The human CRY1 tail controls circadian timing by regulating its association with CLOCK:BMAL1.

Circadian rhythms are generated by interlocked transcription-translation feedback loops that establish cell-autonomous biological timing of ∼24 h. Mutations in core clock genes that alter their stability or affinity for one another lead to changes in circadian period. The human CRY1Δ11 mutant lengthens circadian period to cause delayed sleep phase disorder (DSPD), characterized by a very late onset of sleep. CRY1 is a repressor that binds to the transcription factor CLOCK:BMAL1 to inhibit its activity and close the core feedback loop. We previously showed how the PHR (photolyase homology region) domain of CRY1 interacts with distinct sites on CLOCK and BMAL1 to sequester the transactivation domain from coactivators. However, the Δ11 variant alters an intrinsically disordered tail in CRY1 downstream of the PHR. We show here that the CRY1 tail, and in particular the region encoded by exon 11, modulates the affinity of the PHR domain for CLOCK:BMAL1. The PHR-binding epitope in exon 11 is necessary and sufficient to disrupt the interaction between CRY1 and the subunit CLOCK. Moreover, PHR-tail interactions are conserved in the paralog CRY2 and reduced when either CRY is bound to the circadian corepressor PERIOD2. Discovery of this autoregulatory role for the mammalian CRY1 tail and conservation of PHR-tail interactions in both mammalian cryptochromes highlights functional conservation with plant and insect cryptochromes, which also utilize PHR-tail interactions to reversibly control their activity.

Primary histiocytic sarcoma of the clivus with focal extension into central nervous system and neurologic manifestations: First description at an unusual site with an overwhelming and rapid progression.

Histiocytic sarcoma (HS) is a rare malignant neoplasm of macrophage-dendritic cell lineage that can occur at any site. Primary base of skull involvement is exceedingly rare. We present the case of a previously healthy 56-year-old man who complained of headaches and showed localized neurologic symptoms. Magnetic resonance imaging demonstrated a hyperintense and enhancing mass involving the sphenoid bone and the clivus with an extradural component that compressed the distal pons. The differential diagnosis included chordoma or chondrosarcoma. An endoscopic trans-sphenoidal resection was performed. Microscopically, the tumor showed epithelioid and spindle morphology with atypia, mitoses, and necrosis. No osteoid, cartilaginous, or myxoid matrix was identified. By immunohistochemistry, the tumor was positive for CD68 (KP-1) and lysozyme, variably positive for CD4, CD11c, CD14, CD68 (PGM-1), CD45, and CD163, and negative for markers of epithelial, melanocytic, lymphoid, myeloid, muscle, and dendritic cell origin. Expression of PD-L1 by immunohistochemistry and BRAF V600E mutation analysis by PCR were negative. Tumor recurrence developed after radiation treatment with overwhelming progression into a largely infiltrating mass within 2 weeks with clinical deterioration, and the patient died 3 months later. To our knowledge, this represents the first case of primary HS of the clivus reported to date in the English literature, further expanding the spectrum of neoplasms seen at this site as well as the sites where HS can be seen. The overall prognosis of HS in the skull base is poor, with no standard treatment. Further research is warranted to develop effective treatment approaches, which in the future may rely on the expression of checkpoint inhibitors and/or specific molecular markers.

Standardization and validation of a novel UPLC-MS/MS method to quantify first line anti-tuberculosis drugs in plasma and dried blood spots.

Tuberculosis (TB) is a high-burden infectious disease with high prevalence and mortality rates. The first-line anti-TB drugs include isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA), and ethambutol (EMB). At present, the standard method of blood sampling for therapeutic drug monitoring (TDM) analysis is venipuncture. Dried blood spots (DBS) are a minimally invasive method for collecting small quantities of whole blood from fingertips. The aim of the current study was to develop an ultrahigh-performance liquid chromatography technique coupled to tandem mass spectrometry (UPLC-MS/MS) for simultaneous quantification of the first-line anti-TB drugs in human plasma and DBS as a sampling alternative. The separation and detection conditions were optimized to quantify INH, RMP, PZA, and EMB in both matrices in an ACQUITY UPLC H Class system coupled to a XEVO TQD detector. Chromatographic separation was performed through an Acquity HSS T3 column (2.1 × 100 mm, 1.8 µm) with 0.1% formic acid in water and acetonitrile as the mobile phase. The total run time was 7 min for both methods, with retention time in plasma of 0.85, 1.22, 3.16, and 4.04 min and 0.74, 0.87, 0.97, and 4.16 min for EMB, INH, PZA, and RMP in DBS, respectively. The bioanalytical methods developed were proved selective, linear, precise, and accurate (inter- and intra-assay); the matrix effect was demonstrated to be within the established limits. Short- and long-term stability, freeze-thaw cycles for plasma, and short-term stability for DBS were established. A total of 15 patients with 46 ± 17 (mean ± SD) years old were included, and anti-TB drug concentrations were quantified on plasma and DBS as proof of concept. Based on RMP and INH plasma concentrations (Cp), and Bayesian estimation of individual pharmacokinetic parameters, a dose adjustment was necessary for 93% of patients. The slopes of the correlation lines between plasma and DBS concentrations of RMP, EMB, INH, and PZA were 0.5321, 0.8125, 0.5680, and 0.6791, respectively. Finally, significant correlations (p < 0.05) were observed between DBS and plasma concentrations for RMP (r2 = 0.6961), EMB (r2 = 0.4369), INH (r2 = 0.8675) and PZA (r2 = 0.7363). A simple, fast, and reliable UPLC-MS/MS method was developed to quantify first-line anti-TB drugs in plasma and DBS, which provides an easy sampling and storage to be applied as a new strategy for TDM in patients with TB.

