Herramientas para la evaluación integral de la función sexual en pacientes con esclerosis múltiple / Tools for comprehensive evaluation of sexual function in patients with multiple sclerosis

Introducción: La esclerosis múltiple (EM) es una enfermedad desmielinizante del sistema nervioso central (SNC) que afecta a adultos jóvenes, ocasionando una variedad de síntomas (motores, visuales, control de esfínteres, alteraciones de la marcha) que impactan la funcionalidad del paciente; sin embargo, otros síntomas, como la disfunción sexual (DS), también pueden tener un efecto sobre la calidad de vida.DesarrolloLa DS puede presentarse en cualquier momento del curso de la enfermedad, su prevalencia varía entre 50 y 90%, puede ser secundaria a lesiones desmielinizantes en médula espinal y/o cerebro, ocasionada por síntomas que no incluyen directamente el sistema nervioso —fatiga, aspectos psicológicos, sociales y culturales—. Si bien se ha logrado establecer su prevalencia y su impacto sobre la calidad de vida, la DS todavía es una condición frecuentemente subestimada, razón por la cual en este artículo se revisan las diferentes escalas que ayudan a evaluar la presencia o la severidad de esta para dar un manejo multidisciplinario temprano, según corresponda.ConclusiónCinco cuestionarios han sido evaluados y/o diseñados para pacientes con EM, los cuales podrían identificar la presencia de DS, su etiología y, con esto, determinar posibilidades de tratamiento. La EM debe ser comprendida como una enfermedad compleja que abarca y compromete diferentes aspectos de la salud de los pacientes, y va más allá de solo medir escalas de discapacidad. (AU)

Introduction: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) that affects young adults, causing a variety of symptoms (motor alterations, visual alterations, loss of sphincter control, gait alterations) that impair the patient's functional status. However, other symptoms, such as sexual dysfunction, can also have an effect on quality of life.DevelopmentSexual dysfunction can occur at any time during the course of the disease; its prevalence varies between 50% and 90%, and it can be secondary to demyelinating lesions in the spinal cord and/or brain or caused by symptoms that do not directly involve the nervous system (fatigue; psychological, social, and cultural factors; etc.). Although its prevalence and impact on quality of life are well known, sexual dysfunction is still frequently underestimated. Therefore, in this article we review the different scales for assessing presence or severity of sexual dysfunction, in order to offer early multidisciplinary management.ConclusionWe evaluated 5 questionnaires that could identify the presence of sexual dysfunction in patients with MS and determine its aetiology, assisting in treatment decision making. MS must be understood as a complex disease that encompasses and compromises different aspects of patients’ health, and goes beyond simply measuring disability. (AU)

Tools for comprehensive evaluation of sexual function in patients with multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) that affects young adults, causing a variety of symptoms (motor alterations, visual alterations, loss of sphincter control, gait alterations) that impair the patient's functional status. However, other symptoms, such as sexual dysfunction, can also have an effect on quality of life. DEVELOPMENT: Sexual dysfunction can occur at any time during the course of the disease; its prevalence varies between 50% and 90%, and it can be secondary to demyelinating lesions in the spinal cord and/or brain or caused by symptoms that do not directly involve the nervous system (fatigue; psychological, social, and cultural factors; etc.). Although its prevalence and impact on quality of life are well known, sexual dysfunction is still frequently underestimated. Therefore, in this article we review the different scales for assessing presence or severity of sexual dysfunction, in order to offer early multidisciplinary management. CONCLUSION: We evaluated 5 questionnaires that could identify the presence of sexual dysfunction in patients with MS and determine its aetiology, assisting in treatment decision making. MS must be understood as a complex disease that encompasses and compromises different aspects of patients' health, and goes beyond simply measuring disability.

Tools for comprehensive evaluation of sexual function in patients with multiple sclerosis. / Herramientas para la evaluación integral de la función sexual en pacientes con esclerosis múltiple.

