Exacerbated Activation of the NLRP3 Inflammasome in the Placentas from Women Who Developed Chronic Venous Disease during Pregnancy.

Chronic venous disease (CVD) comprises a spectrum of morphofunctional disorders affecting the venous system, affecting approximately 1 in 3 women during gestation. Emerging evidence highlights diverse maternofetal implications stemming from CVD, particularly impacting the placenta. While systemic inflammation has been associated with pregnancy-related CVD, preliminary findings suggest a potential link between this condition and exacerbated inflammation in the placental tissue. Inflammasomes are major orchestrators of immune responses and inflammation in different organs and systems. Notwithstanding the relevance of inflammasomes, specifically the NLRP3 (nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3)- which has been demonstrated in the placentas of women with different obstetric complications, the precise involvement of this component in the placentas of women with CVD remains to be explored. This study employs immunohistochemistry and real-time PCR (RT-qPCR) to examine the gene and protein expression of key components in both canonical and non-canonical pathways of the NLRP3 inflammasome (NLRP3, ASC-apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain-caspase 1, caspase 5, caspase 8, and interleukin 1ß) within the placental tissue of women affected by CVD. Our findings reveal a substantial upregulation of these components in CVD-affected placentas, indicating a potential pathophysiological role of the NLRP3 inflammasome in the development of this condition. Subsequent investigations should focus on assessing translational interventions addressing this dysregulation in affected patient populations.

Placentas from Women with Late-Onset Preeclampsia Exhibit Increased Expression of the NLRP3 Inflammasome Machinery.

Pre-eclampsia is a harmful and potentially lethal medical condition during pregnancy clinically diagnosed by hypertension and commonly accompanied by proteinuria and multiorgan affections. According to the time of diagnosis, it is differentiated between early-onset (EO-PE) and late-onset preeclampsia (LO-PE). Despite being less dangerous and presenting distinct pathophysiological signatures, LO-PE has a greater prevalence than EO-PE, both having significant consequences on the placenta. Previous works have evidenced that exacerbated inflammation in this organ might play a potential pathogenic role in the development of pre-eclampsia, and there is some preliminary evidence that the hyperactivation of inflammasomes can be related to the altered immunoinflammatory responses observed in the placentas of these patients. However, the precise role of inflammasomes in the placentas of women with LO-PE remains to be fully understood. In this work, we have studied the gene and protein expression of the main components related to the canonical and non-canonical pathways of the inflammasome NLRP3 (NLRP3, ASC, caspase 1, caspase 5, caspase 8, interleukin 1ß, and interleukin 18) in the placental tissue of women with LO-PE. Our results show a marked increase in all these components in the placentas of women who have undergone LO-PE, suggesting that NLRP3 inflammasome plays a potentially pathophysiological role in the development of this entity. Future works should aim to evaluate possible translational approaches to this dysregulation in these patients.

Vulvovaginal atrophy in the CRETA study: the healthcare professionals' perception.

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.

Impact of vulvovaginal atrophy therapies on postmenopausal women's quality of life in the CRETA study measured by the Cervantes scale.

OBJECTIVE: To assess the correlation of different vulvovaginal atrophy therapeutic options with the quality of life of postmenopausal women. STUDY DESIGN: The CRETA study is a descriptive, observational, cross-sectional, multicenter study designed to measure, besides treatment satisfaction and adherence, the quality of life of postmenopausal women diagnosed with vulvovaginal atrophy in 29 hospitals and centers across Spain. MAIN OUTCOME MEASURES: The study enrolled postmenopausal women currently receiving treatment with vaginal moisturizers, local estrogen therapy or ospemifene. Clinical features and treatment perceptions were collected by self-report questionnaire and quality of life was evaluated using the Cervantes scale. RESULTS: Among the 752 women included, the ospemifene cohort showed a statistically significant lower global score (44.9 ± 21.7) on the Cervantes scale (and therefore, a better quality of life) than the cohorts treated with moisturizers (52.5 ± 21.6, p = 0.003) or local estrogen therapy (49.2 ± 23.8, p = 0.0473). In the analysis by domains, ospemifene-treated women showed statistically significant better scores in menopause & health and psychological status than moisturizers-treated women (p < 0.05). In the domains of sexuality and couple relations, the score for the quality of life of the ospemifene cohort was statistically significantly better than the scores in either of the cohorts treated with moisturizers (p < 0.001) or local estrogen therapy (p < 0.05). CONCLUSIONS: Postmenopausal women diagnosed with vulvovaginal atrophy and treated with ospemifene have better quality of life than women treated with vaginal moisturizers or local estrogen therapy. The improvement observed with ospemifene is more remarkable in those aspects related to sex life and couple relations. CLINCIALTRIALS. GOV NUMBER: NCT04607707.