Effectiveness of COVID-19 vaccines in Ecuador: A test-negative design.

Background: The COVID-19 pandemic poses a significant global health threat, characterized by high morbidity, severity, and the emergence of concerning variants. Latin America has been greatly affected, with high infection and mortality rates. Vaccination plays a crucial role in mitigating severe disease and controlling the pandemic. This study aims to assess the effectiveness of COVID-19 vaccines in preventing SARS-CoV-2 severe acute respiratory infections (SARI) in hospitalized vaccination target groups in Ecuador. Methods: This is a test-negative design study. We used data reported through sentinel surveillance of SARI between May 2021 and March 2022 in Ecuador. Patients with case criteria of SARI and hospitalized for a minimum of 24 hours were included in the study. Cases were defined as patients with SARI with a positive RT-qPCR test for SARS-CoV-2 and controls were those with a negative result. Information on vaccination status was obtained from the national vaccination registry, a valid dose of vaccination was considered when it was administered at least 14 days prior to symptom onset. Vaccine effectiveness (VE) (1-OR/OR) was calculated using a logistic regression. Results: A total of 1,277 patients were included in the analysis of VE. The adjusted vaccine effectiveness (aVE) in preventing hospitalization, adjusted for sex, age group, presence of one or more comorbidities, and period of the predominance of the omicron variant, was 44.5% for the partial primary schedule, 74.7% for the complete primary schedule, and 79.9% for the complete primary schedule plus booster doses. The aVE in avoiding ICU admissions was close to 80% with both the complete primary schedule and the booster doses, and in avoiding deaths, the aVE was 89% and 98%, respectively. Conclusions: In Ecuador, COVID-19 vaccination prevents hospitalizations, ICU admissions, and deaths. The effectiveness of the vaccines improves with more doses, offering increased protection across all age groups.

Synchronous plasma cell neoplasm and B lymphoblastic leukemia/lymphoma at initial presentation: first report of an unusual association with a good outcome.

A synchronous diagnosis of a plasma cell neoplasm (PCN) and a non-plasma cell hematologic malignancy is very rare. We report what we believe is the first instance of a synchronous PCN and B lymphoblastic leukemia/lymphoma (B-ALL) diagnosed at initial presentation. The patient underwent laboratory evaluation for an underlying plasma cell neoplasm, including immunology studies, bone marrow biopsy, and flow cytometry immunophenotyping. Serum lambda free light chain and serum IgG were elevated, with an IgG lambda M-protein identified by serum protein electrophoresis and immunofixation. The clinical working diagnosis was plasma cell myeloma. Bone marrow biopsy was positive for a composite PCN and B-ALL. The patient received treatment with VDT-PACE chemotherapy followed by autologous stem cell transplant and maintenance therapy with bortezomib/daratumumab and is in complete remission for both diseases 3.5 years after diagnosis. This case not only adds to the known repertoire of hematologic neoplasms that can occur in association to a PCN, but also demonstrates that patients presenting with this rare combination of hematopoietic neoplasms can be effectively treated simultaneously with excellent responses. Additional research is warranted to understand the pathophysiology, to identify potential prognostic factors, and to develop specific therapeutic plans for these patients.

A Model for the Signal Initiation Complex Between Arrestin-3 and the Src Family Kinase Fgr.

