Low genitourinary tract risks in women living with the human immunodeficiency virus.

This review analyzes the clinical associations between specific low genitourinary tract clinical circumstances in perimenopausal and postmenopausal women living with human immunodeficiency virus (WLHIV). Modern antiretroviral therapy (ART) improves survival and reduces opportunistic infections and HIV transmission. Despite appropriate ART, WLHIV may display menstrual dysfunction, risk of early menopause, vaginal microbiome alterations, vaginal dryness, dyspareunia, vasomotor symptoms and low sexual function as compared to women without the infection. They have increased risks of intraepithelial and invasive cervical, vaginal and vulvar cancers. The reduced immunity capacity may also increase the risk of urinary tract infections, side-effects or toxicity of ARTs, and opportunistic infections. Menstrual dysfunction and early menopause may contribute to the early onset of vascular atherosclerosis and plaque formation, and increased osteoporosis risks requiring specific early interventions. On the other hand, the association between being postmenopausal and having a low sexual function is significant and related to low adherence to ART. WLHIV deserve a specific approach to manage different low genitourinary risks and complications related to hormone dysfunction and early menopause.

Microdeleción 1q21.1 y psicosis. A próposito de un caso / A case report of 1q21.1 microdeletion and psychosis

La microdeleción 1q21.1 no constituye por sí misma un síndrome clínico reconocible, ya que algunas personas con la deleción no presentan hallazgos clínicos y otras tienen repercusiones variables. Sin embargo, se han descrito alteraciones relacionadas con la ausencia de los genes localizados en dicho fragmento. Entre estas características se incluyen microcefalia, rasgos faciales dismórficos, alteraciones oculares, defectos cardíacos, anomalías genitourinarias, malformaciones esqueléticas, convulsiones, retraso en el neurodesarrollo, dificultades en el aprendizaje y discapacidad intelectual leve. En cuanto a patologías psiquiátricas, hay mayor incidencia de trastornos del espectro autista, trastorno por déficit de atención con hiperactividad, trastornos de ansiedad y del estado de ánimo, trastornos del sueño y esquizofrenia. Presentamos el caso clínico de una paciente portadora de microdeleción 1q21.1 hospitalizada en una Unidad de Psiquiatría del Niño y el Adolescente por sintomatología delirante y alucinaciones

The 1q21.1 microdeletion does not cause a typical clinical syndrome, since some people with the deletion do not show clinical findings and others have different manifestations. However, alterations related to the absence of localized genes in that fragment have been described. These characteristics include microcephaly, dysmorphic facial features, ocular alterations, heart diseases, genitourinary anomalies, skeletal malformations, seizures, neurodevelopmental disorders, learning disabilities and mild intellectual disability. About psychiatric pathologies, there is a higher incidence of autism spectrum disorders, attention deficit hyperactivity disorder, anxiety and mood disorders, sleep disorders and schizophrenia. We report a clinical case of a female patient with the 1q21.1 microdeletion admitted in a Child and Adolescent Psychiatry Unit with delusional symptoms and hallucinations

Morphometric study of the greater palatine canal: cone-beam computed tomography.

PURPOSE: To analyze greater palatine canal (GPC) dimensions using cone-beam computed tomography (CBCT) images, and to evaluate the position of the greater palatine foramen (GPF) with respect to various landmarks selected in relation to dental status. METHODS: This study included 150 CBCTs. Axial slices were used to determine the position and dimensions of the GPF. Sagittal slices were used to assess GPC length. Reference lines were established to evaluate the GPC diameter in sagittal and coronal slices. RESULTS: From the 77 GPF analyzed, 76 were located on level 2. Average posterior GPF distance was 6.59 ± 3.27 mm on right side and 7.35 ± 3.40 mm on left side. Several measurements to determine the position and dimensions of the GPF presented significant values (p ≤ 0.05). GPC length was 12.31 ± 1.96 mm on right side and 12.52 ± 2.15 mm on left side, statistically significant differences were detected between genders only on right canal (p ≤ 0.004). Sagittal and coronal reference lines presented significantly higher values for men except for the S3 (p < 0.062) and C1 (p < 0.067) in the left GPC. CONCLUSIONS: CBCT is a useful tool for evaluating GPC morphometrically in the three anatomical slices. The sagittal nasal plane and posterior nasal plane are two intraoral anatomical landmarks for the location of the GPF. Their scant variability allows accurate identification of GPFs in both dentate as well as edentulous patients.

