SARS-CoV-2 S protein activates NLRP3 inflammasome and deregulates coagulation factors in endothelial and immune cells.

BACKGROUND: Hyperinflammation, hypercoagulation and endothelial injury are major findings in acute and post-COVID-19. The SARS-CoV-2 S protein has been detected as an isolated element in human tissues reservoirs and is the main product of mRNA COVID-19 vaccines. We investigated whether the S protein alone triggers pro-inflammatory and pro-coagulant responses in primary cultures of two cell types deeply affected by SARS-CoV-2, such are monocytes and endothelial cells. METHODS: In human umbilical vein endothelial cells (HUVEC) and monocytes, the components of NF-κB and the NLRP3 inflammasome system, as well as coagulation regulators, were assessed by qRT-PCR, Western blot, flow cytometry, or indirect immunofluorescence. RESULTS: S protein activated NF-κB, promoted pro-inflammatory cytokines release, and triggered the priming and activation of the NLRP3 inflammasome system resulting in mature IL-1ß formation in both cell types. This was paralleled by enhanced production of coagulation factors such as von Willebrand factor (vWF), factor VIII or tissue factor, that was mediated, at least in part, by IL-1ß. Additionally, S protein failed to enhance ADAMTS-13 levels to counteract the pro-coagulant activity of vWF multimers. Monocytes and HUVEC barely expressed angiotensin-converting enzyme-2. Pharmacological approaches and gene silencing showed that TLR4 receptors mediated the effects of S protein in monocytes, but not in HUVEC. CONCLUSION: S protein behaves both as a pro-inflammatory and pro-coagulant stimulus in human monocytes and endothelial cells. Interfering with the receptors or signaling pathways evoked by the S protein may help preventing immune and vascular complications driven by such an isolated viral element. Video Abstract.

Evaluation of Fetal Lung Maturity by Quantitative Analysis (quantusFLM) in Women with Gestational Diabetes Mellitus.

OBJECTIVES: The aim of the present study was to evaluate fetal lung maturity using the noninvasive method of quantitative ultrasound analysis of fetal lung texture (quantusFLM) in women with gestational diabetes mellitus (GDM). METHODS: A total of 96 women at 36-38 weeks of gestation were enrolled. They were classified as follows: 33 GDM cases treated with diet, 30 GDM cases treated with diet plus insulin, and 33 normoglycemic women (control group). A quantitative analysis of lung texture was performed. RESULTS: There were significant differences in the lung maturity results among groups (p = 0.004). These differences were established between the insulin-treated group of patients and both the control (p = 0.006) and diet-only (p = 0.003) groups. While none of the women in the control group or in the diet group had a high risk of immaturity, 16.7% of those treated with insulin (5/30) did (p = 0.003). There was no statistically significant correlation between HbA1c and the result of the test. CONCLUSIONS: Quantitative ultrasound study of fetal lung texture suggests that a significant percentage of pregnant women with GDM treated with insulin had fetal lung immaturity in the late preterm to early term.

Intrapartum synthetic oxytocin reduce the expression of primitive reflexes associated with breastfeeding.

AIM: Several synthetic peptide manipulations during the time surrounding birth can alter the specific neurohormonal status in the newborn brain. This study is aimed at assessing whether intrapartum oxytocin administration has any effect on primitive neonatal reflexes and determining whether such an effect is dose-dependent. MATERIALS AND METHODS: A cohort prospective study was conducted at a tertiary hospital. Mother-infant dyads who received intrapartum oxytocin (n=53) were compared with mother-infant dyads who did not receive intrapartum oxytocin (n=45). Primitive neonatal reflexes (endogenous, antigravity, motor, and rhythmic reflexes) were quantified by analyzing videotaped breastfeeding sessions in a biological nurturing position. Two observers blind to the group assignment and the oxytocin dose analyzed the videotapes and assesed the newborn's state of consciousness according to the Brazelton scale. RESULTS: The release of all rhythmic reflexes (p=0.01), the antigravity reflex (p=0.04), and total primitive neonatal reflexes (p=0.02) in the group exposed to oxytocin was lower than in the group not exposed to oxytocin. No correlations were observed between the dose of oxytocin administered and the percentage of primitive neonatal reflexes released (r=0.03; p=0.82). CONCLUSIONS: Intrapartum oxytocin administration might inhibit the expression of several primitive neonatal reflexes associated with breastfeeding. This correlation does not seem to be dose-dependent.