Arrestins regulate a wide range of signaling events, most notably when bound to active G protein-coupled receptors (GPCRs). Among the known effectors recruited by GPCR-bound arrestins are Src family kinases, which regulate cellular growth and proliferation. Here, we focus on arrestin-3 interactions with Fgr kinase, a member of the Src family. Previous reports demonstrated that Fgr exhibits high constitutive activity, but can be further activated by both arrestin-dependent and arrestin-independent pathways. We report that arrestin-3 modulates Fgr activity with a hallmark bell-shaped concentration-dependence, consistent with a role as a signaling scaffold. We further demonstrate using NMR spectroscopy that a polyproline motif within arrestin-3 interacts directly with the SH3 domain of Fgr. To provide a framework for this interaction, we determined the crystal structure of the Fgr SH3 domain at 1.9 Å resolution and developed a model for the GPCR-arrestin-3-Fgr complex that is supported by mutagenesis. This model suggests that Fgr interacts with arrestin-3 at multiple sites and is consistent with the locations of disease-associated Fgr mutations. Collectively, these studies provide a structural framework for arrestin-dependent activation of Fgr.

The Two Non-Visual Arrestins Engage ERK2 Differently.

Arrestin binding to active phosphorylated G protein-coupled receptors terminates G protein coupling and initiates another wave of signaling. Among the effectors that bind directly to receptor-associated arrestins are extracellular signal-regulated kinases 1/2 (ERK1/2), which promote cellular proliferation and survival. Arrestins may also engage ERK1/2 in isolation in a pre- or post-signaling complex that is likely in equilibrium with the full signal initiation complex. Molecular details of these binary complexes remain unknown. Here, we investigate the molecular mechanisms whereby arrestin-2 and arrestin-3 (a.k.a. ß-arrestin1 and ß-arrestin2, respectively) engage ERK1/2 in pairwise interactions. We find that purified arrestin-3 binds ERK2 more avidly than arrestin-2. A combination of biophysical techniques and peptide array analysis demonstrates that the molecular basis in this difference of binding strength is that the two non-visual arrestins bind ERK2 via different parts of the molecule. We propose a structural model of the ERK2-arrestin-3 complex in solution using size-exclusion chromatography coupled to small angle X-ray scattering (SEC-SAXS). This binary complex exhibits conformational heterogeneity. We speculate that this drives the equilibrium either toward the full signaling complex with receptor-bound arrestin at the membrane or toward full dissociation in the cytoplasm. As ERK1/2 regulates cell migration, proliferation, and survival, understanding complexes that relate to its activation could be exploited to control cell fate.

An Eight Amino Acid Segment Controls Oligomerization and Preferred Conformation of the two Non-visual Arrestins.

G protein coupled receptors signal through G proteins or arrestins. A long-standing mystery in the field is why vertebrates have two non-visual arrestins, arrestin-2 and arrestin-3. These isoforms are ~75% identical and 85% similar; each binds numerous receptors, and appear to have many redundant functions, as demonstrated by studies of knockout mice. We previously showed that arrestin-3 can be activated by inositol-hexakisphosphate (IP6). IP6 interacts with the receptor-binding surface of arrestin-3, induces arrestin-3 oligomerization, and this oligomer stabilizes the active conformation of arrestin-3. Here, we compared the impact of IP6 on oligomerization and conformational equilibrium of the highly homologous arrestin-2 and arrestin-3 and found that these two isoforms are regulated differently. In the presence of IP6, arrestin-2 forms "infinite" chains, where each promoter remains in the basal conformation. In contrast, full length and truncated arrestin-3 form trimers and higher-order oligomers in the presence of IP6; we showed previously that trimeric state induces arrestin-3 activation (Chen et al., 2017). Thus, in response to IP6, the two non-visual arrestins oligomerize in different ways in distinct conformations. We identified an insertion of eight residues that is conserved across arrestin-2 homologs, but absent in arrestin-3 that likely accounts for the differences in the IP6 effect. Because IP6 is ubiquitously present in cells, this suggests physiological consequences, including differences in arrestin-2/3 trafficking and JNK3 activation. The functional differences between two non-visual arrestins are in part determined by distinct modes of their oligomerization. The mode of oligomerization might regulate the function of other signaling proteins.

Actualización sobre el conocimiento y la comprensión de la COVID 19 en el adulto mayor

RESUMEN Partiendo de la revisión efectuada en la literatura disponible en el curso de la pandemia de la COVID-19 ocasionada por el nuevo coronavirus SARS-CoV-2, se expone información actualizada sobre el conocimiento y la comprensión de esta enfermedad, específicamente en el adulto mayor.

ABSTRACT Based on the review carried out in the literature available during the COVID-19 pandemic caused by the new SARS-CoV-2 coronavirus, updated information is presented on the knowledge and understanding of this disease, specifically in the elderly.

Trastornos del sueño en adulto mayor. Actualización diagnóstica y terapéutica / Sleeping disorders in older adults. Diagnostic and therapeutic update

RESUMEN Los trastornos del sueño en el adulto mayor son una afección frecuente. Sin embargo, es una parte de la medicina relativamente nueva, dado que ha sido en los últimos 40 años cuando se ha trabajado realmente en ella. El objetivo de esta revisión es profundizar y actualizar aspectos diagnósticos y terapéuticos sobre dichos trastornos, lo cual constituye siempre un reto para el médico que atiende este grupo poblacional.