Morphometric differences of nasopalatine canal based on 3D classifications: descriptive analysis on CBCT.

PURPOSE: This descriptive retrospective study analyzed differences among sagittal, coronal and axial NC groups based on the dimensions of nasopalatine canal (NC), buccal bone plate (BBP) and palatal bone plate (PBP) to canal. METHODS: Measurements were made on 224 CBCTs for NC, BBP and PBP on the three anatomic planes at three levels: level 1, when the incisive foramen is completely closed on the axial plane; level 2, at the midpoint of NC length (NCL) on the sagittal plane; and level 3, at the foramina of Stenson on the sagittal plane. ANOVA tests with post hoc tests were used. The intraclass correlation coefficient and Kappa test were used for evaluating the intraobserver agreement. RESULTS: Regarding coronal classification, these significant differences were found: BBP length (BL)level 1 was lower for the two parallel canals group; PBP length (PL)level 1 was lower for single canal group; and NCL was lower for Y-type canal group. Regarding axial classification, these significant differences were found: LPlevel 1 was lower for 3.1-3 group; PBP width (PW)level 3 was the greatest for 3.1-3; and LPlevel 3 was lower for 1.1. CONCLUSIONS: Presurgical evaluation with CBCT in premaxillae region should include analysis on coronal and axial planes and not only on sagittal plane seeing as morphometric differences were found on coronal and axial planes. Following the morphological coronal classification, two parallel canals presented a higher NCL, a higher LP and a lower LV at inferior edge of alveolar ridge.

Descriptive study of the bifid mandibular canals and retromolar foramina: cone beam CT vs panoramic radiography.

OBJECTIVES: To examine the presence and morphologic characteristics of bifid mandibular canals (BMCs) and retromolar foramens (RFs) using cone beam CT (CBCT) and to determine their visualization on panoramic radiographs (PANs). METHODS: A sample of 225 CBCT examinations was analysed for the presence of BMCs, as well as length, height, diameter and angle. The diameter of the RF was also determined. Subsequently, corresponding PANs were analysed to determine whether the BMCs and RFs were visible or not. RESULTS: The BMCs were observed on CBCT in 83 out of the 225 patients (36.8%). With respect to gender, statistically significant differences were found in the number of BMCs. There were also significant differences in anatomical characteristics of the types of BMCs. Only 37.8% of the BMCs and 32.5% of the RFs identified on CBCT were also visible on PANs. The diameter had a significant effect on the capability of PANs to visualize BMCs and RFs (B = 0.791, p = 0.035; B = 1.900, p = 0.017, respectively). CONCLUSIONS: PANs are unable to sufficiently identify BMCs and RFs. The diameter of these anatomical landmarks represents a relevant factor for visualization on PANs. Pre-operative images using only PANs may lead to underestimation of the presence of BMCs and to surgical complications and anaesthetic failures, which could have been avoided. For true determination of BMCs, a CBCT device should be considered better than a PAN.

Three-dimensional study of nasopalatine canal morphology: a descriptive retrospective analysis using cone-beam computed tomography.

