Parir después de los 50 años. Estudio piloto observacional / Birth over 50: A pilot observational study

Objetivos: Evaluar si existe una mayor tasa de resultados obstétricos adversos, incontinencia urinaria posparto y problemas sexuales entre las mujeres que dan a luz después de los 50 años.Material y métodos: Estudio observacional ambispectivo de un solo centro. Se registraron la tasa de parto por cesárea, la diabetes gestacional, la preeclampsia, la restricción del crecimiento intrauterino (RCIU), la prematuridad, la incontinencia urinaria (Cuestionario de incontinencia en formato corto [ICIQ-SF]) y la disfunción sexual (índice de función sexual femenina [FSFI-6]). Resultados: Veinticinco (0,06%) de 38.510 nacimientos ocurrieron en mujeres mayores de 50 años durante el período de estudio en nuestro centro. Hubo 16 (64%) partos por cesárea. Siete (28%) mujeres padecieron diabetes gestacional. Se diagnosticó preeclampsia en 3 (12%) mujeres. Hubo 5 (20%) casos de RCIU. Hubo 5 (20%) partos prematuros. Las diferencias en la tasa de parto por cesárea, diabetes gestacional y RCIU entre el grupo de estudio y la población total fueron estadísticamente significativas. Los resultados de los cuestionarios ICIQ-SF y FSFI-6 se obtuvieron de 17 mujeres. Se encontró algún grado de incontinencia urinaria en 7 (41,1%) y disfunción sexual en 9 (52,9%) mujeres. Conclusiones: Los embarazos en mujeres mayores de 50 años parecen estar asociados con una mayor tasa de diabetes gestacional, RCIU y preeclampsia. Hay una alta prevalencia de incontinencia urinaria y problemas sexuales entre estas mujeres.(AU)

Objectives: To assess whether there is a higher rate of adverse obstetric outcomes, postpartum urinary incontinence, and sexual problems among women who give birth over 50. Material and methods: A single-center ambispective observational study. Rate of cesarean birth, gestational diabetes, preeclampsia, intrauterine growth restriction (IUGR), prematurity, urinary incontinence (Incontinence Questionnaire Short Form [ICIQ-SF]), and sexual dysfunction (Female Sexual Function Index [FSFI-6]) were recorded. Results: Twenty-five (0.06%) of 38,510 births occurred in women over 50 during the study period. There were 16 (64%) cesarean births. Seven (28%) women had gestational diabetes. Preeclampsia was diagnosed in 3 (12%) women. There were 5 (20%) cases of IUGR. There were 5 (20%) preterm births. The differences in the rate of cesarean birth, gestational diabetes, and IUGR between the study group and the total population were statistically significant. The results of the ICIQ-SF and FSFI-6 questionnaires were obtained from 17 women. Some degree of urinary incontinence was found in 7 (41.1%) and sexual dysfunction in 9 (52.9%) women. Conclusions: Pregnancies in women over 50 may be associated with a higher rate of gestational diabetes, IUGR, and preeclampsia. There is a high prevalence of urinary incontinence and sexual problems among these women.(AU)

Effects of oral iodine supplementation in very low birth weight preterm infants for the prevention of thyroid function alterations during the neonatal period: results of a randomised assessor-blinded pilot trial and neurodevelopmental outcomes at 24 months.