ABSTRACT Sleeping disorders in the elderly are a frequent condition. However, it is a part of relatively new medicine, since it has only been in the last 40 years it has really studied. The objective of this review is to deepen and update diagnostic and therapeutic aspects of these disorders, which is always a challenge for the doctor who attends this age group.

Resultados de la atención estomatológica a embarazadas. 2018 / Results of the dental attention to pregnant. 2018

RESUMEN Se realizó un estudio descriptivo retrospectivo. La población estuvo constituida por el total de gestantes captadas por lo médicos de Consultorios Médicos de Familia (CMF) del Policlínico III ¨René Vallejo Ortiz, del municipio Manzanillo, de enero a diciembre de 2018, con el objetivo de describir los resultados de la atención estomatológica a embarazadas. La información se obtuvo de los datos reflejados en los informes estadísticos del Departamento de Registros Médicos y Estadísticos del Policlínico, se obtuvo como resultado que se examinó el 101,9 % del universo, el 34,4% no necesitaba tratamiento estomatológico y se le dio alta de servicios básicos al 100 % de las embarazadas, llegando a la conclusión que en el Policlínico Docente III ¨René Vallejo Ortiz del municipio Manzanillo, se le brinda una buena atención estomatológica integral a las embarazadas y se cumplió con los indicadores estomatológicos de atención a este grupo priorizado.

ABSTRACT Was carried out a retrospective descriptive study. The population was constituted by the gestantes total captured by the medical of Medical Clinics of Family of the Clinic III ¨René Vallejo Ortiz, of the Manzanillo City, of January to December of 2018, with the objective of describing the results of the to pregnant. The information was obtained of the data reflected in the statistical reports of the Medical department and Statistical Registrations of the clinic, itwasobtained as a result that 101,9% was examined of the universe, 34,4% didn't need treatment estomatológico and was given high of basic services to 100% of the pregnantones, reaching the conclusion that in the clinic III ¨René Vallejo Ortiz¨ of the Manzanillo City, is offered a good attention integral dentist to the pregnantones and it was fulfilled the indicative dentist of attention to this prioritized group.

Assessment of sleep quality and correlates in a large cohort of Colombian women around menopause.

OBJECTIVE: The aim of this study was to determine the relationship between self-reported sleep quality, menopausal symptom intensity, and correlates (including ethnicity) among middle-aged women. METHODS: The present cross-sectional study involved 1,078 Colombian women aged 40 to 59 years who completed the Pittsburgh Sleep Quality Index (PSQI), the Menopause Rating Scale (MRS), and a general questionnaire exploring sociodemographic data. RESULTS: The median [interquartile range] age of the whole sample was 49.0 [9.0] years. Among the participants, 45.4% were postmenopausal, 57.2% had increased body mass index values, 13.9% were black, 20.7% had hypertension, 74.1% had a stable partner, and 3.8% used hormone therapy. The prevalence of poor sleep quality was 57.1% (PSQI global score ≥5). Significant correlations between PSQI global scores and MRS total and subscale scores were found. Multiple linear regression analysis found that higher PSQI scores (poorer quality of sleep) correlated with higher MRS psychological and somatic subscale scores (more severe symptoms), smoking habit, and hypertension. Menopause status and black ethnicity were excluded from the final regression model. CONCLUSIONS: Despite study limitations, poor sleep quality is highly prevalent in this large middle-aged Colombian female sample and is related to menopausal symptom severity, tobacco use, and presence of hypertension.

Prevalence of insomnia and related factors in a large mid-aged female Colombian sample.

OBJECTIVE: To assess the prevalence of insomnia and related factors in a large cohort of mid-aged Colombian women of different ethnical background. METHODS: This cross-sectional study involved 1325 women aged 40-59 of 3 ethnical groups: Mestizo (70.0%), Black (11.5%) and Zenú indigenous (18.5%), who completed the items of the Athens Insomnia Scale (AIS), the Menopause Rating Scale (MRS) and a general questionnaire containing personal socio-demographic data. RESULTS: Median [interquartile range] age of the whole sample was 48.0 [10.0] years. A 43.4% were postmenopausal, 51.7% had increased body mass index values, 18.2% had hypertension and 5.1% used hormone therapy. A 27.5% displayed insomnia (AIS total score ≥6). Significant Spearman rho correlations were found between total AIS and MRS scores (total and subscales). Multiple linear regression analysis found that higher total AIS scores (more insomnia) correlated with tobacco consumption and higher MRS psychological and somatic subscale scores (more severe symptoms). Age, ethnicity and partner and menopausal status were excluded from the final regression model. CONCLUSIONS: In this large mid-aged Colombian cohort insomnia was present in nearly one third of cases, related to smoking habit and the severity of somatic and psychological menopausal symptoms and independent of ethnics and menopausal status.