PURPOSE: For dental implant treatment planning and placement, a precise anatomic description of the nasopalatine canal (NC) is necessary. This descriptive retrospective study evaluated dimensions of the NC and buccal bone plate (BBP) and the tridimensional association of the anatomic variants of NC, using cone-beam computed tomography (CBCT). METHODS: This study included 230 CBCTs. Sagittal slices were used for measurements of the NC and BBP and to evaluate shape and direction-course of the NC. Coronal slices were used to assess NC shape and axial slices to assess number of incisive foramina and foramina of Stenson. RESULTS: Mean NC length was 12.34 ± 2.79 mm, statistically significant differences were detected between genders (p < 0.001). Mean BBP length was 20.87 ± 3.68 mm, statistically significant differences were found for the dental status (p < 0.001) and mean BBP width was 6.83 ± 1.28 mm, significant differences were detected between genders (p < 0.001). Mean nasopalatine angle was 73.33° ± 8.11°, significant differences were found in sagittal and coronal classifications. The most prevalent canal was: cylindrical sagittal shape (48.2 %); slanted-straight direction-course (57.6 %); Ya-type coronal shape (42.4 %); and one foramen incisive with two Stenson's foramina (1-2) (50.9 %). Sagittal shape was associated with sagittal direction-course (p < 0.001). Coronal shape was associated with axial classification (p < 0.001). CONCLUSIONS: The NC anatomy is highly variable. Gender is related to the NC length and BBP width, while dental status is related to BBP length. There was an association between the different sagittal classifications of the NC and between the coronal shape and axial classification.

Vitamin D, sunlight and longevity.

Humans acquire vitamin D through skin photosynthesis and digestive intake. Two hydroxylations are needed to obtain the bioactive compound, the first produces 25-hydroxyvitamin D [25(OH)D], and the second 1,25-dihydroxyvitamin D [1,25(OH)2D]. There is no consensus regarding the appropriate cut-off level to define the normal serum 25(OH)D range. Experimental, epidemiological and clinical studies have related low vitamin D status with longevity. Although some results are controversial, low serum 25(OH)D levels have been linked to all-cause, cardiovascular, cancer and infectious related mortality. Throughout life span a significant proportion of human beings display insufficient (20-30 ng/mL) or deficient (<20 ng/mL) serum 25(OH)D levels. Appropriate lifestyle changes, such as regular short exposures to sunlight (15 min a day), and an adequate diet that includes vitamin D rich components, are not always easily accomplished. Studies relating to vitamin D supplementation have methodological limitations or are based on relatively low doses. Therefore, dosages used for vitamin D supplementation should be higher than those traditionally suggested. In this sense, there is an urgent need for prospective controlled studies using high daily vitamin D doses (2,000 IU or higher) including cardiovascular, cancer, infectious and other endpoints. Relationship between vitamin D and health outcomes is not linear, and there are probably various optimal vitamin D levels influencing different endpoints.

Hemorragia durante la cesárea: factores de riesgo / Blooder in caesarean section: risk factors

Objetivos Definir los factores que influyen en la producción de anemia poscesárea. Material y métodos Seiscientas veintiocho pacientes asistidas en el Servicio de Obstetricia del Hospital Universitario San Cecilio de Granada (España) sometidas a una cesárea durante 1 año, analizando las características sociodemográficas y los diferentes factores que pueden influir en la producción de anemia. Se calcula la incidencia de anemia y la necesidad de transfusión postintervención. Resultados El 80% de las pacientes tiene anemia poscesárea, y la pérdida es inferior a 2g/dl. La multiparidad, cesárea previa, edad gestacional menor a 30 semanas y cesárea urgente se asocia con mayores tasas de anemia, sin diferencias significativas en cuanto a antecedentes como preeclampsia previa o tipo de anestesia empleada. La técnica de Misgav-Ladach disminuye dicha pérdida. Conclusiones En nuestro estudio, la multiparidad y la cesárea de urgencia se asocian con mayores tasas de anemia (AU)

Objectives To identify the factors influencing blood loss after cesarean section. Material and methods A total of 628 patients who underwent a cesarean section during a 1-year period at the Obstetrics Service of the University Hospital of San Cecilio in Granada (Spain) were studied. The patients’ socio-demographic characteristics and the distinct factors that could be related to blood loss were analyzed. The incidence of anemia and the need for postsurgical transfusion were calculated. Results Postcesarean anemia was found in 80% of the patients, but with a loss below 2g/dl. The factors associated with a higher rate of blood loss were multiparity, previous cesarean section, gestational age <30 weeks and urgent cesarean section. No significant differences were found with regard to a history of preeclampsia or the type of anesthesia used. The Misgav-Ladach technique for cesarean section reduced blood loss. ConclusionsIn our study, multiparity and urgent cesarean section were associated with a higher rate of anemia( AU)