The trace element iodine (I) is essential for the synthesis of thyroid hormones. Parenteral nutrition solutions, formula milk, and human breast milk contain insufficient iodine to meet recommended intake for preterm infants. Iodine deficiency may affect thyroid function and may be associated with morbidity or neurological outcomes. The primary objective is to assess the evidence that dietary supplementation with iodine affects thyroid function during the neonatal period. The design was a randomised controlled pilot trial. Infants who met the inclusion criteria were enrolled through consecutive sampling and assigned to two different groups. The setting was a Spanish university hospital. Ninety-four patients with very low birth weight (under 1500 g) were included. Intervention group: 30 µg I/kg/day of iodine in oral drops given to 47 infants from their first day of life until hospital discharge. Control group: 47 infants without supplements. Formula and maternal milk samples for the determination of iodine content were collected at 1, 7, 15, 21, 30 days, and at discharge. Blood samples were collected for thyroid hormones. Neurological development was assessed at 2 years of age (Bayley III Test). Infants in the supplemented group reached the recommended levels from the first days of life. The researchers detected the effects of iodine balance on the plasma levels of thyroid hormones measured during the first 12 weeks of age. The trial assessed the impact of the intervention on neurodevelopmental morbidity.Conclusion: Thyroid function is related to iodine intake in preterm infants. Therefore, supplements should be added if iodine intake is found to be inadequate. The analyses found no effects of iodine supplementation on the composite scores for Bayley-III assessments in all major domains. The study results indicate potentially important effects on language development related to low iodine excretion during the first 4 weeks of life What is Known: • Thyroid function is related to iodine intake in preterm infants. • Preterm babies on formula preparations and with exclusive parenteral nutrition are at high risk of iodine deficiency. What is New: • Iodine intake should be monitored during the neonatal period. • Iodine supplements should be added if iodine intake is found to be inadequate.

Laringe canina y humana: un estudio para establecer homología / Laringe canina e humana: um estudo para estabelecer homologia / Canine and human larynx: a study to establish homologies

En este trabajo se describen las características anatómicas de la laringe canina y humana, con el objeto de encontrar rasgos relevantes que permitan hacer una homologación entre ambas especies. Se trabajó con cuatro laringes caninas y cinco humanas. Nuestros resultados muestran similitudes y diferencias en líneas generales y semejanzas entre las estructuras asociadas a los cartílagos tiroides y aritenoides. La articulación cricotirohidea y cricoaritenoídea son muy parecidas entre ambas especies. Una situación similar se observa en la musculatura intrínseca y extrínseca. Las diferencias más notables corresponden al tipo de articulación que se establece en el perro entre los cartílagos aritenoides, corniculados y cuneiformes que es una sincondrosis. Nuestros hallazgos permiten apoyar el hecho de que la laringe del perro puede ser usada con fines experimentales para resolver problemas animales y humanos.

Neste trabalho se descrevem as características anatômicas das lanringes do cão e do homem, com o objetivo de encontrar características relevantes que permitam fazer uma comparação entre ambas espécies. Trabalhou-se com quatro laringes caninas e cinco humanas. Os resultados mostram semelhanças e diferenças em linhas gerais e semelhanças entre as estruturas associadas às cartilagens tiróides e aritenóides. A articulação cricotiroidea e cricoaritenoidea são muito parecidasem ambas espécies. Uma situação similar se observa na musculatura intrínseca e extrínseca. As diferenças mais notáveis correspondem ao tipo de articulação que se estabelece no cão entre as cartilagens aritenóides, corniculados e cuneiformes que é uma sincondrose. As descobertas permitem apoiar o fato de que a laringe do cão pode ser usada com fi ns experimentais para resolver problemas animais e humanos.

In this paper the anatomical characteristics of canine and human larynx are described, with the purpose to detect relevant features that allows to fi nd homologies in both species. Four canine and fi ve human larynges were employed. The results shown resemblances and differences between the structures associated to general aspects but resemblance at level of thyroid and arytenoid cartilages. The cricothyroid and cricoarytenoid articulation are very similar in both species. A similar situation is observed in the intrinsic and extrinsic muscles. The most outstanding differences correspond with the articulation type, which is established between arytenoid, corniculate and cuneiform cartilages which corresponds to a synchondrosis in the dog. Findings probably allow to use the dog larynx be used with experimental purpose in order to solve surgical problems in animal and human beings.