Quality of life in a large cohort of mid-aged Colombian women assessed using the Cervantes Scale.

OBJECTIVE: The aim of this study was to assess quality of life (QoL) in a cohort of mid-aged Colombian women using the Cervantes Scale (CS). METHODS: In this cross-sectional study, 1,739 healthy women aged 40 to 59 years were asked to simultaneously fill out the CS and a questionnaire containing general female demographic data. The CS includes four domains: menopause and health (15 items), psychological (9 items), sexuality (4 items), and couple relationship (3 items). In addition, the menopause and health domain includes three subdomains: vasomotor symptoms, health, and aging. The global CS score may range from 0 to 155 (from better to worse QoL). RESULTS: Multiple linear regression determined that CS scores (global and domains) significantly increased (therefore, worse QoL) with age, menopause status, body mass index, parity, race, and marital and working status. The CS displayed a high internal consistency as Cronbach α values for the global and domain scores were above 0.80. CONCLUSIONS: This is the first study to report QoL assessment using the CS among mid-aged Latin American women from Colombia in whom age, menopause status, body mass index, and other personal factors influenced QoL.

Hábitos bucales deformantes en niños de 5 a 11 años / Deforming oral habits in 5-11 years children

Se realizó un estudio descriptivo y transversal de 86 niños de 5-11 años de edad con hábitos bucales deformantes, quienes pertenecían al área de salud del Policlínico Universitario No. 3 "René Vallejo Ortiz" de Manzanillo, Granma, en el período comprendido de enero a junio del 2013, a fin de identificar dichas costumbres nocivas y sus manifestaciones bucales en este grupo etario, para lo cual se consideraron las variables: edad, sexo, principales hábitos y características clínicas; las que fueron relacionadas y analizadas estadísticamente. Entre los resultados sobresalientes figuraron el sexo femenino, la edad de 9 años y los hábitos succión digital y lengua protráctil; asimismo, los varones presentaron con mayor frecuencia más de un hábito bucal deformante, fundamentalmente en la edad de 9 años, y la característica clínica preponderante en ambos sexos fue la versión vestibular de los incisivos superiores.

A descriptive and cross-sectional study of eighty six 5-11 years children with deforming oral habits who belonged to the health area from "René Vallejo Ortiz" No.3 University Polyclinic, Granma was carried out in the period from January to June, 2013, in order to identify these noxious habits and their oral manifestations in this age group, for which the variables: age, sex, main habits and clinical characteristics were considered; that were statistically related and analyzed. Among the excellent results there were the female sex, 9 years age and the habits digital suction and protractile tongue; likewise, males presented more frequently more than one deforming oral habit, mainly in the 9 years, and the predominant clinical characteristic in both sexes was the vestibular version of the upper incisors.

El sobrepeso y la obesidad se asocian a mayor prevalencia de síntomas menopaúsicos y deterioro severo de la calidad de vida / Overweight and obesity are associated with increased prevalence of menopausal symptoms and severe impairment of quality of life

Objetivo: establecer en un grupo de mujeres colombianas la asociación entre obesidad y sobrepeso, síntomas menopáusicos y deterioro de la calidad de vida. Metodología: estudio transversal que hace parte del proyecto "Calidad de Vida en la Menopausia y Etnias Colombianas (cavimec)", que involucra mujeres colombianas indígenas, afrodescendientes y mestizas de las costas Caribe y Pacífica. Realizado con la escala Menopause Rating Scale (mrs), versión en español, ya validada en dicho idioma. Aplicada deforma anónima y voluntaria en las comunidades de residencia con visita puerta a puerta. Las mujeres fueron agrupadas según Índice de Masa Corporal (imc). Resultados: población de estudio: 2167 mujeres. Edad promedio: 48.6±5.9 años. imc: 25.4±4.2. IMC normal: 44.2 %, bajo peso: 3.5 %, sobrepeso: 40.1 %, obesidad: 12.0 %. Premenopáusicas: 35.0 % y posmenopáusicas: 41.5 %. Edad promedio de menopausia: 47.4±3.7, y número promedio de años desde el último sangrado: 6.0±4.1 años. La edad promedio de menopausia se incrementó levemente con el aumento del imc (p=0.027). La prevalencia de todos los síntomas menopáusicos y el deterioro de las dimensiones se incrementaron con el aumento en el imc. El sobrepeso tuvo or ajustado:1.61 (1.35-1.93) y la obesidad: or ajustado: 1.40(1.06-1.84) para deterioro severo de la calidad de vida. Conclusiones: el sobrepeso y la obesidad se asociaron a mayor presencia de síntomas menopáusicos, mayor deterioro somático, psicológico, urogenital y mayor deterioro severo de la calidad de vida.

