Relación del insomnio con la calidad de vida en una población de adultos mayores / Relationship of insomnia with quality of life in a population of older adults

Antecedentes: el insomnio es considerado un problema de salud pública por su alta prevalencia, se manifiesta por una percepción subjetiva de insatisfacción por la cantidad del sueño, dificultad para iniciar o mantener el sueño, despertar antes de lo deseado, incapacidad para volver a dormir y que ocurre a pesar de contar con las condiciones adecuadas, presentándose con frecuencia en adultos mayores afectando la calidad de vida, además, altera la funcionalidad física, mental y social de las personas mayores , y es un factor predisponente para deterioro cognitivo y depresión. Objetivo: determinar la relación del insomnio con la calidad de vida en una población de adultos mayores. Metodología: estudio analítico, transversal y comparativo, en una población de 107 adultos mayores de la Ciudad de México, con insomnio y sin insomnio, a los cuales se les aplicó la escala de Atenas para diagnosticar insomnio; como pruebas de tamizaje para deterioro cognitivo el MiniMental de Folstein, la Escala de Depresión Geriátrica Yesavage para probable depresión, y para calidad de vida el Cuestionario WHOQoL-BrefdelaOMS. Los datos fueron analizados a través de X2y t de Student y como estimador de riesgos razón de momios con un intervalo de confianza al 95%. Resultados:laprevalenciadeinsomniofuedel57%;enlascaracterísticassociodemográficas no se encontraron diferencias significativas; en las pruebas de tamizaje, se observó una relación estadísticamente significativa entre la presencia de insomnio y depresión (p<0.05); se encontró que los adultos mayores con insomnio tienen 6 veces mayor riesgo de presentar depresión en comparación con los que no lo presentan (RM 7.292.9, IC95%=2.319-22.925, p<0.05); respecto a la relación del insomnio con la calidad de vida, en los pacientes con insomnio fue estadísticamente significativa con un puntaje menor en la calidad de vida global(con insomnio 93 ± 13.7 vs. sin insomnio 102 ± 11.9, p<0.05); en la relación del insomnio y el nivel de calidad de vida, se encontró que los adultos mayores sin insomnio presentan una calidad de vida alta, en comparación con los adultos mayores con insomnio, donde se observó que es promedio (con Insomnio 70% vs. sin insomnio 30%, p<0.05); de acuerdo con los valores promedio de las diferentes dimensiones de la calidad de vida y su relación con el insomnio, se detectó que el grupo con insomnio obtuvo puntajes menores en las dimensiones salud física, aspectos psicológicos, relaciones sociales y medio ambiente observándose diferencias estadísticamente significativas entre los dos grupos; se detectó que el insomnio aumenta el riesgo de percibir la calidad de vida como promedio-mala, primordialmente en las dimensiones salud física, aspectos psicológicos y relaciones sociales. Conclusiones: La población de estudio con insomnio presentó alteración en las 4 dimensiones de la calidad de vida (salud física, aspectos psicológicos, relaciones sociales y medio ambiente).

Background: insomnia is considered as a public health problem because of its high prevalence, is manifested by a subjective perception of dissatisfaction with the amount of sleep, difficulty initiating or maintaining sleep, to wake up earlier than desired , inability to go back to sleep. These events happen despite having the suitable conditions, occurring frequently in older adults affecting the quality of life, also alters the physical, mental and social functionality of older people, and it's a predisposing factor for cognitive impairment and depression. Objective: to determine the relationship of insomnia with quality of life in a population of older adults. Methodology: analytical, cross-sectional and comparative study in a population of 107older adults in Mexico City, with insomnia and without insomnia, to which the Athenas scale was applied to diagnose insomnia; as screening tests for cognitive impairment the Folstein Mini Mental, the Yesavage Geriatric Depression Scale for probable depression, and the WHOQoL-Bref Questionnaire of WHO, for quality of life were used. The data were analyzed using X2and Student's t test,and as an estimator odds ratio risks with a 95%confidence interval. Results: the prevalence of insomnia was 57%; no significant differences were found in sociodemographic characteristics; in the screening tests, a statistically significant relationship was observed between the presence of insomnia and depression (p<0.05); it was found that older adults with insomnia have a 6times greater risk of presenting depression compared to those without it (OR 7,292.9, 95% CI = 2,319-22,925, p<0.05); with respect to the relationship between insomnia and quality of life, in patients with insomnia it was statistically significant with a lower score in global quality of life (with insomnia 93 ± 13.7vs. without insomnia 102 ± 11.9, p <0.05); in the relationship between insomnia and the level of quality of life, it was found that older adults without insomnia have a high quality of life, compared to older adults with insomnia, where it was observed that it is average (with insomnia 70%vs. without insomnia 30%, p<0.05); according to the average values of the different dimensions of quality of life and their relationship with insomnia, it was detected that the group with insomnia obtained lower scores in the dimensions of physical health, psychological aspects, social relations,and environment, observing statistically significant differences between the two groups. Insomnia was found to increase the risk of perceiving quality of life as average-poor, primarily in the dimensions of physical health, psychological aspects, and social relationships. Conclusions: The study population with insomnia presented alteration in the 4dimensions of quality of life (physical health, psychological aspects, social relationships,and environment).