Is pH a vaginal health marker? Phemale Study.

BACKGROUND: Epidemiological data regarding vaginal pH in Spain are scarce. An epidemiological study was therefore undertaken to confirm the physiological pattern of vaginal pH in Spanish women. The primary outcome measure was vaginal pH. Secondary outcomes included the relationship between vaginal pH and BMI, physical activity, working status, contraceptive use, sexual intercourse in the two days prior to the visit and clinical vaginal symptoms. METHODS: Cross-sectional study in which 2136 healthy women over 18 years of age who requested a check-up were recruited. Vaginal pH was determined using specific for pH testing. Results were compared using Spearman's correlation test and ANOVA. RESULTS: The mean vaginal pH observed in the different age groups was 4.82 in women aged under 30, 5.10 in those aged between 30 and 35, 5.11 in those aged 36 to 40, and 6.48 in those aged over 55. No association was found between vaginal pH and BMI or sexual intercourse in the two previous days. Lower vaginal pH values were observed in women with some degree of physical activity and in contraceptive users, with higher vaginal pH values observed in women who presented clinical symptoms (P<0.01). CONCLUSIONS: This study confirms the physiological patterns of vaginal pH changes in Spanish women. Any degree of physical activity and the use of contraceptives were associated with lower pH values. The presence of vulvo-vaginal symptoms was related with higher vaginal pH values. Vaginal pH is a marker of vaginal health.

Análisis de la discapacidad en el paciente crónico mediante la herramienta WHODAS II / Analysis of disability in chronic patients, using the WHODAS II tool

La Dependencia Funcional se define como la pérdida de autonomía física, psíquica o intelectual a causa de procesos relacionados con la salud del individuo. La discapacidades un atributo inseparable de la dependencia, pero no recíproco. La dependencia funcional es el resultado de una discapacidad, pero no todos los discapacitados tienen dependencia funcional puesto que no precisan ayuda de terceros. El objetivo del estudio es valorarla discapacidad y dependencia funcional y comparar los resultados obtenidos mediante el Índice de Barthel, con los obtenidos según el World Health Organization Disability Schedule versión 2 y relacionarlos con una variable predictora de dependencia funcional como el Índice de Comorbilidad de Charlson modificado por edad para evaluar la congruencia de ambas medidas. Material y método: Estudio epidemiológico de corte trasversal. Resultados: Analizando conjuntamente los valores de Índicede Barthel y World Health Organization Disability Schedule versión 2 con el Índice de Comorbilidad deCharlson modificado por edad obtuvimos que si bien ambas correlacionan significativamente con la comorbilidad (p<0,05), parece que la dependencia funcional lo hace con mayor fuerza que la discapacidad. Conclusiones: La medida de la discapacidad y su adscripción y tabulación en una clasificación como la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud nos permite identificar de forma precoz áreas de discapacidad física, psíquica o relacional que en un futuro pudieran abocarse a dependencia funcional (AU)

Functional dependency is defined as the loss of physical, mental or intellectual autonomy due to health related factors. Disability is an inseparable but not reciprocal attribute of dependency. Functional dependency is therefore a consequence of a disability but not all persons with disabilities are functionally dependents as they may not require any help from others. The objective of the study is to evaluate disability and functional dependency comparing the scores obtained using the Barthel Index and the World Health Organization Disability Assessment Schedule version 2 and relate these scores to the age adjusted - functional dependency predictor Charlson Comorbidity Index to assess the consistency of all these methods. Material and method: Cross - sectional epidemiological study. Result: Significant comorbidity correlation (p<0,05) between the Barthel Index and the World Health Organization Disability Assessment Schedule version 2 scores and the age adjusted Charlson Comorbidity Index was found by analyzing together all the values but functional dependency correlation seems to be stronger than disability’s. Conclusions: The evaluation of disability and its ascription and tabulation in the frame of a classification such as the International Functionality, Disability and Health Classification allow us to early identify physical, mental or relational disability areas that may evolve to a functional dependency (AU)

Relationship between psychological complaints and vasomotor symptoms during climacteric.