Newborn feeding behaviour depressed by intrapartum oxytocin: a pilot study.

AIM: To investigate the effect intrapartum oxytocin administration can have on Primitive Neonatal Reflexes. The secondary objective was to observe the influence of intrapartum oxytocin may have on breastfeeding. METHODS: Twenty healthy primiparae with a single gestation at term were included. To assess Primitive Neonatal Reflexes, video film was taken during an experimental situation designed to elicit Primitive Neonatal Reflexes. Three independent observers blinded to the oxytocin dose that had been administered coded the Primitive Neonatal Reflexes. Data regarding breastfeeding were collected by telephone at 3 months. RESULTS: Medium oxytocin dose was 1931.9 ± 1754.4 mUI. A Kappa index >0.75 was obtained for four Primitive Neonatal Reflexes: swallow, jaw jerk, suck and gazing. A negative association was found between oxytocin dose and sucking (p = 0.03). At 3 months of life, women exclusively breastfeeding (63.1%) had received a significantly lower average dose of oxytocin than those not exclusively breastfeeding (36.8%) (p = 0.04). CONCLUSION: In this pilot study, intrapartum exogenous oxytocin seems to disturb sucking and breastfeeding duration. Further studies are required to confirm these results and to ascertain whether there could be other effects of intrapartum oxytocin on newborn behaviour.

Oxytocin and autism: a hypothesis to research. Can perinatal oxitocinergic manipulation facilitate autism?

The study of the neurohormonal and behavioral processes and neural mechanisms involved in the development of attachment between the infant and the mother has received increased attention over the last years. Oxytocin has been shown to play a central role in the regulation of affiliate social behavior, including sexual behavior, mother infant bonding and social memory and recognition. Following normal physiological vaginal birth highest levels plasmatic endogenous oxytocin are achieved, which has been related to the presence of a sensitive period which seems to facilitate bonding and initial mother and newborn attachment. Perinatal manipulation of peptidic hormones like oxytocin can have life long lasting effects on social and sexual behaviors in animal models. Disregulation of oxytocinergic system has been observed in individuals with autistic disorders. A review of the possible effects of oxytocinergic perinatal manipulation in human newborns is discussed in the present review article. The hypothesis of the possible effect of perinatal oxytocin manipulation on the ethiology of autism is discussed.

Hipopotasemia / Hypokalemia

La hipopotasemia es una alteración hidroelectrolítica que puede deberse a múltiples causas. Presentamos el caso de un varón de 21 años que consulta por crisis convulsiva generalizada (AU)

Hypokalemia is a electrolyte disordered that can be due to multiple causes. We displayed the case of a man of 21 years who consults by generalized convulsive seizures (AU)

Cesarea electiva en la presentacion podalica. Impacto en un hospital del Servicio Madrileno de Salud / Elective cesarean section for breech presentation. Impact in a public tertiary hospital in Madrid

Objetivo: Evaluar el impacto que ha supuesto la adopción del nuevo protocolo de la SEGO sobre la asistencia al parto en presentación podálica en un hospital de nivel III perteneciente a la Red Pública de la Comunidad de Madrid (Fundación Hospital Alcorcón). Sujetos y métodos: Se incluyó en el estudio a un total de 197 gestantes con feto único a término en presentación podálica, atendidas en nuestro servicio desde septiembre de 1999 hasta noviembre de 2003. Fueron divididas en 2 grupos, según pertenecieran al período anterior o posterior a la instauración del nuevo protocolo (104 y 93, respectivamente). Se explotaron los datos recogidos en los formularios de las historias clínicas electrónicas de las pacientes y se realizó el análisis estadístico con el programa SPSS. Resultados: En el análisis de las variables maternas y perinatales sólo se encontraron diferencias estadísticamente significativas en las semanas de gestación (39,27 semanas en el primero y de 38,73 en el segundo; U de Mann-Whitney, 3.285; p < 0,0001), el tiempo de estancia media en el hospital (en el primer grupo fue de 2,8 días frente a 3,17 días del segundo [U de Mann-Whitney = 3.908; p = 0,029] y color del LA (X2 = 9.919; p = 0,002). Conclusiones: La realización de cesárea electiva a todas las gestaciones con feto único a término en presentación podálica no ha supuesto hasta el momento una mejoría en nuestros resultados de morbilidad materna y fetal