Human sperm decondensation in vitro is related to cleavage rate and embryo quality in IVF.

PURPOSE: To investigate whether the ability of human spermatozoa to decondense in vitro in the presence of heparin (Hep) and glutathione (GSH) is related to assisted reproduction (ART) success. METHODS: Cross-sectional pilot study involving male partners of 129 infertile couples undergoing ICSI with (45) or without (84) donor oocytes at two infertility clinics in CABA, Argentina, between October 2012 and December 2013. In vitro decondensation kinetics with Hep and GSH and DNA fragmentation (TUNEL) were determined on the same sample used for ICSI. The possible relationship of decondensation parameters (maximum decondensation and decondensation velocity) and TUNEL values with ART success was evaluated. RESULTS: Embryo quality correlated positively with decondensation velocity (D60/D30) (Spearman's correlation, p < 0.05). According to D60/D30 values, patients were classified as slow decondensers (SlowD) (n = 68) or fast decondensers (FastD) (n = 61). Embryo quality was better in FastD (unpaired t test, p < 0.05). FastD and SlowD were subdivided according to use of donor oocytes. Among SlowD, biochemical and clinical pregnancy rates per transfer were significantly higher in donor (n = 19) vs. in non-donor (n = 31) cycles (Fisher's exact test, p < 0.05). TUNEL values were not related to embryo quality, but no clinical pregnancies or live births were achieved in TUNEL+ SlowD (n = 7). CONCLUSION: Decondensation kinetics of human spermatozoa in vitro with Hep and GSH could be related to embryo quality and ART success.

Prognostic role for the derived neutrophil-to-lymphocyte ratio in early breast cancer: a GEICAM/9906 substudy.

PURPOSE: Elevated markers of host inflammation, a hallmark of cancer, have been associated with worse outcomes in several solid tumors. Here, we explore the prognostic role of the derived neutrophil-to-lymphocyte ratio (dNLR), across different tumor subtypes, in patients with early breast cancer. PATIENTS AND METHODS: This was a retrospective analysis of 1246 patients with lymph node-positive, operable early breast cancer enrolled in the GEICAM/9906 trial, a multicenter randomized phase 3 study evaluating adjuvant chemotherapy. dNLR was calculated as the ratio of neutrophils and the difference between total leukocytes and neutrophils in peripheral blood before chemotherapy. Disease-free survival (DFS) and overall survival were explored using a Cox proportional hazard analysis. RESULTS: The analysis comprised 1243 (99.8%) patients with dNLR data, with a median follow-up of 10 years. Data on intrinsic subtypes were available from 818 (66%) patients (luminal A 34%, luminal B 32%, HER2-enriched 21% and basal-like 9%). Median dNLR was 1.35 [interquartile range (IQR) 1.08-1.71]. In the whole population, dNLR was not prognostic after adjustment for clinico-pathological factors. However, dNLR ≥ 1.35 was independently associated with worse DFS in the hormone receptor-negative/HER2+ population (HR 2.86; p = 0.038) and in patients with one to three lymph node metastases (HR 1.32, p = 0.032). There was a non-significant association with worse DFS in non-luminal and in HER2-enriched tumors (HR 1.40, p = 0.085 and HR 1.53, p = 0.067). No significant interaction was observed between the treatment arm and dNLR. CONCLUSION: Elevated dNLR appears to be an adverse prognostic factor in hormone receptor-negative early breast cancer. TRIAL REGISTRATION: EudraCT: 2005-003108-12 (retrospectively registered 28/06/2005). ClinicalTrials.gov Identifier: NCT00129922 (retrospectively registered 10/08/2005). Results of this study were presented in part at the 2016 ESMO conference October 7-11, 2016, Copenhagen, Denmark (oral presentation).

