COVID-19: Social Displacement and Glucocorticoid Resistance

This study aims to evaluate the effect or lack thereof, of glucocorticoids on Black, Asian, and Minority ethnic groups (BAME) when compared to white populations in the setting of COVID-19 treatment

11ß-hydroxysteroid dehydrogenase type-II activity is affected by grapefruit juice and intense muscular work

ABSTRACT Objective The enzymatic activity of 11β-hydroxysteroid dehydrogenase-2 (11β-HSD2) is key to protecting mineral corticoid receptors from cortisol and has been implicated in blood pressure regulation. Grapefruit juice (GFJ) and acidity are thought to inhibit this enzyme in vitro. This study examines the effect of GFJ and intense exercise on 11β-HSD2 enzyme activity in vivo. Subjects and methods Eighteen subjects ingested GFJ or apple juice (CON) on separate days prior to reporting to the laboratory in a randomized order. Saliva (Sal) samples were obtained at baseline, 15 and 45 minutes post-treadmill stress test; Sal cortisone (E) and cortisol (F) levels were determined, and the Sal cortisone:cortisol (E:F) ratio was used as an index of 11β-HSD2 enzyme activity at rest and after intense muscular work. Results GFJ treatment decreased baseline 11β-HSD2 enzyme activity (44%) and Sal-E (28%) compared to CON (both, p < 0.05). Sal-E (r = 0.61, p < 0.05) and Sal-F (r = 0.66, p < 0.05) were correlated with diastolic blood pressure (DBP) in GFJ-treated individuals. Treadmill stress significantly increased Sal-E and Sal-F but did not alter 11β-HSD2 enzyme activity regardless of treatment. When treatments were examined separately, CON 11β-HSD2 enzyme activity decreased by 36% (p < 0.05) from baseline to 15 post-treadmill exercise. Conclusion Our findings suggest that GFJ and intense muscular work decrease 11β-HSD-2 activity independently, and no additive effect was noted. The association between DBP and the levels of Sal-F and Sal-E during the GFJ trial should be interpreted cautiously and warrants further investigation.

Hombres violentos contra la pareja: trastornos mentales y perfiles tipológicos

Los objetivos de este artículo teórico son analizar los trastornos mentales y los déficits psicológicos más relevantes de los hombres violentos contra la pareja, así como señalar los distintos tipos de maltratadores existentes según las clasificaciones de Holtzworth-Munroe y Stuart (1994) y deFernández-Montalvo y Echeburúa (1997). Para ello se ha realizado una revisión de múltiples trabajosteóricos y empíricos. Los principales resultados indican que los agresores suelen presentar con frecuencia alteraciones psicológicas –falta de control sobre la ira, dificultades en la expresión de emociones, distorsiones cognitivas, déficits de habilidades de comunicación y de solución de problemasy baja autoestima-, y, en menor medida, cuadros clínicos bien definidos (por ejemplo, alcoholismo, trastornos de la personalidad, celos delirantes). En conclusión, existen diferentes tipos de hombres violentos -agresores limitados al ámbito familiar, agresores con características borderline/disfóricasy agresores violentos en general/antisociales- que requieren programas de tratamiento, adaptados asus características y necesidades específicas. Por último, se comentan las líneas de investigación másurgentes.

The aims of this theoretical paper are to analyze the mental disorders and the most relevant psychological deficits of intimate partner violent men, as well as to identify different types of batterers according to the classifications of Holtzworth-Munroe and Stuart (1994) and of Fernandez-Montalvo and Echeburúa (1997). A review of multiple theoretical and empirical papers has been carried out with this purpose. The main results show that the aggressors usually show psychologicaldeficits –lack of control over anger, difficulty in expressing emotions, cognitive distortions, deficit incommunication skills and problem solving, and low self-esteem-, and, not as often, well-established clinical disorders (eg, alcoholism, personality disorders, delusional jealousy). In conclusion, there are different types of violent men –family only, dysphoric/borderline and generally violent/antisocialwho require treatment programs adapted to their specific characteristics and needs. Finally, the future perspectives and the most relevant goals of research are commented on.

Os objetivos deste artigo teórico são analisar os transtornos mentais e os déficits psicológicos mais relevantes dos homens violentos contra o casal, assim como assinalar os diferentes tipos de agressores existentes segundo as classificações de Holtzworth-Munroe e Stuart (1994) e de Fernández-Montalvoe Echeburúa (1997). Para isso se realizou uma revisão de múltiplos trabalhos teóricos e empoíricos.Os principais resultados indicam que os agressores costumam apresentar com freqüência alterações psicológicas –falta de controle sobre a ira, dificuldades na expressão de emoções, distorções cognitivas, déficits de habilidades de comunicação e de solução de problemas, e baixa auto-estima-, e, em menor medida, quadros clínicos bem definidos (por exemplo, alcoolismo, transtornos da personalidade, ciúmes delirantes). Em conclusão, existem diferentes tipos de homens violentos -agressores limitadosao âmbito familiar, agressores com características “borderline/disfóricas” e agressores violentos em geral/anti-sociais- que requerem programas de tratamento adaptados a suas características e necessidades específicas. Por último, se comentam as linhas de pesquisa mais urgentes.

Translating exercise biology into the Venezuelan medical education and health care system

En la ausencia de agentes farmacológicos, el ejercicio físico fue ampliamente usado por médicos a finales del siglo 19 para tratar numerosas enfermedades. Durante el siglo 20, en la década de los 50`s, la evidencia epidemiológica ya suger¡a una asociación entre la actividad física y la salud, y comenzaba un incremento en el interés en la biología del ejercicio con aplicación clínica. Ya en la década de los 90`s, suficiente investigación fue acumulada indicando el beneficio del ejercicio, en Norteamérica ya asociaciones de medicina, entes gubernamentales y la Organización Mundial de la Salud publicaron guías sobre ejercicio para poblaciones clínicas y público en general. No obstante de esto, los dirigentes de educación médica han permanecido renuentes a incorporar la biología del ejercicio al pénsum médico curricular, o a implementarlo sistématicamente en la educación médica de postgrado. Este manuscrito revisa la trayectoria de la biología del ejercicio en Venezuela y sus aplicaciones médicas. Científicos y clínicos venezolanos han hecho contribuciones en áreas tales como pruebas de evaluación cardiopulmonar, adaptaciones de músculo esquelético al enfrentamiento físico y en farmacología cardiovascular en ejercicio en pacientes, sujetos sedentarios y atletas. Se sugiere que hay la necesidad de desarrollar programas de educación e investigación en biología del ejercicio con el fín de incorporar estos conocimientos en la formación del estudiante de medicina, médicos residentes y profesionales aleados al sistema de salud. Se propone una serie de pasos tentativos para iniciar este proceso.

COVID-19 and ethnicty: Does reduced responsiveness to glucocorticiods explain the more aggressive nature of disease among minorities?

Marked ethnic variations in complications and mortality have been noted following infection with COVID-19, In the United States, the age-adjusted mortality rate among Blacks is 3.8 times, Hispanics 2.5 times, and Asians 1.5 times higher than Whites. In the United Kingdom, the age-adjusted mortality rate among Blacks is 2.9 times, Pakistani and Bangladeshi 2.2 times, and South Indians 1.8 times than that of Whites. One should consider that the increased mortality seen in BAME may be a consequence of impaired glucocorticoid sensitivity stemming from several intrinsic reasons such as chronic social stress and lower circulating levels of Vitamin D. This study aims to evaluate the effect, or lack thereof, of glucocorticoids on Black, Asian and Minority ethnic groups (BAME) when compared to White populations in the setting of COVID-19 treatment.