Objective: To evaluate the impact of the new breech delivery protocol of the Spanish Society of Obstetrics and Gynecology in a tertiary public hospital (Fundación Hospital Alcorcón, Madrid, Spain). Subjects and methods: One hundred ninety-seven pregnant women with full-term single-breech presentation attending our hospital between September 1999 and November 2003 were included in this study. The women were divided into two groups: 104 women (group 1) who gave birth before the introduction of the new protocol and 93 women (group 2) who delivered after the introduction of this protocol. The data available in patients' electronic records were processed using the SPSS statistical package. Results: Comparison of variables in the two groups only revealed significant differences in weeks of pregnancy at delivery (39.27 in group 1 versus 38.73 in group 2; Mann-Whitney U test: 3285; p < 0.0001), mean length of hospital stay (2.80 days in group 1 versus 3.17 in group 2; Mann-Whitney U test: 3908; p = 0.029), and color of amniotic fluid (X2: 9.919; p = 0.002). Conclusions: In our hospital, performing elective cesarean section in all full-term pregnant women with single-breech presentation has not improved maternal and fetal morbidity to date

Sexualidad en nuestros ancianos / Sexuality in our elderly

Objetivo. Conocer las características y el interés de la sexualidad en nuestros ancianos.Diseño. Estudio descriptivo transversal.Emplazamiento. Atención primaria. Centros de salud urbanos en el Área Sanitaria de Albacete.Participantes. Se seleccionó, mediante muestreo aleatorio simple, una muestra de 111 sujetosmayores o menores de 65 años con Índice de Katz A o B y puntuación en el test de Pfeiffer de 0 a 2.Mediciones principales. Mediante entrevista personal concertada se obtuvieron: datos sociodemográficos, valoración geriátrica (índice de Katz y test de Pfeiffer) y respuestas a un cuestionario sobre actividad sexual e interés en ella.Resultados. Edad media de 74 años (IC 95% 73,4–75,7), siendo el 59,5% mujeres. Vivía en pareja el 64,8% (casados el 69,4%). Manifestó interés por la vida sexual un 43,2%, con un claro predominio por parte de los hombres (p<0,001). La relación más practicada era el coito vaginal con un 43,2%, presentando la frecuencia en las relaciones una amplia variabilidad: desde másde una vez por semana (30,9%) a por lo menos una vez al año (27,3%). El 67,5% reconoció presentar algún tipo de disfunción sexual, siendo la más frecuente en hombresla disfunción eréctil (55,6%). Sólo uno presentaba dos tipos de disfunción (retardo en la eyaculacióny falta de libido). En las mujeres la más frecuente fue la disminución de la lubricación vaginal (53,3%). El motivo más frecuente de no practicar relaciones sexuales fue el carecer de pareja (48,3%).Conclusiones. A pesar de presentar una edad avanzada, en los encuestados persiste el interéspor la actividad sexual, sobre todo en varones. Así mismo, existe un importante número de disfunciones sexuales que en la mayoría de casos no son consultadas, por lo que debemos tomar la iniciativa en atención primaria y manifestar interés por la sexualidad de nuestros ancianos

Objective. To know the characteristics and sexual interests of our elderly population.Design. Cross-sectional descriptive study.Location. Primary care. A basis area of urban health in Albacete.Participants. Simple, random selection of a sample of 111 subjects aged 65 or more, with Katz ofA or B and scoring from 0 to 2 in the Pfeiffer test.Main measurements. By means of arranged personal interview, sociodemographic data were collected, geriatrical appraisal (Katz index and test of Pfeiffer) and survey on sexual interests and activity.Results. Average age of 74 years (IC 95% 73,4-75,7), being 59,5% women. 64,8% living as a couple and 69,4% being married. A 43,2% showed interest in sexual life with a clear predominance on the part of men (p<0,001). The most practiced relation was the vaginal intercourse with an 43,2%. The frequency in the relations presented a wide distribution: from more of once a week(30,9%), to at least once a year (27,3%). 67,5% recognized to present some kind of sexual dysfunction, being the most frequent the erectile dysfunction in men (55,6%). Only one presented two types of dysfunctions (retarded ejaculation and lack of libido). The most frequent dysfunction among women was a decrease of vaginal lubrication (53,3%). The most frequent reason for not having sexual relations was the lack ofcouple (48,3%).Conclusions. In spite of their age, almost all the interviewed showed interest in sexual activity,above all, male ones. There is also a high number of dysfunctions which have never been consultedwith a doctor, so we must take the initiative in the Primary Care Service and show interest aboutour elderly population’s sexual life