Galician consensus on management of cardiotoxicity in breast cancer: risk factors, prevention, and early intervention.

This Galician consensus statement is a joint oncologists/cardiologists initiative indented to establish basic recommendations on how to prevent and to manage the cardiotoxicity in breast cancer with the aim of ensuring an optimal cardiovascular care of these patients. A clinical screening of the patients before treatment is recommended to stratify them into a determined risk group based on their intrinsic cardiovascular risk factors and those extrinsic arose from breast cancer therapy, thereby providing individualized preventive and monitoring measures. Suitable initial and ongoing assessments for patients with low and moderate/high risk and planned treatment with anthracyclines and trastuzumab are given; also, measures aimed at preventing and correcting any modifiable risk factor are pointed out .

Evaluation and management of chemotherapy-induced cardiotoxicity in breast cancer: a Delphi study.

PURPOSE: While much progress has been made in the treatment of breast cancer, cardiac complications resulting from therapy remain a significant concern. Both anthracyclines and novel targeted agents can inflict cardiac damage. The present study aimed to evaluate the difference between what it is currently done and what standards of care should be used to minimizing and managing cardiac toxicity in breast cancer survivors. METHODS: A two-round multicenter Delphi study was carried out. The panel consisted of 100 oncologists who were asked to define the elected therapies for breast cancer patients, the clinical definition and patterns of cancer drug-derived cardiac toxicity, and those protocols focused on early detection and monitoring of cardiovascular outcomes. RESULTS: Experts agreed a more recent definition of cardiotoxicity. Around 38 % of patients with early-stage disease, and 51.3 % cases with advanced metastatic breast cancer had preexisting risk factors for cardiotoxicity. Among risk factors, cumulative dose of anthracycline ≥450 mg/m2 and its combination with other anticancer drugs, and a preexisting cardiovascular disease were considered the best predictors of cardiotoxicity. Echocardiography and radionuclide ventriculography have been the proposed methods for monitoring changes in cardiac structure and function. Breast cancer is generally treated with anthracyclines (80 %), so that the panel strongly stated about the need to plan a strategy to managing cardiotoxicity. A decline of left ventricular ejection fraction (LVEF) >10 %, to an LVEF value <53 % was suggested as a criterion for changing the dose schedule of anthracyclines, or suspending the treatment of chemotherapy plus trastuzumab until the normalization of the left ventricular function. The use of liposomal anthracyclines was strongly suggested as a treatment option for breast cancer patients. CONCLUSIONS: The present report is the first to produce a set of statements on the prevention, evaluation and monitoring of chemotherapy-induced cardiac toxicity in breast cancer patients.

A definition for aggressive disease in patients with HER-2 negative metastatic breast cancer: an expert consensus of the Spanish Society of Medical Oncology (SEOM).

PURPOSE: To converge on an expert opinion to define aggressive disease in patients with HER2-negative mBC using a modified Delphi methodology. METHODS: A panel of 21 breast cancer experts from the Spanish Society of Medical Oncology agreed upon a survey which comprised 47 questions that were grouped into three sections: relevance for defining aggressive disease, aggressive disease criteria and therapeutic goals. Answers were rated using a 9-point Likert scale of relevance or agreement. RESULTS: Among the 88 oncologists that were invited to participate, 81 answered the first round (92%), 70 answered the second round (80%), and 67 answered the third round (76%) of the survey. There was strong agreement regarding the fact that identifying patients with aggressive disease needs to be adequately addressed to help practitioners to decide the best treatment options for patients with HER2-negative mBC. The factors that were considered to be strongly relevant to classifying patients with aggressive HER2-negative mBC were a high tumor burden, a disease-free interval of less than 12-24 months after surgery, the presence of progressive disease during adjuvant or neoadjuvant chemotherapy and having a triple-negative phenotype. The main therapeutic goals were controlling symptoms, improving quality of life and increasing the time to progression and overall survival. CONCLUSIONS: High tumor burden, time to recurrence after prior therapy and having a triple-negative phenotype were the prognostic factors for which the greatest consensus was found for identifying patients with aggressive HER2-negative mBC. Identifying patients with aggressive disease leads to different therapeutic approaches.