Violencia sexual: un nuevo enfoque institucional / Sexual violence: a new institutional approach

Introducción: la violencia por motivos de género es una cuestión social que cobra un enorme precio en materia de salud mental y física. Es posible que la mitad de todas las mujeres estén sujetas en algún momento de su vida actos de violencia por motivos de género. Cada año, dos millones de niñas y mujeres corren riesgo de mutilación genital. La violencia puede ser evidente, como en el caso de los castigos físicos o las agresiones sexuales, o encubierta, como en el abandono o en maltrato emocional. Objetivo: Contribuir a la concientización del cuerpo profesional, a fin de hacerlo perceptivo a las necesidades de las víctimas de violaciones, pudiendo así lograr el desarrollo de un programa asistencial integral de las mismas. Material y método: Se realizó una revisión de los conceptos de definición y diagnósticos diferenciales de violación y abuso sexual. Se realizó el estudio comparativo entre distintos Códigos Penales (Españo, Argentino y su modificatoria del año 1999) de los principales artículos que reglamentan este tema. Se selecionaron las principales normativas vigentes que reglamentan los derechos humanos, la eliminación de las formas de discriminación de la mujer y los principios fundamentales de justicia para las víctimas de delitos. Resultados: Se conceptualizaron premisas profesionales, éticas y humanas que creemos fundamentales en el abordaje de esta problemática. Se plantea como necesidad una definición más abarcativa de violación de nuestro Código Penal, que permita instaurar una forma inequívoca la fellatio in ore como delito de violación. Se reseñan los principales indicadores específicos y de sospecha, así como los estudios infectológicos y la profilaxis a instaurar en caso de violación y abuso sexual. Conclusiones: No actuar para asegurar los derechos de la mujer es ponerse del lado del abuso y la violencia. Al ser indiferentes, resultaremos destructivos

Violencia sexual: un nuevo enfoque institucional / Sexual violence: a new institutional approach

Introducción: la violencia por motivos de género es una cuestión social que cobra un enorme precio en materia de salud mental y física. Es posible que la mitad de todas las mujeres estén sujetas en algún momento de su vida actos de violencia por motivos de género. Cada año, dos millones de niñas y mujeres corren riesgo de mutilación genital. La violencia puede ser evidente, como en el caso de los castigos físicos o las agresiones sexuales, o encubierta, como en el abandono o en maltrato emocional. Objetivo: Contribuir a la concientización del cuerpo profesional, a fin de hacerlo perceptivo a las necesidades de las víctimas de violaciones, pudiendo así lograr el desarrollo de un programa asistencial integral de las mismas. Material y método: Se realizó una revisión de los conceptos de definición y diagnósticos diferenciales de violación y abuso sexual. Se realizó el estudio comparativo entre distintos Códigos Penales (Españo, Argentino y su modificatoria del año 1999) de los principales artículos que reglamentan este tema. Se selecionaron las principales normativas vigentes que reglamentan los derechos humanos, la eliminación de las formas de discriminación de la mujer y los principios fundamentales de justicia para las víctimas de delitos. Resultados: Se conceptualizaron premisas profesionales, éticas y humanas que creemos fundamentales en el abordaje de esta problemática. Se plantea como necesidad una definición más abarcativa de violación de nuestro Código Penal, que permita instaurar una forma inequívoca la fellatio in ore como delito de violación. Se reseñan los principales indicadores específicos y de sospecha, así como los estudios infectológicos y la profilaxis a instaurar en caso de violación y abuso sexual. Conclusiones: No actuar para asegurar los derechos de la mujer es ponerse del lado del abuso y la violencia. Al ser indiferentes, resultaremos destructivos (AU)

Antibodies to macrophage inflammatory protein-1beta in preoptic area of rats fail to suppress PGE2 hyperthermia.