Dolor pélvico crónico: enfoque multidisciplinario / Chronic pelvic pain: a multidiscipli nary approach

El dolor pélvico crónico supone para el médico general o el especialista un duro reto. Esto se explica por la complejidad de las estructuras englobadas en esta región anatómica, por su rica inervación, con componentes viscerales, simpáticos y parasimpáticos y por la multitud de cuadros sintomáticos que engloba esta definición. A todo ello, hay que añadir el importante papel que los aspectos psicológicos y sociales pueden llegar a jugar en el desarrollo y perpetuación de un dolor de estas características.Nos vamos a encontrar, por tanto, frente a un paciente que frecuentemente ha visitado varios especialistas y re a l izado múltiples pruebas diagnósticas sin obtener resultados satisfactorios. Dada la complejidad de estos cuadros, los pacientes con dolor pélvico crónico deben ser evaluados desde un enfoque multidisciplinar, incluyendo en la anamnesis una valoración de su entorno familiar y psicosocial. La actitud terapéutica debe estar basada en todo lo anterior, empleando todos los recursos farmacológicos y psicológicos disponibles y reservando la cirugía, en la que la laparoscopia está alcanzando un papel cada vez más protagonista, como opción última, dado que los resultados de ésta son inciertos en este grupo tan dishomogéneo de pacientes (AU)

Distribution of acetylcholinesterase and choline acetyltransferase in the main and accessory olfactory bulbs of the hedgehog (Erinaceus europaeus).

The distribution of cholinergic markers was studied in the main olfactory bulb (MOB) and accessory olfactory bulb (AOB) of the western European hedgehog (Erinaceus europaeus) by using choline acetyltransferase (ChAT) immunocytochemistry and acetylcholinesterase (AChE) histochemistry. A dense network of AChE-containing and ChAT-immunoreactive fibers was observed innervating all layers of the MOB except the olfactory nerve layer, where neither AChE- nor ChAT-labeled elements were found. The highest density of AChE- and ChAT-positive axons was found in the glomerular layer (GL)/external plexiform layer (EPL) boundary, and in the internal plexiform layer. This general distribution pattern of ChAT- and AChE-stained axons resembled the distribution pattern found in rodents. Nevertheless, some interspecies differences, such as the lack of atypical glomeruli in the hedgehog, were also found. In addition to fibers, a population of noncholinergic and presumably cholinoceptive AChE-active neurons was observed in the hedgehog. All mitral and tufted cells of the hedgehog MOB showed a dark AChE staining unlike previous observations in the mitral and tufted cells of rodents. As in other species previously reported, subpopulations of external tufted cells and short-axon cells were also AChE-active. Finally, a population of small AChE-containing cells was observed in the EPL of the hedgehog MOB. The size, shape, and location of these cells coincided with those of satellite and perinidal cells, two neuronal types described previously in the EPL of the hedgehog and not present in the rodent MOB. The AOB of the hedgehog showed a distribution of AChE- and ChAT-positive fibers similar to the rodent AOB. Nevertheless, a heterogeneous innervation of vomeronasal glomeruli by bundles of AChE- and ChAT-labeled axons found in the hedgehog has not been previously found in any other species. As in the MOB, all mitral cells in the AOB showed a strong AChE activity. These results demonstrate some similarities but also important differences between the distribution of ChAT and AChE in the MOB and AOB of rodents and this primitive mammalian. These variations may indicate a different organization of the cholinergic modulation of the olfactory information in the insectivores.

A population of cholinergic neurons is present in the macaque monkey thalamus.

Three new cholinergic markers were employed to study the cholinergic innervation in the thalamus of adult macaque monkeys. They were: two antibodies against choline acetyltransferase (ChAT), one polyclonal and one monoclonal; and a polyclonal antibody against the vesicular transporter of acetylcholine (VAChT), a powerful new marker that colocalizes with ChAT. This approach led to an unexpected finding: the three antibodies positively immunostained a population of neurons in the paracentral nucleus. The immunostained cells are confined to the dorsal region of this nucleus along its rostrocaudal extent. Measurement of the somatic areas of the immunostained neurons indicated that they correspond to a population of large neurons thought to be projection neurons. Because dorsal paracentral neurons are known to project to the dorsal striatum and specific cortical areas involved in visual and visuomotor mechanisms, these structures might be modulated by cholinergic thalamic neurons.