A novel HLA-A allele, A*74:23, identified in an individual from Costa Rica.

The new HLA-A*74:23 allele differs from the closest allele A*74:01 by a nucleotide change in exon 3 at codon 97.

Breast cancer management in the elderly.

The increase in life expectancy in the western world means that we are faced with patients diagnosed with breast cancer in old age with increasing frequency. The management of these cases is a challenge for the oncologist, who must take into account the conditions associated with advanced age and the lack of trials in this population. In this review, we addressed the incorporation of geriatric assessment methods that may be useful in making decisions, the particular biological characteristics of breast cancer in elderly patients and their treatment in both localized and advanced disease. Finally, we collected recommendations based on scientific evidence regarding the monitoring and life-style after finishing treatment.

Heparin enhances protamine disulfide bond reduction during in vitro decondensation of human spermatozoa.

BACKGROUND: Human sperm nuclear decondensation in vivo involves protamine disulfide bond reduction by glutathione (GSH) and protamine/histone exchange, presumably with heparan sulfate (HS) as the protamine acceptor. The aim of the present study was to test the hypothesis that these two events occur simultaneously rather than sequentially, as has been hitherto accepted, and to test for the presence of HS in the human oocyte. METHODS: Spermatozoa and isolated sperm nuclei obtained from normal volunteers were exposed in vitro to heparin, the functional analogue of HS and either GSH or dithiothreitol (DTT) as the disulfide reducing agent. Decondensing reagents were added either simultaneously or sequentially. Percentage sperm nuclear decondensation was assayed by phase contrast microscopy. Thiol reduced status of isolated sperm nuclei was evaluated both indirectly [acridine orange (AO) staining of acid-denatured DNA] and directly [monobromobimane (mBBr) staining of protamine-free thiols]. The presence of HS in mature metaphase II (MII) human oocytes was analyzed by immunocytochemistry. RESULTS: Sequential addition of reagents always resulted in significantly lower decondensation if GSH was used as the disulfide bond reducer (P < 0.05 for sperm and P < 0.001 for nuclei), but only when heparin was used first, when DTT was the disulfide reducing agent (P < 0.05 for sperm and P < 0.01 for nuclei). Both AO staining of DNA and mBBr staining of protamines revealed that the addition of heparin to GSH but not to DTT significantly increased the thiol reduced status of sperm chromatin. HS was detected in the ooplasm of zona-free MII human oocytes. CONCLUSIONS: The results presented in this paper clearly show that heparin enhances the sperm chromatin thiol reducing activity of GSH in vitro, suggesting that in vivo thiol reduction and protamine/histone exchange could occur as simultaneous, rather than sequential, events. We also demonstrate for the first time the presence of HS in the human oocyte.

Current controversies in the management of breast cancer.

The following manuscript summarises the content of the Breast Symposium that was held in May 2008 in Barcelona in which four controversies regarding the management of breast cancer were discussed. The design of the symposium included two speakers per controversy, one in favour and one diverging, and the audience had to vote before and after the presentations to assess changes in the participants' views. The four controversies included: (1) the role of non-conventional predictive factors in selecting treatment for breast cancer; (2) the role of surgery in disseminated disease; (3) are taxanes indicated in the adjuvant treatment of patients with lymph-node-negative disease?; (4) is treatment with tamoxifen (TAM) always required after surgery in patients with ductal carcinoma in situ (DCIS)? The symposium concluded with the presentation titled: 'Features of a well designed clinical trial in the adjuvant treatment of breast cancer'.

Metabolic and proteomic study of NS0 myeloma cell line following the adaptation to protein-free medium.

Proteomics and metabolomics technologies are potentially useful tool for the study of the very complex process of cell adaptation to protein-free medium. In this work, we used the iTRAQ technology to analyze different protein levels in adapted and non-adapted NS0 myeloma cell line. Several proteins with differential expression profile were characterized and quantified. Carbohydrate metabolism, protein synthesis and membrane transport were the principal pathways that change after the adaptation. Changes in lactate production rate with respect to glucose consumption rate were observed according to the changes observed by proteomic.

The presence of heparan sulfate in the mammalian oocyte provides a clue to human sperm nuclear decondensation in vivo.