INTRODUCTION: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) that affects young adults, causing a variety of symptoms (motor alterations, visual alterations, loss of sphincter control, gait alterations) that impair the patient's functional status. However, other symptoms, such as sexual dysfunction, can also have an effect on quality of life. DEVELOPMENT: Sexual dysfunction can occur at any time during the course of the disease; its prevalence varies between 50% and 90%, and it can be secondary to demyelinating lesions in the spinal cord and/or brain or caused by symptoms that do not directly involve the nervous system (fatigue; psychological, social, and cultural factors; etc.). Although its prevalence and impact on quality of life are well known, sexual dysfunction is still frequently underestimated. Therefore, in this article we review the different scales for assessing presence or severity of sexual dysfunction, in order to offer early multidisciplinary management. CONCLUSION: We evaluated 5 questionnaires that could identify the presence of sexual dysfunction in patients with MS and determine its aetiology, assisting in treatment decision making. MS must be understood as a complex disease that encompasses and compromises different aspects of patients' health, and goes beyond simply measuring disability.

Comprehending and improving cannabis specialized metabolism in the systems biology era.

Cannabis sativa is a source of food, fiber and specialized metabolites such as cannabinoids, with psychoactive and pharmacological effects. Due to its expanding and increasingly-accepted use in medicine, cannabis cultivation is acquiring more importance and less social stigma. Humans initiated different domestication episodes whose later spread gave rise to a plethora of landrace cultivars. At present, breeders cross germplasms from different gene pools depending on their specific use. The fiber (hemp) and drug (marijuana) types of C. sativa differ in their cannabinoid chemical composition phenotype (chemotype) and also in the accumulation of terpenoid compounds that constitute a strain's particular flavor and scent. Cannabinoids are isoprenylated polyketides among which cannabidiolic acid (CBDA) and (-)-trans-Δ9-tetrahydrocannabinol acid (THCA) have been well-documented for their many effects on humans. Here, we review the most studied specialized metabolic pathways in C. sativa, showing how terpenes and cannabinoids share both part of the isoprenoid pathway and the same biosynthetic compartmentalization (i.e. glandular trichomes of leaves and flowers). We enlist the several studies that have deciphered these pathways in this species including physical and genetic maps, QTL analyses and localization and enzymatic studies of cannabinoid and terpene synthases. In addition, new comparative modeling of cannabinoid synthases and phylogenetic trees are presented. We describe the genome sequencing initiatives of several accessions with the concomitant generation of next-generation genome maps and transcriptomic data. Very recently, proteomic characterizations and systems biology approaches such as those applying network theory or the integration of multi-omics data have increased the knowledge on gene function, enzyme diversity and metabolite content in C. sativa. In this revision we drift through the history, present and future of cannabis research and on how second- and third-generation sequencing technologies are bringing light to the field of cannabis specialized metabolism. We also discuss different biotechnological approaches for producing cannabinoids in engineered microorganisms.

Gestational chronodisruption leads to persistent changes in the rat fetal and adult adrenal clock and function.

KEY POINTS: Light at night is essential to a 24/7 society, but it has negative consequences on health. Basically, light at night induces an alteration of our biological clocks, known as chronodisruption, with effects even when this occurs during pregnancy. Here we explored the developmental impact of gestational chronodisruption (chronic photoperiod shift, CPS) on adult and fetal adrenal biorhythms and function. We found that gestational chronodisruption altered fetal and adult adrenal function, at the molecular, morphological and physiological levels. The differences between control and CPS offspring suggest desynchronization of the adrenal circadian clock and steroidogenic pathway, leading to abnormal stress responses and metabolic adaptation, potentially increasing the risk of developing chronic diseases. ABSTRACT: Light at night is essential to a 24/7 society, but it has negative consequences on health. Basically, light at night induces an alteration of our biological clocks, known as chronodisruption, with effects even when this occurs during pregnancy. Indeed, an abnormal photoperiod during gestation alters fetal development, inducing long-term effects on the offspring. Accordingly, we carried out a longitudinal study in rats, exploring the impact of gestational chronodisruption on the adrenal biorhythms and function of the offspring. Adult rats (90 days old) gestated under chronic photoperiod shift (CPS) decrease the time spent in the open arm zone of an elevated plus maze to 62% and increase the rearing time to 170%. CPS adults maintained individual daily changes in corticosterone, but their acrophases were distributed from 12.00 h to 06.00 h. CPS offspring maintained clock gene expression and oscillation, nevertheless no daily rhythm was observed in genes involved in the regulation and synthesis of steroids. Consistent with adult adrenal gland being programmed during fetal life, blunted daily rhythms of corticosterone, core clock gene machinery, and steroidogenic genes were observed in CPS fetal adrenal glands. Comparisons of the global transcriptome of CPS versus control fetal adrenal gland revealed that 1078 genes were differentially expressed (641 down-regulated and 437 up-regulated). In silico analysis revealed significant changes in Lipid Metabolism, Small Molecule Biochemistry, Cellular Development and the Inflammatory Response pathway (z score: 48-20). Altogether, the present results demonstrate that gestational chronodisruption changed fetal and adult adrenal function. This could translate to long-term abnormal stress responses and metabolic adaptation, increasing the risk of developing chronic diseases.