This study determined whether macrophage inflammatory protein-1beta (MIP-1beta) plays a role in the hyperthermia caused by prostaglandin E2 (PGE2) given intracerebroventricularly (i.c.v.) in the rat. In these experiments, anti-murine MIP-1beta antibody (anti-MIP-1beta) was micro-injected in the anterior hypothalamic, preoptic area (AH/POA) just before i.c.v. PGE2. The results showed that anti-MIP-1beta failed to alter the PGE2 hyperthermia. However, immunocytochemical studies revealed MIP-1beta immunoreactivity detectable in both the organum vasculosum laminae terminalis (OVLT) and AH/POA in the febrile rat. These data thus demonstrate that MIP-1beta is sequestered in diencephalic structures underlying thermoregulation even though it is not involved in PGE2 hyperthermia. This dissociation supports the viewpoint that at least two distinct systems exist in the brain which underlie a febrile response: MIP-1beta underlies one component whereas PGE2 comprises the other.

Macrophage inflammatory protein-1beta (MIP-1beta) produced endogenously in brain during E. coli fever in rats.

Macrophage inflammatory protein-1 (MIP-1) evokes an intense fever, independent of a prostaglandin mechanism, and is now thought to play an important role in the defence response to bacterial pyrogens. The purpose of this study was 2-fold: (i) to determine whether the potent doublet of this cytokine, MIP-1beta, is actually produced in the brain in response to a pyrogenic dose of a lipopolysaccharide of Escherichia coli and (ii) to determine the anatomical site of synthesis of this cytokine in the brain. Following the intense fever produced by intraperitoneal administration of lipopolysaccharide in the unrestrained rat, MIP-1beta immunoreactivity was identified post mortem in two regions of the brain implicated in fever: the organum vasculosum laminae terminalis (OVLT) and the anterior hypothalamic, preoptic area (AH/POA). Microinjection of goat anti-mouse MIP-1beta antibody (anti-MIP-1beta) directly int the AH/POA markedly suppressed fever in rats in response to lipopolysaccharide. Further anti-MIP-1beta administered 180 min after the injection of lipopolysaccharide acted as an antipyretic and reversed the fever induced by the endotoxin. anti-MIP-1beta or control immunoglobulin G antibody microinjected into the hypothalamus immediately before the intraperitoneal injection of the control saline did not alter the temperature of the rats. Taken together, the present results demonstrate that MIP-1beta is produced in the brain in response to a bacterial endotoxin. These observations, in the light of earlier data on fever induced by MIP-1beta, further support the hypothesis that endogenously synthesized MIP-1beta acts as an intermediary factor in the evocation of fever by acting on the thermosensitive cells of the brain.

Hypothalamic interaction between macrophage inflammatory protein-1 alpha (MIP-1 alpha) and MIP-1 beta in rats: a new level for fever control?

1. The microinjection of macrophage inflammatory protein-1 (MIP-1 alpha; 5.0 and 25 pg) into the anterior hypothalamic, preoptic area (AHPOA) induced a slow onset; monophasic fever in rats that persisted for a long period. Microinjection of 25 pg MIP-1 beta into the AHPOA induced a fever of rapid onset, whereas 5.0 pg MIP-1 beta did not alter body temperature (Tb) significantly. When either MIP-1 alpha or MIP-1 beta was heated to 70 degrees C for 30 min prior to their injection, no pyrexic response was produced. 2. The concurrent microinjection of 25 pg MIP-1 alpha and 25 pg MIP-1 beta into the AHPOA attenuated the effects on Tb of either cytokine alone. However, pretreatment with either 5.0 pg MIP-1 beta or 5.0 pg MIP-1 alpha suppressed the febrile response induced by 25 pg MIP-1 alpha or 25 pg MIP-1 beta, given at the same site, respectively. 3. The present experiments show that MIP-1 alpha and MIP-1 beta are active individually and possess distinct differences in their evocation of a febrile response. Further, our results suggest a functional antagonism between MIP-1 alpha and MIP-1 beta that could represent a new level in the development of fever.

Role of interleukin-1 beta, interleukin-6 and macrophage inflammatory protein-1 beta in prostaglandin-E2-induced hyperthermia in rats.