BACKGROUND: Previous results from our laboratory have led us to propose heparan sulfate (HS) as a putative protamine acceptor during human sperm decondensation in vivo. The aim of this paper was to investigate the presence of glycosaminoglycans in the mammalian oocyte in an effort to better support this contention. METHODS: Two experimental approaches are used: oocyte labeling to identify the presence of HS and analysis of sperm decondensing ability of fresh oocytes in the presence or absence of specific glycosidases. RESULTS: Staining of mouse zona-intact oocytes with the fluorescent cationic dye, Rubipy, at pH 1.5 allowed for the detection of sulfate residues in the ooplasm by confocal microscopy. HS was detected in the ooplasm by immunocytochemistry. A sperm decondensation microassay using heparin and glutathione was successfully developed. The same level of sperm decondensation could be attained when heparin was replaced by mouse zona-free oocytes. Addition of heparinase to the oocyte/glutathione mixture significantly reduced sperm decondensation (P = 0.0159), while there was no effect following addition of either chondroitinase ABC or hyaluronidase. CONCLUSIONS: The results presented in this paper demonstrate for the first time that HS is present in the mammalian oocyte and show that HS is necessary for fresh oocytes to express their sperm decondensing ability in vitro.

Characterization of a recombinant monoclonal antibody by mass spectrometry combined with liquid chromatography.

In this report, we present the characterization of a humanized monoclonal antibody specific for the human epidermal growth factor receptor (hEGFR). Direct analysis by matrix assisted laser desorption ionization mass spectrometry (MALDI-MS) of peptide mixtures and chromatographically isolated fractions allowed identification of 94.0% and 85.4% of the amino acid sequence of light and heavy chains, respectively. Microheterogeneity sources were identified in light and heavy chains and a previously unreported posttranslational modification for immunoglobulins was found. One N-glycosylation site was identified in the heavy chain with non-sialylated bianntenary fucosylated structures. This study is one of the first to assess the potential of MALDI-MS in combination with more conventional protein chemistry techniques for the characterization of monoclonal antibodies.

The acrosome reaction response assay: a new way to identify patients in whom pentoxifylline would improve the human follicular fluid-induced acrosome reaction.

The effect of pentoxifylline on the spontaneous and follicular fluid (hFF)-induced acrosome reaction (AR) was studied in an attempt to identify those patients who would benefit from the use of pentoxifylline as an AR-stimulating agent. Pentoxifylline (1 mg/ml) produced no significant increase over spontaneous AR at any of the time points studied (60 min: 6.2% +/- 2.0 spontaneous AR vs 7.4% +/- 2.0 pentoxifylline AR; 120 min: 7.1% +/- 1.6 spontaneous vs 9.0% +/- 2.5 pentoxifylline; 180 min: 7.0% +/- 1.8 spontaneous vs 10.9% +/- 4.0 pentoxifylline, n = 6). On the other hand, hFF produced a significant increase in AR (6.9% spontaneous AR vs 11.2% hFF AR, p < 0.001, n = 39) and this effect was enhanced by pre-incubation with pentoxifylline (15.0% pentoxifylline + hFF AR vs 11.2% hFF AR, p < 0.001). There were no differences in percentage AR induced by hFF or pentoxifylline + hFF between patients with normal (n = 16) and abnormal (n = 25) semen samples. Individual analysis of the effects of hFF and pentoxifylline + hFF on AR showed great variability between patients and enabled us to classify them into four categories: inducible-responder (15%), non-inducible-responder (23%), inducible-non-responder (41%) and non-inducible-non-responder (21%). An induction index (II) (induction produced by hFF divided by spontaneous AR) and a response index (RI) (induction produced by pentoxifylline + hFF divided by hFF) were calculated for each sample. Patients previously classified as inducible exhibited an II > 0.30 and patients previously classified as responders showed an RI > 0.26. There was no correlation between II and RI values (Spearman, r = -0.185, p = 1). Our results show that pentoxifylline is an enhancer of the induced AR only in some patients. We propose an 'AR response assay' to identify responder patients and thus enable rational use of this drug.

[Persistent diarrhea]. / Diarrea persistente.

In this article the current concepts on persistent diarrhoea are reviewed. Persistent diarrhoea is important because its aetiology is unclear, is difficult to treat, affects the nutritional status and increases the risk of death. The identification of risk factors for persistent diarrhoea is important because it can obtain valuable information relative to the pathogenesis and prevention of this disease. The concepts of diarrhoea and risk factors are also reviewed. In addition we explore the methods of management and treatment of patients with persistent diarrhoea.