better health-related quality of life. Serum concentrations of IL-1ß, TNF-α, IL-8, IL-6 and TGF-ß, as well as eHsp72, were markedly decreased. Besides, systemic levels of cortisol increased significantly. These results confirm that the clinical benefits of mud therapy may well be mediated, at least in part, by its systemic anti-inflammatory effects and neuroendocrine-immune regulation in OA patients. Thus, mud therapy could be an effective alternative treatment in the management of OA.

[Ultrasound guidance in pediatric regional anesthesia]. / Uso de la ecografía en anestesia regional pediátrica.

Ultrasound imaging is being used to guide pediatric nerve block procedures. Difficulties that arise because of the smaller anatomical structures in children can be compensated for by the greater aqueous consistency and reduced calcification. Given the shorter distance between the surface of the skin and nerves, it is advisable to use a linear array transducer working at a high frequency (7-10 MHz). Like adults, children benefit when ultrasound guidance is used in the performance of neuraxial nerve trunk blocks, particularly of the umbilical and ilioinguinal nerves, and in greater measure in spinal blocks. Ultrasound guidance enhances efficacy and also affords the important advantage of greater safety. The main disadvantages are the cost of equipment and the necessary learning curve.

Sexualidad y relaciones de pareja en la vida de mujeres que sufrieron violación en su niñez o adolescencia / Sexuality and partner relationships in women who suffered rape during their childhood or adolescence

El objetivo de este estudio prospectivo fue investigar la sexualidad y las relaciones de parejas que establecen mujeres que sufrieron violación en su niñez y adolescencia. La población del estudio la constituyó una cohorte de 225 mujeres adolescentes cuyos embarazos fueron productos de violación y que fueron atendidas en CEMERA durante los años 1984 a 1994. A todas ellas se les aplicó una encuesta en la primera consulta. Se estudiaron variables relacionadas con sexualidad y relaciones de pareja. Los resultados corresponden a 124 mujeres que fueron localizadas y entrevistadas lo que representa el 55 por ciento de la población en estudio. Características personales y familiares: El 50 por ciento tienen entre 16 y 19 años mientras que el 40 por ciento tienen entre 20 y 30 años, un 80 por ciento son solteras, un 55 por ciento realizan labores de casa, sólo un 42 por ciento alcanzó E. Media, un 61 por ciento vive y depende de su familia de origen. Situación de pareja: Un 41 por ciento no ha establecido ningún tipo de relación afectiva con el sexo opuesto, mientras que un 17 por ciento se casó y un 14 por ciento esta conviviendo. Aspecto de sexualidad: El 52 por ciento de ellas había iniciado actividad sexual voluntaria posterior. De este porcentaje la mitad inició actividad sexual antes del año. El 63 por ciento de ellas había tenido una sola pareja sexual mientras que el 25 por ciento había tenido 2 parejas sexuales y un 12 por ciento 3 y más parejas. Un 33 por ciento de sus parejas tienen entre 30 y 57 años. El 64 por ciento de las entrevistadas indicó que su pareja supo de la violación, un 72 por ciento de los supieron reaccionaron bien y la apoyaron pero un 28 por ciento la abandonó. Es importante notar que estas mujeres encontraron parejas que más bien satisfacieron sus necesidades materiales más que las necesidades emocionales. En general ellas no tuvieron éxito en tener una relación de pareja completa, feliz en lo sexual y emocional

[Sexual dysfunction with antidepressive agents. Effect of the change to amineptine in patients with sexual dysfunction secondary to SSRI]. / Disfunción sexual con antidepresivos. Efecto del cambio a amineptino en pacientes con disfunción sexual secundaria a ISRS.