The purpose of this study was to investigate the role of pyrogenic cytokines, such as IL-1 beta, IL-6 and MIP-1 beta, in the mechanisms underlying the hyperthermic response of rats to central injection of PGE2. Thus, specific murine neutralizing antibodies against these cytokines were micro-injected directly into the anterior hypothalamic, preoptic area (AH/POA) of unrestrained rats just before intracerebroventricular injection of PGE2. The significant hyperthermia induced by PGE2 was markedly suppressed by micro-injection of anti-IL-6 and partially attenuated by anti-IL-1 beta. However, the micro-injection of anti-MIP-1 beta failed to alter the hyperthermic response. The results indicate that PGE2-induced hyperthermia is presumably mediated through actions of IL-6 on the thermosensitive cells of the AH/POA and confirm that distinct and alternate pathways exist in the rat brain for the induction of fever.

Fever induced in rats by intrahypothalamic macrophage inflammatory protein (MIP)-1 beta: role of protein synthesis.

The effect of macrophage inflammatory protein-1 beta (MIP-1 beta) on body temperature, following its injection into the anterior hypothalamic pre-optic area (AH/POA), was examined by a radiotelemetry system in the freely moving rat. The purpose of this study was to examine the action of an inhibitor of protein synthesis, anisomycin, on the pyrexia which follows intrahypothalamic injection of MIP-1 beta. The micro-injection of 10 to 20 pg MIP-1 beta into the AH/POA induced a dose-dependent monophasic increase in body temperature, whereas a higher dose of 25 pg of the cytokine caused a biphasic febrile response. When MIP-1 beta was heated at 70 degrees C for 30 min prior to its administration, the pyrogenic response was abolished. Pretreatment of the micro-injection site in the AH/POA with 10 micrograms anisomycin did not alter the febrile response to 25 pg MIP-1 beta given at the same site in the AH/POA. When 10 mg/kg anisomycin was administered subcutaneously, the febrile response to 25 pg MIP-1 beta injected in the AH/POA was significantly suppressed. The present results suggest that fever caused by MIP-1 beta within the cells of the AH/POA may not require the synthesis of a new protein factor; however, the de novo synthesis of a protein outside of the AH/POA presumably plays a functional role, at least in part, in the intense fever produced by this cytokine in the hypothalamus.

[An analysis of drug advertising in non-specialty medical journals]. / Análisis de la publicidad medicamentosa en revistas médicas no especializadas.

It has been evaluated drug advertisement in four medical journals during 1989. A questionnaire allows us to evaluate pharmacological and advertising data. The main results obtained are the following: amoxicillin + clavulanic acid was the more advertising drug; the ratio publicity/pharmacological information was 3:1; 60% of the advertising products were new drugs, and only a 6% were essentials drugs according to WHO; slogans were acceptable; generally, aspects such as dosage and toxicology are referred. However, it is necessary to improve information about drug use in elderly patients, patients with impaired renal functional, as well as the necessary information in adverse drug reactions.

[The effects of allopurinol on experimental mesenteric ischemia in the rat]. / Efectos del alopurinol sobre la isquemia mesentérica experimental en la rata.

The effect of allopurinol at doses of 25, 50 and 100 mu p/Kg on the release of free toxic radicals in acute mesenteric ischemia (AMI) produced experimentally has been studied in rats after clamping the superior mesenteric artery. Mortality and variations in haematological, biochemical and morphological parameters (both microscopic and ultrastructural) were recorded. A dose-dependent effect of a bolus of intraperitoneal alopurinol on the severity of mucosal lesions has been noted. A protection against mucosal damage was observed which may be due to the block by alopurinol of the xantine-oxidase system in the ischaemic reperfused intestine. This should be confirmed by larger studies. Alopurinol might be useful prophylactically to prevent damage of the intestine after ischaemia-revascularization events.

Effect of PK 11195, an antagonist of benzodiazepine receptors, on platelet aggregation in a model of anxiety in the rat.

1. Anxiety induced by forced swimming increases maximal intensity (h) of platelet aggregation (PAG) and time to reach it (t). 2. PK 11195 pretreatment (12.5 and 25 mg/kg) reverses anxiety-induced PAG changes. At 6.25 mg/kg it inhibits PAG. 3. Changes induced by anxiety on PAG may be mediated by peripheral-benzodiazepine receptors.