Objective: to establish the association between obesity and overweight, menopausal symptoms and impaired quality of lije in a group of Colombian women. Methods: cross-sectional study that is part of the proyecto de investigación "Calidad de Vida en la Menopausia y Etnias Colombianas (cavimec)", involving indigenous, black and mestizo Colombian women of the Caribe and Pacific coasts. Menopause Rating Scale (mrs) validated Spanish version was applied anonymously and voluntarily in their community of residence with door to door visits. Women were grouped according to Body Mass Index (bmi). Results: study population: 2167 women. Average age: 48.6 ± 5.9 years. bmi: 25.4 ± 4.2. Normal bmi: 44.2 %, underweight: 3.5 %, overweight: 40.1 %, obese: 12.0 %. Premenopausal: 35.0 % and postmenopausal women: 41.5 %. Average age of menopause: 47.4 ± 3.7 and mean number of years since the last bleeding: 6.0 ± 4.1 years. The average age of menopause increased slightly with increasing bmi (p = 0.027). The prevalence of all menopausal symptoms and the deterioration of dimensions increased with increasing bmi. Overweight had adjusted or: 1.61 (1.35-1.93) and obesity had adjusted or 1.40 (1.061.84) for severe impairment of quality of life. Conclusions: overweight and obesity are associated with increased menopausal symptoms, greater somatic, psychological and urogenital impairment and more severe impairment of quality of life.

Sulfato de magnesio y protección neuronal prenatal / Magnesium sulfate for prenatal neuroprotection

Antecedentes: la prematuridad es importante factor de riesgo para el desarrollo de parálisis cerebral (PC). El Sulfato de Magnesio (MgSO4) se ha planteado como una estrategia para reducir el riesgo de PC en recién nacidos por debajo de las 34 semanas de gestación. Objetivo: precisar con la evidencia disponible, la validez del uso del MgSO4 para protección neuronal prenatal en embarazadas en riesgo de parto pretér-mino (PP) inminente. Método: se revisaron las bases de datos PubMed, ScienceDirect, EBSCOhost, Scielo y OvidSP en búsqueda de estudios clínicos y epidemiológicos, revisiones sistemáticas, consensos y meta análisis. Se realizó revisión temática de los artículos que cumplieron los criterios de selección. Resultados: experimentos en modelos animales mostraron la posibilidad que el MgSO4 fuese protector neuronal. Estudios observacionales señalaron la posible asociación entre la exposición fetal al MgS04 y reducción en morbilidad neurológica en nacidos pretérmino (NP). Cinco ensayos clínicos entre 2002-2008, individualmente no mostraron datos concluyentes. En el 2009 se publicaron tres metaanálisis, basados en esos mismos ensayos y mostraron significativa reducción de PC en NP expuestos prenatalmente al MgSO4. Conclusión: existe evidencia para recomendar MgSO4 para protección neuronal prenatal antes de las 34 semanas de embarazo y con riesgo inminente de PP, aunque no está definida la dosis óptima. Se recomienda aplicar hasta el parto o por 12-24 horas.

Background: prematurity is a leading risk factor for development of cerebral palsy (CP). The use of Magnesium sulphate (MgSO4) has been proposed as a strategy to reduce the risk of cerebral palsy in preterm infants less than 34 weeks of gestation. Aims: to assess the best available evidence in order to validate the use of MgSO4 for prenatal neuroprotection in pregnant women at risk of imminent preterm delivery. Methods: we searched the PubMed, ScienceDirect, EBSCOhost, Scielo and OvidSP databases for clinical and epidemiological studies, systematic reviews, consensus and meta-analysis about the use of Magnesium sulphate to prevent cerebral palsy. Thematic review was conducted of articles that met the selection criteria. Results: experiments in animal models showed properties of MgSO4 for neuroprotection. Observational studies indicated the possible association between fetal exposures to MgS04 and reduced neurological morbidity in PP. Five clinical trials between 2002 and 2008 showed no conclusive data individually. In 2009, three meta-analysis showed significant reduction of cerebral palsy in MgSO4 exposed preterm infants. Conclusion: there is evidence to recommend the use of MgSO4 for prenatal neuroprotection before 34 weeks of pregnancy and imminent risk of preterm birth. It is unclear the optimal dose of MgSO4; is recommended until delivery or by 12-24 hours.