UNLABELLED: Sexual dysfunction secondary to the use of antidepressants, especially clomipramine or SSRI's is an adverse effect that is often underestimated and according to earlier studies, this can affect approximately 60% of the patients. This presents as a decrease in libido, alterations in the ability to reach orgasm/ejaculation, and an erectile dysfunction or a decreased vaginal lubrication. This dysfunction appears to be related with the resulting increase in serotonin and with the stimulation of serotonin 5HT2 receptors. OBJECTIVES: 1) Evaluate the effect of amineptine, a drug with an increased dopamine transmission and scant serotonin transmission, on the sexual function of depressed patients who begin treatment, and 2) evaluate whether the change to amineptine improves the sexual function in patients who presented sexual dysfunction after beginning treatment with a SSRI. MATERIAL AND METHODS: Prospective, observational, open and multicentric design. 111 patients with an average age of 41.3 years (36 men, 75 women) were distributed into three groups: Group 1 (n= 26): patients with depression (DSM IV) who begin de novo treatment with amineptine 200 mg/day. Group 2 (n= 47): depressed patients undergoing treatment with a SSRI who show a favorable response and who present sexual dysfunction secondary to a poorly tolerated treatment, so the treatment is changed to 200 mg/day of amineptine. Group 3 (n= 38): patients with the same characteristics as those of group 2, but whose treatment was changed to 20 mg/day of paroxetine. The <> (Montejo et al, 1996) was used together with the Hamilton Depression Scale, the IGC Scale, and an adverse events scale, over a 6 months follow up period during which visits took place at: baseline, month 1, month 2, month 3, and month 6. RESULTS: In group 1, treated with amineptine from the beginning, of the 5 patients who showed a decrease in the libido at the beginning of the treatment, only one still presented this in the 6th month. The Hamilton Scale decreased from 23.12 (baseline) to 5.25 after 6 months. After substituting amineptine for SSRI's in patients with sexual dysfunction, the incidence of any type of sexual dysfunction decreased significantly from 100% (baseline) to 55.3% after 6 months. (P< 0.001). The incidence of delayed orgasm dropped to 15.8%, anorgasmia to 17.4%, and impotence dropped to 15.8% in this group, with the antidepressant effect that had already been achieved with the SSRI being maintained. However, in group 3 there was barely any improvement on the sexual function after changing to paroxetine (20 mg/day), with the baseline incidence being 100% and the incidence after 6 months being 89.7%. In this last group the antidepressant effect present at the baseline level, was maintained. CONCLUSIONS: Amineptine was shown to be an effective antidepressant in the patients studied, and did not cause secondary sexual dysfunction, and even improved the dysfunction that was present in some patients. In those patients previously treated with SSRI's, amineptine is able to significantly improve the sexual dysfunction and yet maintain the efficacy of the antidepressive treatment used before these 6 months. On the other hand, Paroxetine did not improve the sexual dysfunction of the people in whom this drug substituted another SSRI, as this is an adverse effect common to the entire group of selective serotonin re-uptake inhibiting drugs. Amineptine showed a good safety and tolerance profile. Its most common side effect (anxiety/restlessness) disappeared 2 months after the beginning of the treatment.

[Evaluation of the quality of prenatal care]. / Evaluación de la calidad de la atención prenatal.

OBJECTIVES: To evaluate the professionals involved in monitoring pregnancies and the quality of antenatal care in the counties of Berguedà and the Bages (central Catalonia). DESIGN: Observational and descriptive. SETTING: The data were obtained after the birth by interviewing the new mother. PARTICIPANTS: The 171 women who gave birth during February and March 1994 in the hospitals of the counties under study. MEASUREMENTS AND MAIN RESULTS: 95% of the women had attended for a check-up during the first three months. 44% had the pregnancy card; and 44% also attended motherhood classes. 34% of the pregnant women underwent some kind of antenatal diagnostic test for Chromosomopathies. The number of ecographs ranged from 2 to 12, with an average of 4.7. The new mother identified as professionals involved in monitoring her pregnancy: the gynaecologist (99%), the midwife (32%), the General Practitioner (22%) and other specialists (1%). CONCLUSIONS: A high percentage of variables (weight, number of attendances, attendance in first three months, identification of risk) fall within the recommendations of the different quality criteria of the procedures of the Spanish Gynaecology and Obstetrics Society (SEGO). However the number of ecographies varied a lot; there was low attendance at motherhood classes and low identification by the new mother of the midwife as a professional involved.