Enfermedad periodontal y factores relacionados en escolares con síndrome de Down en Cartagena, Colombia / Periodontal disease and related factors in scholars with Down syndrome from Cartagena, Colombia

Objetivo: Describir el estado de salud periodontal y factores relacionados en escolares con Síndrome de Down en Cartagena, Colombia. Materiales y métodos: Estudio descriptivo de corte transversal en 91 individuos entre 3 y 18 años en una institución de Cartagena. Se aplicó un cuestionario sobre factores sociodemográficos, hábitos de higiene bucal y factores relacionados con enfermedad periodontal; además una valoración clínica de factores locales (mal posiciones dentales, apiñamiento dental, adaptación de restauraciones, presencia de aparatología intraoral, presencia de movilidad dental, exudado y lesiones de furca), cuantificación de placa bacteriana con Índice de Placa Comunitario de Corchuelo, estado gingival y periodontal utilizando el Índice Comunitario de Necesidades de Tratamiento Periodontal. Los datos fueron analizados con proporciones y la prueba chi cuadrado para significancia en las relaciones, asumiendo un límite de 0,05. Resultados: La enfermedad periodontal más frecuente fue gingivitis en 46,1% (IC 95%: 35,7-56,6). El índice de placa bacteriana fue ≥80% (IC 95%: 83,8-96,3) y el cepillado dental fue ≤2 veces/día en la mayoría de sujetos. La necesidad más frecuente de tratamiento periodontal fue instrucción de higiene bucal en 36,2% (IC 95%: 26,1-46,3). En análisis bivariado, la edad presentó relación estadísticamente significativa con enfermedad periodontal, los individuos entre 13 y 18 años fueron los más afectados (p=0,045). Conclusión: es necesario realizar una evaluación continua para detectar posibles factores de riesgo individual en la población con síndrome de Down para enfermedad periodontal (AU)

Objective: Describe the status of periodontal health and related factors in scholars with Down Syndrome in Cartagena, Colombia. Materials and methods: cross-sectional descriptive study in 91 individuals between 3 and 18 years in an institution of Cartagena, was applied a questionnaire assessing sociodemographic factors, oral hygiene habits and factors associated with periodontal disease; moreover a clinical assessment, which included the identification of local factors (dental malpositions, dental crowding, adaptations of restorations, presence of intraoral appliances, presence or absence of tooth mobility, furcation involvement and exudate), quantification of dental plaque with oral hygiene index for community use (CPI), gingival and periodontal status using the Community Treatment Needs Index. Data were analyzed from proportions and chi-Square test was used for significance in relationships, assuming a limit of 0.05. Results: the most common periodontal disease was gingivitis 46.1% (35.7 to 56.6% CI). The plaque index was ≥80% (83.8 to 96.3% IC) and tooth brushing was ≤2 times/day in most subjects with Down syndrome. The most common need for periodontal treatment was oral hygiene instruction in 36.2% (26.1 to 46.3% IC). In bivariate analysis, age showed statistically significant relationship with periodontal disease, individuals between 13 and 18 years were most affected (p=0.045). Conclusion: it is necessary a continuing periodontal evaluation to detect possible risk factors Individual in people with Down syndrome for periodontal disease (AU)

Longitudinal speech perception performance of young children with cochlear implants and tactile aids plus hearing aids.