BACKGROUND: It has been suggested that hormonal changes and environmental alterations during the climacteric period are important in the development of psychological symptoms. OBJECTIVE: To evaluate the role of biological and psycho-social factors in the prevalence of climacteric symptoms. DESIGN: Open, cross-sectional, observational and descriptive study. MATERIAL AND METHODS: A total of 300 women between 40 and 59 years of age were evaluated using Greene scale for climacteric symptoms, Cooper questionnaire for psychosomatic symptoms of stress, Smilkstein family apgar for family dysfunction, Duke-UNC questionnaire for social support and Israel scale for vital events. All these tests have been previously validated in Spanish. RESULTS: Postmenopausal women do not have higher prevalence of psychological symptoms, they only have more vasomotor symptoms. Premenopausal women with vasomotor symptoms have more psychological and somatic symptoms and stress, independently of the vital events, family dysfunction or poor social support. Vasomotor symptoms in the premenopause are associated with increased risk of anxiety (OR: 3.7, IC: 1.4-9.7; P<0.008), depression (OR: 8.1, IC: 2.5-26.4; P<0.0005), somatic symptoms (OR: 14.9, IC: 3.4-65.3; P<0.0003), sexual dysfunction (OR: 7.2, IC: 2.5-20.6; P<0.0002) and stress (OR: 7.5, IC: 3.5-15.9; P<0.0001). Negative vital events and family dysfunction increase in minor intensity the risk of anxiety, depression and stress. CONCLUSION: In conclusion, psychological symptoms are frequent in the premenopause and are associated to vasomotor symptoms. This observation links psychological symptoms with menopausal transition and might suggest an organic base in their origin. The negative psycho-social environment is a factor that favours the development of these symptoms.

Influence of psycho-social factors on climacteric symptoms.

BACKGROUND: It has been suggested that psycho-social factors may be crucial in the development of climacteric symptoms. MATERIAL AND METHODS: In order to evaluate the effect of psycho-social and biological factors on menopausal symptoms, Greene (climacterical symptoms), Cooper (psychosomatic symptoms of stress), Smilkstein (family dysfunction), Duke-UNC (social support) and Israel (life events) tests were passed to 300 Chilean women between 40 and 59 years of age. Data were evaluated with ANOVA, chi2 and logistic regression using the Epi-info package. RESULTS: Perimenopausal women had a significant increase in stress and climacteric symptoms; however comparing with pre and postmenopausal women, tests for life events, family dysfunction or social support did not show any differences. A history of premenstrual syndrome was the main risk predictor f or climacteric symptoms (OR: 3.6, IC: 1.5-8.5; P < 0.03 ), followed by perimenopausal state (OR: 2.9, IC: 1.4-6.0; P < 0.001 ) and negative life events (OR: 2.3, IC: 1.0-5.3; P < 0.05 ). The psycho-social factors were predictors for anxiety and depression; on the other hand, perimenopausal state was a risk factor for somatic and vasomotor symptoms. During premenopause, women with regular cycles and vasomotor symptoms have more psychological symptoms and stress. CONCLUSION: Climacteric symptoms that appear in the perimenopause are more intense in those women who have a biological predisposition such as premenstrual syndrome and are modulated by psycho-social factors.

Influences of hormone replacement therapy on postmenopausal women's health perceptions.

OBJECTIVE: To assess the beliefs of climacteric women regarding their health, menopause, and hormone replacement therapy (HRT). DESIGN: Medical students asked to interview 526 healthy women, ranging from 40 to 64 years of age, between January and February of 2002. Of that number, 26 (4.9%) declined to participate in the interview. Thus, 500 women were interviewed about their beliefs and perceptions regarding their quality of life and health risks, as well as their opinions on menopause and HRT. RESULTS: The mean age of the sample was 53.3 +/- 6.2 years; 83.4% were postmenopausal, and 18.8% were HRT users. Of the women interviewed, 38.6% believed that their health was good. Although 78.8% thought that cancer is the main cause of death, 64% of them considered themselves to be at high risk for cardiovascular disease and osteoporosis. Most (64%) believed that menopause deteriorates the quality of life and that it increases cardiovascular risk (52.4%) and osteoporosis (72.0%). The HRT users perceived that they had better health status (48.9% v 36.2%, P < 0.02) and smaller cardiovascular risk (54.3% v 66.3%, P < 0.04) than did the nonusers; however, they ignored the preventive effect of estrogens in osteoporosis. CONCLUSIONS: Women believe that menopause deteriorates their health. The HRT users perceived themselves to be healthier and to have a smaller risk for cardiovascular disease.