Prevalencia de la sintomatología urogenital en mujeres indígenas colombianas en posmenopausia / Prevalence of urogenital symptoms among Colombian indigenous postmenopausal women

Introducción: el deterioro de la calidad de vida en las mujeres posmenopáusicas es diferente según el grupo étnico al cual pertenecen. Objetivo: comparar la frecuencia de síntomas urogenitales y el deterioro de la dimensión urogenital en mujeres indígenas en posmenopausia. Metodología: se estudió por medio de la Menopause Rating Scale a 609 mujeres posmenopáusicas, entre 40 y 59 años, de tres asentamientos indígenas colombianos: 161 (26,4%) de diferentes etnias residentes en la Amazonia, 297 (48,8%), zenúes y 151 (24,8%), wayuús. Resultados: el puntaje de la dimensión urogenital en las indígenas amazónicas fue 3,8 ± 3,2; en las zenúes, 6,2 ± 1,3 y en las wayuús, 2,9 ± 2,6; el puntaje del grupo total en esta dimensión fue 4,8 ± 2,7, todos más altos que los de otras poblaciones colombianas y latinoamericanas. El puntaje total de la MRS fue: 13,8 ± 8,2 en las amazónicas, 14,7 ± 2,5 en las zenúes y 10,0 ± 6,7 en las wayuús. En 9,1% del grupo total se encontraron síntomas severos con respecto a problemas sexuales, en 48,0% había incontinencia urinaria y en 12,1%, sequedad vaginal. El 42% tenían deterioro de la dimensión urogenital. Conclusiones: las mujeres indígenas en posmenopausia de las tres poblaciones estudiadas tienen alta prevalencia y aparición precoz de síntomas relacionados con la dimensión urogenital. La mitad de la población estudiada, con edad promedio de 53 años, tiene deteriorada la esfera urogenital.

Introduction: Deterioration of life quality in postmenopausal women differs according to their ethnicity. Objective: To compare the frequency of urogenital symptoms and the deterioration of the urogenital dimension in indigenous postmenopausal women belonging to three different communities. Methods: By means of the Menopausal Rating Scale, 609 indigenous postmenopausal women, aged between 40-59 years, were studied: 161 (26.4%) belonged to different Amazonic tribes, 297 (48.8%) were Zenu and 151 (24.8%), Wayuu. Results: Scores in the urogenital dimension were as follows: 3.8 ± 3.2 in the Amazonic women; 6.2 ± 1.3 in the Zenu community, and 2.9 ± 2.6 among the Wayuu. The score for the whole group was 4.8 ± 2.7; all these scores are higher than those of other Colombian and Latinamerican populations. Total score in the MRS was 13.8 ± 8.2 (Amazonic women), 14.7 ± 2.5 (Zenu), and 10.0 ± 6.7 (Wayuu). In the whole group, 9.1% had severe symptoms concerning sexual problems, 48.0% had urinary incontinence, and 12.1% suffered from vaginal dryness. The urogenital dimension was altered in 42%. Conclusion: Indigenous postmenopausal Colombian women belonging to different communities have high prevalence and early appearance of symptoms related to the urogenital dimension. Half of the studied population, with average age 53 years, have urogenital deterioration.

La calidad de vida de las mujeres en edad media varía según el estado menopáusico / Quality of life in middle aged women varies with menopausal status

Objetivo: evaluar con la escala MRS (Menopause Rating Scale) la frecuencia y gravedad de los síntomas menopáusicos presentes en un conjunto de mujeres saludables en la edad media de la vida. Metodología: estudio transversal con aplicación de la escala MRS entre noviembre de 2006 y enero de 2009 a 1.215 mujeres saludables de 40-59 años de edad, originarias y residentes en distintas comunidades de la región Caribe colombiana. El grupo incluyó afrodescendientes, indígenas y mestizas (hispano-colombianas). Se las dividió en premenopáusicas, perimenopáusicas y postmenopáusicas. Resultados: las molestias musculares y articulares, oleadas de calor, cansancio físico y mental e irritabilidad se presentaron en más del 60% de las mujeres, pero el síntoma predominante fue diferente en cada estado menopáusico. El cansancio físico y mental predominó en la premenopausia (58,9%), las molestias musculares y articulares en la perimenopausia (78,9%) y las oleadas de calor en la postmenopausia (83,2%). Se evidenció un deterioro progresivo de la calidad de vida, en todos los ítems evaluados, al pasar del estado premenopáusico al posmenopáusico. También se halló deterioro de la calidad de vida con el paso del estado premenopáusico al perimenopáusico en todos los ítems (con excepción de los problemas vesicales); de la perimenopausia a la posmenopausia se observó deterioro a expensas de oleadas de calor, problemas sexuales y de vejiga, sequedad vaginal y molestias músculo-articulares, en tanto que los puntajes de molestias cardíacas, trastornos del sueño, estado de ánimo depresivo, irritabilidad, ansiedad, cansancio físico y mental se redujeron en la posmenopausia, aunque permanecieron por encima de los puntajes de la premenopausia. Conclusiones: Caracterizar los síntomas climatéricos y su comportamiento a lo largo de los estados menopáusicos permite establecer medidas de prevención y de intervención que mejoren la calidad de vida de la mujer en esta etapa.