Nineteen profoundly deaf children who utilize either cochlear implants (CIs) or multichannel tactile aids plus hearing aids (T + HAs) and who were enrolled in a full-day educational program that specializes in the use of sensory aids were evaluated using a battery of speech perception tests either developed in house or chosen because they were part of a standard battery of tests developed for children with sensory aids. The tests were organized into four perceptual levels ranging from pattern perception at level one to open set word identification at level four. For each level, data were analyzed for changes over time and for differences between performance of CI children and those using T + HAs. The results indicate that overall, across levels, both groups improved significantly over time but no differences were found between users of T + HAs and CIs at any level.

Practical evaluation procedure to assess and remediate speech perception skills.

The University of Miami/Dade County Public Schools Model Program for the Deaf and Hard of Hearing is a research and training effort dedicated to the utilization of sensory aids including hearing aids, tactual vocoders, and cochlear implants. The program's teachers and clinicians follow the Miami Cochlear Implant, Auditory, and Tactile Skills (CHATS) Curriculum for the development of individualized speech perception and production goals. A series of peech perception tests has been used for the past five years to evaluate the children's progress. The test battery, administered at six month intervals, is extensive and impractical for school clinicians and teachers to administer to their students. To assist teachers and clinicians in the process of selecting appropriate goals and objectives for sensory aid training, a speech perception test has been developed to accompany the curriculum. This paper includes a discussion of the test design as it correlates with the curriculum.

A longitudinal evaluation of the speech perception capabilities of children using multichannel tactile vocoders.

Thirty children (mean age 6:11, range 4:3 to 11:0, SD = 2:3) with profound hearing impairments were followed longitudinally over a 3-year period and evaluated every 6 months with a battery of speech perception tests. The battery spanned several levels of perception, from pattern perception to open-set word recognition. The children were all enrolled in a single full-day educational program that used multichannel tactile aids in addition to hearing aids. Testing was conducted in Auditory alone (A), Tactile plus Auditory (TA), Tactile alone (T), and in one instance, Tactile plus Auditory plus Vision (TAV) conditions because the primary interest of the work was the relationship between auditory and tactile training on perception. Results indicated that children's performance improved with age, with the oldest children achieving open-set speech recognition in the TA condition. Performance in the TA condition generally exceeded that in both A and T conditions. Outcomes were compared to those from two studies in the literature for children of similar age with cochlear implants and tactile aids on the same tests. Results suggest that performance of children who had cochlear implants for an average of 21 months was similar to TA and TAV performance of children in the present study who had tactile experience over a similar period.

Tratamiento de dermatofitosis con itraconazo. Comparación de dos esquemas de tratamiento. Unidad Médica – Centro de Especialistas CES. Septiembre 1988 – Febrero 1990 / Dermatophytosis treatment with itraconazol. Comparison of two treatment schemes. Specialists Medical Unit – CES. September 1988 – February 1990

Se realizó un estudio descriptivo, prospectivo y al azar, determinando la eficacia del Itraconazol en el tratamiento de las dermatofitosis, a una dosis de 100 mg. diarios durante 15 o 30 días en la Unidad Médica CES en Medellín y el Centro de Salud CES en Sabaneta, desde Septiembre de 1988 a Febrero de 1990. Se estudiaron 25 pacientes con diagnóstico clínico y comprobación micológica de dermatofitosis; se práctico evaluación clínica, micológica y de laboratorio antes y al final del tratamiento, y sólo clínica 15 días post-terapia. El principal microorganismo aislado fue el T. rubrum (53 por ciento). Las manifestaciones clínicas más frecuentemente encontradas fueron descamación, inflamación y síntomas subjetivos; se observó un aumento en la curación de éstas a los 15 días de haber finalizado el tratamiento: del 21 por ciento al 57 por ciento en el grupo de tratamiento por 15 días y del 9 por ciento al 27 por ciento en el grupo de tratamiento por 30 días. La curación micológica al final del tratamiento se presentó en el 78.5 por ciento de los pacientes tratados por 15 días y en el 72.7 por ciento de los tratados por 30 días, datos que son semejantes pero no estadísticamente significativos. Dos pacientes presentaron efectos adversos y sólo se retiró uno del estudio por esta causa...