Estradiol impairs epithelial CXCL1 gradient in the cervix to delay neutrophil transepithelial migration during insemination.

Female reproductive mucosa must allow allogenic sperm survival whereas at the same time, avoid pathogen infection. To preserve sperm from neutrophil attack, neutrophils disappear from the vagina during the ovulatory phase (high estradiol); although the mechanisms that regulate neutrophil influx to the vagina during insemination remain controversial. We investigated the sex hormone regulation of the neutrophil migration through the cervix during insemination and revealed that ovulatory estradiol dose fades the CXCL1 epithelial expression in the ectocervix and fornix; hence, retarding neutrophil migration and retaining them in the epithelium. These mechanisms spare sperm from neutrophil attack to preserve reproduction, but might compromise immunity. However, luteal progesterone dose promotes the CXCL1 gradient expression to restore neutrophil migration, to eliminate sperm and prevent sperm associated pathogen dissemination. Surprisingly, these mechanisms are hormone dependent and independent of the insemination. Thus, sex hormones orchestrate tolerance and immunity in the vaginal lumen by regulating neutrophil transepithelial migration in the fornix and ectocervix.

Pre Frail 80: Multifactorial Intervention to Prevent Progression of Pre-Frailty to Frailty in the Elderly.

OBJECTIVES: Preventing or delaying frailty has important benefits in the elderly, and in health and social services. Studies have demonstrated the effectiveness of multifactorial interventions in the frail elderly, but there are fewer studies on community-dwelling pre-frail individuals. Identifying pre-frail individuals susceptible to intervention could prevent or delay frailty and its consequences and associated disability and might reverse the state from pre-frail to robust. To evaluate a multifactorial, interdisciplinary primary care intervention in community-dwelling pre-frail elderly patients aged ≥ 80 years. DESIGN: Randomized clinical trial in a Barcelona primary healthcare centre. SETTING: We included 200 community-dwelling subjects aged ≥ 80 years meeting the Fried pre-frailty criteria. Participants were randomized to intervention and control groups. INTERVENTION: The intervention group received a 6-month interdisciplinary intervention based on physical exercise, Mediterranean diet advice, assessment of inadequate prescribing in polypharmacy patients and social assessment, while the control group received standard primary healthcare treatment. RESULTS: 173 pre-frail participants (86.5%) completed the study; mean age 84.5 years, 64.5% female. At twelve months, frailty was lower in the intervention group (RR 2.90; 95%CI 1.45 to 8.69). Reversion to robustness was greater in the intervention group (14.1% vs.1.1%, p <0.001). Functional and nutritional status, adherence to Mediterranean diet, quality of life, and functional mobility were improved in the intervention group (p ≤0.001). CONCLUSION: A multifactorial, interdisciplinary primary healthcare intervention focused on physical exercise, nutrition, review of polypharmacy and social assessment prevented frailty in pre-frail elderly patients, and improved functional capacity, quality of life and adherence to the Mediterranean diet.

Desórdenes psiquiátricos en el puerperio: nuestro papel como obstetras / Psychiatric disorders in the puerperium: Our role as obstetricians

La enfermedad mental constituye un grave problema de salud pública en nuestro ámbito, con una elevada morbilidad, unos costes sociosanitarios muy altos y con una mayor incidencia en mujeres. El periodo gestacional y el puerperio se erigen como factores estresantes capaces de desencadenar o exacerbar la enfermedad mental preexistente. Con esta revisión bibliográfica pretendemos sensibilizarnos sobre la importancia que la morbilidad psíquica oculta representa para la mujer (como individuo) y para la sociedad (como colectivo), identificar los grandes síndromes psiquiátricos más frecuentes, (distinguiendo los que nosotros podemos tratar de los que deben ser derivados al especialista en salud mental), y profundizar en las entidades estrechamente relacionadas con la Obstetricia durante el periodo puerperal (depresión y psicosis posparto)

Mental illness is a serious public health problem in our setting, leading to high morbidity and very high social costs. The incidence of mental illness is higher in women. Pregnancy and the puerperium are stressors that can trigger or exacerbate preexisting psychiatric disorders. This review aims to raise awareness of the importance of hidden psychological morbidity in women both for individuals and for society as a whole, to identify the most common major psychiatric syndromes -distinguishing those that can be treated by gynecologists from those that require referral to a specialist mental health service- and to examine in greater depth the disorders that are closely related to Obstetrics during the puerperium (depression and postpartum psychosis)

Prevalence of sarcopenia in healthy community-dwelling elderly in an urban area of Barcelona (Spain).

INTRODUCTION: The purpose of this study was to evaluate the prevalence of sarcopenia in a cohort of healthy community-dwelling elderly in an urban area in Barcelona (Spain) for native benchmarks and compare them with those published in other geographical areas. MATERIAL AND METHODS: We prospectively evaluated a series of 200 healthy elderly in the community with preserved functional capacity and absence of cognitive impairment. We performed a comprehensive geriatric assessment and determined anthropometric data, muscle mass (MM) and the muscle mass index (MMI). Assessment of muscle mass was performed by bioelectrical impedance analysis (BIA). The cut-off point for defining sarcopenia MMI was established as less than 2 SD of the mean of a reference group comprising 220 healthy volunteers (20-42 years) in the same area. Results were compared with studies undertaken in the USA, France and Taiwan. RESULTS: The cut-off points obtained were 8.31 Kg/m(2) for men and 6.68 Kg/m2 for women, being similar to those observed in France and Taiwan but different from the USA. The prevalence of sarcopenia observed was 33% for elderly women and 10% for males. On comparison of the prevalence of sarcopenia in the four populations, we observed some differences, particularly in males. CONCLUSIONS: We have defined reference values for sarcopenia, determined by BIA, in our setting. We also observed a remarkable prevalence of sarcopenia in the healthy elderly community, especially in females, showing some differences from those in other geographical regions.