Adrenergic innervation of the monkey thalamus: an immunohistochemical study.

The distribution and function of the neurotransmitter adrenaline in the primate brain are poorly understood. Biochemical studies have shown the presence of adrenaline or its biosynthetic enzyme, phenylethanolamine-N-methyltransferase, in the rat and human thalamus. However, the distribution of the adrenergic fibres in the thalamus has only been demonstrated in rats. We study the adrenergic innervation of the macaque monkey thalamus using immunohistochemistry against phenyletanolamine-N-methyltransferase. The distribution of phenyletanolamine-N-methyltransferase-immunoreactive fibres is markedly heterogeneous and principally restricted to those nuclei, or their portions, that are located in or close to the midline, with the highest density being found in the paraventricular, parafascicular and mediodorsal nuclei. The paraventricular nucleus is densely innervated by adrenergic axons throughout, while the densest innervation of the parafascicular nucleus is located in its medial part and the strongest mediodorsal nuclear immunolabelling is found in its most posterior and medial region. Moderate or low concentrations of phenyletanolamine-N-methyltransferase-immunopositive fibres are present in the paratenial nucleus, and all parts of the central nucleus, nucleus reuniens, central medial nucleus, centromedian nucleus, medial geniculate body and medial pulvinar nucleus, while only scattered immunoreactive axons are found in other thalamic nuclei. The morphology of the phenyletanolamine-N-methyltransferase-immunoreactive axons is quite diverse, as they have different diameters and most are endowed with diversely-shaped varicosities. These findings are the first morphological evidence for the presence of adrenergic innervation in the primate thalamus and reveal that this innervation is highly selective, heterogeneous and more widely distributed in primates than in rats. The thalamic nuclei innervated by adrenaline are connected to widespread limbic and associative cortical areas as well as to subcortical structures, in particular the neostriatum and amygdala. We hypothesize that thalamic adrenaline may be implicated in emotional, social and attentional mechanisms through its facilitation of co-ordinated action by these brain regions.

Ultrastructural study of the Pacinian corpuscles in the newborn and adult dog forefoot.

Pacinian corpuscles (PC) of the newborn and adult dog forefoot were studied by electron microscopy. The PC of newborn dog forefoot show a rare development: they exhibit a lamellar arrangement, although the lamellar compartments do not surround completely the fiber. The outer core cells show a well-developed perinuclear endoplasmic reticulum. They are surrounded by a discontinuous basal lamina. Mast cells between the lamellae of the outer core are observed. Desmosome-like and zonula adherens junctions, as well as pinocytotic vesicles, are shown in the inner core cells. Intermediate filaments are also observed in the glial cells of the inner core. In PC of adult dog forefoot a general organization of a concentrically arranged capsule, outer core, intermediate layer and inner core around a nerve ending is always present. In the intermediate layer, lamellar cells (specialized fibroblast) do not surround completely the inner core. The inner core lamellae possess numerous pinocytotic vesicles, an extensive network of filaments, special cell junctions (gap, desmosome) and a discontinuous basal lamina. The present results show a conservative structural organization in PC, although differences among species are discussed.

[AIDS and human rights]. / El SIDA y los derechos humanos.

AIDS and human rights are closely related issues. This paper describes the relationship between AIDS and human rights, the impact and consequences of discrimination and the importance of the defense of human rights as a cornerstone strategy in AIDS prevention. Some general ethical aspects are addressed and two dilemmas which have been raised by the epidemic are discussed: the apparent conflict between individual and community rights and the reactions of intolerance and repression from those who claim that only through coercive strategies will the epidemic be brought under control. Specific problems in Mexico are described based on data collected at CONASIDA's Human Rights Department between 1992 and 1994. Finally some conclusions are stated emphasizing that, in the AIDS epidemic, the defense of human rights is the cornerstone of any public health strategy.