Objective: To determine, by means of the MRS scale (Menopause Rating Scale), the frequency and severity of menopausal symptoms in a group of healthy middle-aged, Colombian women. Methods: A cross sectional study was carried out between November 2006 and January 2009. A survey form and the MRS were applied to 1.215 healthy women 40-59 years old, native and resident in different communities of the Colombian Caribbean coast, who were from African, indigenous or mestizo descent. According to their menopausal status they were divided into premenopausal, menopausal and postmenopausal. Results: Joint and muscular discomfort, hot flashes, physical and mental exhaustion, and irritability were present in more than 60% of the whole group. The predominant symptom, however, differed according to the menopausal status: physical and mental exhaustion in premenopausal women (58.9%), joint and muscular discomfort in the perimenopausal ones (78.9%) and hot flashes during the postmenopause (83.2%). A gradual decline in the quality of life (QOL) was evident from premenopause through perimenopause to postmenopause. Deterioration in the QOL was found from premenopause to perimenopause in all items (with the exception of bladder problems). Decline was also observed from perimenopause to postmenopause centered on hot flashes, sex and bladder problems, vaginal dryness and joint and muscular discomfort. In contrast, the scores of heart discomfort, sleep disturbances, depressed mood, irritability, anxiety and physical and mental exhaustion decreased in the postmenopause although they remained higher than those of the premenopausal women. Conclusions: Knowledge of the profile of climacteric symptoms and of their behavior through the menopausal statuses is the basis for preventive strategies and appropriate interventions that improve the quality of life of women.

Manifestaciones músculo-articulares, y no las oleadas de calor, es el síntoma más prevalente en mujeres climatéricas del Caribe colombiano / Joint and muscular discomfort, and not hot flashes, are the most frequent symptoms in middle-age menopause women from the Colombian Caribbean

Objetivo: Evaluar con Menopause Rating Scale la frecuencia y severidad de síntomas menopáusicos presentes en un conjunto global de mujeres saludables en edad media que son originarias y residen en distintas comunidades del Caribe colombiano. Materiales y métodos: Estudio transversal con formulario y escala MRS aplicada entre noviembre de 2006 y enero de 2009 a mujeres saludables entre 40 y 59 años de edad, tomadas de comunidades de la Costa Caribe colombiana: afrodescendientes, indígenas e hispánicas. Se determinó la frecuencia de presentación de los síntomas y su severidad. Resultados: Las molestias músculo-articulares fueron el síntoma más frecuente en un 72.9% de las mujeres, seguido de las oleadas de calor, en un 70.4%. La irritabilidad y el cansancio físico y mental fueron síntomas frecuentes, y se presentaron en más del 60% de las participantes. Las molestias músculo-articulares tienen la mayor puntuación promedio (1,6 +/-1,3), lo cual revela que contribuyen en mayor proporción al deterioro de la calidad de vida. Al considerar la severidad de los síntomas en quienes manifestaron molestias músculo-articulares, los síntomas fueron severos o muy severos en un 29.6%, seguido de los problemas de vejiga, con un 23.2%. Conclusión: Para mejorar la calidad de vida de la mujer en la menopausia es importante caracterizar los síntomas climatéricos en cada población para brindar una mejor atención en salud, descubrir estrategias para el manejo de los síntomas y promover estilos de vida que contribuyan a disminuir su incidencia y severidad.

Objective: Determine the frequency and severity of menopausal symptoms in a set of healthy middle aged women born and living in different communities of the Colombian Caribbean with menopause rating scale (MRS). Materials and Methods: Cross sectional study. Survey form and scale MRS were applied between November 2006 and January 2009 in healthy women between 40 and 59 years old, taken from communities in the Colombian Caribbean: Afro-descents, indigenous and Hispanic. We determined the frequency of symptoms and their severity. Results: Joint and muscular discomfort was the most frequent symptom in 72.9% of women, followed by hot flashes in 70.4%; irritability and physical and mental exhaustion were frequent, occurring in more than 60% of participants. Joint and muscular discomfort had the highest average score (1.6 + / -1.3), revealing that is a major contributor to a poorer quality of life. Considering severity of symptoms, joint and muscular discomfort was expressed as severe or very severe in 29.6%, followed by bladder problems in 23.2%. Conclusion: To improve the quality of life for women in menopause is important to characterize the climacteric symptoms in each population to provide better health care, discover strategies for managing symptoms, and promote lifestyles that help reduce its incidence and severity.