PIP: AIDS and human rights are closely related issues. This paper describes the relationship between AIDS and human rights, the impact and consequences of discrimination, and the importance of the defense of human rights as a cornerstone strategy in AIDS prevention. Some general ethical aspects are addressed and two dilemmas which have been raised by the epidemic are discussed: the apparent conflict between individual and community rights and the reactions of intolerance and repression from those who claim that only through coercive strategies will the epidemic be brought under control. Specific problems in Mexico are described based on data collection at CONASIDA's Human Rights Department between 1992 and 1994. Finally, some conclusions are stated emphasizing that, in the AIDS epidemic, the defense of human rights is the cornerstone of any public health strategy. (author's)

[Campaigns against AIDS in Mexico: the sounds of silence or a bridge over troubled waters?]. / Las campañas contra el SIDA en México: los sonidos del silencio o puente sobre aguas turbulentas?

This paper analyzes the mass media campaigns developed by the Mexican Council for AIDS Control and Prevention (CONASIDA) from 1987 to 1994. This paper presents the lessons learned, a discussion of obstacles and mistakes, and the different evaluation methods which have been used in CONASIDA'S mass media communication strategies and their results. Knowing the opinion of some clue informants was considered relevant--taking into account that evaluations were made by and at CONASIDA--and seven in-depth interviews were conducted among intellectuals, non-governmental organizations (NGO) leaders and public opinion leaders. The importance of society's involvement in AIDS prevention is stated, and two examples of mass media campaigns developed by civil groups are commented. A section about the importance of research as a requisite to produce preventive messages is included, along with some examples. Finally, some conclusions are presented, useful to us, as well as others, in developing new educational campaigns.

Study of Fc gamma murine macrophage receptors (Fc gamma R) in the internalization of Histoplasma capsulatum yeasts.

Reports about Fc gamma R involvement in the phagocytosis of Histoplasma capsulatum yeast are contradictory. Fungal cells were incubated with anti-Histoplasma murine IgG or normal IgG as control. The opsonized yeasts were adjusted and spread on a J774.2 macrophage cell line monolayer. Yeast cells were allowed to attach to the monolayers at 4 degrees C for 1 h prior to initiating the internalization step of the phagocytic process, by shifting the cells to 37 degrees C. The participation of Fc gamma R in the internalization of yeast was monitored by radioiodination labelling of the macrophage surface proteins, and rosette-forming cells for erythrocytes coated with antibodies (RFC-EA). Results showed decreased [125I]-incorporation on the macrophage surface proteins at 15 min post-anti-Histoplasma IgG opsonized yeast infection. The same was observed when high and low virulent H. capsulatum strains were used. A decrease of RFC percentage was also observed at 15 min after IgG opsonized yeast phagocytosis. Results support the disappearance of Fc gamma R at 15 min from the surface of the macrophage that had ingested anti-Histoplasma IgG opsonized yeasts. The recovery of [125I]-counts and the RFC response at a longer time of phagocytosis suggest a possible Fc gamma R recycling mechanism.

Synthesis and structural, conformational, and pharmacological study of some of esters derived from 3-phenethyl-3-azabicyclo[3.2.1]octan-8-beta-ol and the corresponding N-endo-methyl quaternary derivatives.

A series of 8-beta-acyloxy-3-phenethyl-3-azabicyclo[3.2.1]octane and its N-endo methiodides were synthesized and studied by 1H and 13C NMR spectroscopy, and the crystal structure of 8-beta-p-chlorobenzoyloxy-3-phenethyl-3-azabicyclo[3.2.1]octane methiodide (2c) was determined by X-ray diffraction. In CDCl3 solution, 1b-1e display the same preferred conformation. The cyclopentane and piperidine rings adopt an envelope conformation flattened at C-8 and a distorted chair conformation puckered at C-8 and flattened at N-3, respectively, with the N-substituent in the equatorial position with respect to the piperidine ring. In all cases, methylation takes place from the endo position. The ability of the title compounds to antagonize the acetylcholine-induced contraction of guinea pig ileum is also reported. An initial structure-activity relationship is proposed.

[Leukocyte phagocytic activity in gerbils with experimental sporotrichosis treated with potassium iodide]. / Estudio de la actividad fagocítica de los leucocitos de gerbiles con esporotricosis experimental tratados con ioduro de potasio.

One effective treatment against sporotrichosis is the oral administration of potassium iodide (KI). It is not known how it works, and also it is not known if this substance has some effect on the microbicidal activity of polymorphonuclear neutrophils (PMN) and macrophages. In this work the phagocytic activity of gerbils treated with KI was studied. Gerbils cured within 62 days of treatment with KI, their PMN and macrophages showed an increased ability for reducing nitroblue-tetrazolium (NBT); myeloperoxidase activity was decreased in PMN. These results were the expected in any chronic infection and demonstrates that KI effectiveness on the experimental sporotrichosis works by an independent mechanism of phagocytosis.

[Evaluation of immune response in experimental sporotrichosis using T and B lymphocyte count]. / Evaluación de la respuesta inmune en la esporotricosis experimental por el cuanteo de linfocitos T y B.

The effector cells of the immune response are involved in the clinical course of bacterial, viral and mycotic infections. Previous publications have reported that some mycotic infections, including sporotrichosis, can produce a negative modulation of the immune response unfavorable for the host. In this work T and B lymphocytes capable to form direct and indirect rosettes respectively with sheep erythrocytes in gerbils with experimental sporotrichosis, were measured. It was found a significant rise in the number to T and B lymphocytes which means normal immunological reactivity. These results are not in accordance with the idea that sporotrichosis can depress the immune response of the host.

Evaluation of phagolysosome fusion in acridine orange stained macrophages infected with Histoplasma capsulatum.

A phagosome-lysosome (PL) fusion was performed in vitro using peritoneal cells from normal BALB/c mice and the J774.2 macrophage cell line infected with the yeast phase of the fungus Histoplasma capsulatum at ratios of 5 x 10(5), 5 x 10(6) or 1 x 10(7) yeasts per 1 x 10(6) macrophages, and phagocytosis was allowed to proceed for 5, 30 and 60 min. Macrophage lysosomes were pre-labelled with acridine orange and the cells were challenged with the parasite. Fusion was evaluated by fluorescence microscopy and the number of macrophages with stained yeast cells was scored. The phagolysosome fusion frequency (PLFF) was calculated by subtracting the specific fusions of infected macrophages from the non-specific fusions of uninfected macrophages and normalizing the total number of bound yeasts. The PLFF was determined using different doses and strains of H. capsulatum. Results showed that PLFF in infected macrophages depends on the infection dose. Inhibition of PL fusion was detected mainly at a high infection ratio (1 x 10(7) yeasts/1 x 10(6) macrophages), and PL fusion varied with phagocytosis time. No significant differences were observed in the fusions when different Histoplasma strains were used. Results with J774.2 cells were similar to peritoneal cells, indicating that both methodology and fusion calculations employed were useful, in spite of the heterogeneity of macrophage populations used.

AIDS in Mexico: trends and projections.

The first case of AIDS in Mexico was reported in 1981. Through mid-1988, 1,502 cases had been reported, the incidence of cases having doubled every 7.7 months. Of the cases in adults, 87.6% were sexually transmitted, transfusion with contaminated blood or blood products accounted for 10.8%, and intravenous drug abuse for 0.3%. In the 56 pediatric AIDS cases reported, transmission through contaminated blood accounted for 67.9%, sexual contact for 5.4%, and perinatal transmission for 19.6%. The disease appears to be spreading from the large cities to peripheral and rural areas, and to be spreading faster among heterosexuals than among homosexual and bisexual males. Projections based on continued exponential doubling at the 1983-1986 rate suggest the cumulative AIDS case total could exceed 75,000 by the end of 1991. More conservative estimates based on an observed lengthening of the doubling time predict as many as 260,000 cases by the end of 1994.