Fezolinetant: un nuevo tratamiento en estudio para la menopausia / Fezolinetant: A new treatment being studied for menopause

La menopausia es el cese fisiológico de la menstruación que puede presentarse en las mujeres entre los 42 y 58 años con una sintomatología diversa. La clínica más frecuente es la vasomotora, que puede afectar en gran medida a la calidad de vida de las mujeres. Tradicionalmente se ha usado la terapia hormonal sustitutiva, que se considera el tratamiento más efectivo. Sin embargo, existe una serie de contraindicaciones por las que se debe plantear el uso de una terapia no hormonal. Actualmente estas opciones son subóptimas en efectividad y tolerancia, por lo que se está investigando acerca de nuevos tratamientos como el fezolinetant, un antagonista del receptor de neuroquinina 3. Para dilucidar dichas investigaciones se ha realizado una búsqueda bibliográfica en las principales bases de datos. Aunque aún queda por establecer su seguridad y efectos a largo plazo, la terapia con fezolinetant parece ser prometedora en pacientes en las que no se puede usar terapia hormonal. Disminuye la sintomatología vasomotora moderada o grave desde el primer día de tratamiento de manera estadísticamente significativa al compararla con placebo y con otros tratamientos no hormonales, con un buen perfil de tolerancia y escasos efectos secundarios. Sin embargo, este medicamento aún se encuentra en ensayos de fase III, por lo que se necesita continuar con su estudio.(AU)

Menopause is the physiological cessation of menstruation that can occur in women between 42 and 58 years of age with diverse symptoms. The most common clinic is vasomotor, which can greatly affect the quality of life of women. Traditionally, hormone replacement therapy has been used and is considered the most effective treatment. However, there are contraindications for which the use of non-hormonal therapy should be considered. Nowadays, these options are suboptimal in terms of effectiveness and tolerance, which is why research is being carried out on new treatments such as fezolinetant, a neurokinin 3 receptor antagonist. To elucidate these investigations a bibliographic search has been carried out in the main databases. Although its safety and long-term effects remain to be established, fezolinetant looks promising in patients for whom hormonal therapy cannot be used. It decreases statistically significant the moderate or severe vasomotor symptoms from the first day of treatment when compared with placebo and with other non-hormonal treatments with a good tolerance profile and few side effects. However, this drug is still in phase III trials, so it needs to continue with its study.(AU)

Mindfetalness: un método cualitativo de autoevaluación de movimientos fetales / Mindfetalness: a qualitative method for self-assessment of fetal movements

Maternal perception of fetal movements is a subjective indicator of fetal well-being. Pregnant women's awareness of their importance remains a subject of discussion because they can increase maternal anxiety and lead to an increase in consultations about their reduction. Quantitative methods have classically been used for self-assessment, although a new qualitative method called mindfetalness has recently been proposed. Its practice has been shown to promote a better relationship with the fetus and to strengthen the maternal-fetal bond, with pregnant women preferring it to classical methods. Although consultations may increase due to decreased fetal movements, the rate of caesarean section, induction of labour, and newborns with low weight for gestational age decreases, resulting in improved maternal, fetal, and newborn management compared to not reporting fetal movements. It has been shown that pregnant women of lower sociocultural status have worse pregnancy outcomes despite its use. There may be other benefits of practicing mindfetalness such as decreased use of epidural analgesia and improved professional pregnancy care.(AU)

La percepción materna de movimientos fetales es un indicador subjetivo de bienestar fetal. La concienciación de las gestantes sobre su importancia sigue siendo objeto de discusión dado que puede aumentar la ansiedad materna y motivar un aumento de las consultas sobre su disminución. Clásicamente se han usado métodos cuantitativos para realizar su autoevaluación aunque recientemente se ha propuesto un nuevo método cualitativo denominado mindfetalness. Se ha demostrado que su práctica promueve el desarrollo de una mejor relación con el feto y fortalece el vínculo maternofetal, prefiriendo las gestantes este método a los clásicos. Aunque pueden aumentar las consultas por disminución de movimientos fetales disminuye la tasa de cesárea, de inducción del parto y de recién nacidos con bajo peso para la edad gestacional, lo que consigue una mejoría del manejo y resultado tanto materno como fetal o del recién nacido en comparación con no informar sobre la importancia de los movimientos fetales. Se ha demostrado que las gestantes con menor nivel sociocultural tienen peores resultados del embarazo a pesar de su uso. Pueden existir otros beneficios de la práctica de mindfetalness como la disminución del uso de analgesia epidural y la mejoría de la atención profesional del embarazo.(AU)

Uso de indometacina y antibioterapia para el manejo de cérvix corto asintomático / Use of indomethacin and antibiotherapy for the management of asymptomatic short cervix

El cérvix corto es un factor de riesgo para el parto pretérmino con etiopatogenia variada y tratamiento aún por dilucidar. Se piensa que la indometacina y la antibioterapia podrían ser útiles en su manejo, lo que ayudaría a disminuir la morbimortalidad asociada al parto pretérmino. Dada la controversia existente se ha realizado una búsqueda bibliografía en las principales bases de datos sobre su uso y beneficio. El uso de indometacina podría evitar los casos de parto pretérmino en edades gestacionales extremas según los últimos estudios, con una tasa de efectos secundarios baja. Mientras tanto, la antibioterapia sería beneficiosa al intervenir en la resolución de la infección o inflamación estéril intraamniótica y del sludge. Sin embargo, el tratamiento de cérvix corto persiste en revisión y discusión, al igual que el uso o no de la amniocentesis para el estudio del líquido amniótico en estos casos. El consenso en cuanto a su manejo está dificultado por la gran variedad de actuaciones que se realizan en la práctica basadas en la experiencia clínica. Esto impide el establecimiento de una serie de pautas concretas de asistencia.(AU)

Short cervix is a risk factor for preterm delivery with varied aetiopathogenesis and its treatment is still to be specified. It is thought that indomethacin and antibiotherapy could be useful in its management, which would help reduce the morbidity and mortality associated with preterm delivery. Given the existing controversy, a literature search about its use and benefit was conducted in the main databases. The use of indomethacin could prevent cases of preterm birth at extreme gestational ages according to recent studies, with a low rate of side effects. Meanwhile antibiotherapy would be beneficial in intervening in the resolution of infection or sterile intraamniotic inflammation and sludge. However, the treatment of short cervix remains under review and discussion, as does the use or otherwise of amniocentesis to study the amniotic fluid in these cases. Consensus on its management is hampered by the great variety of actions that are carried out in practice based on clinical experience. This prevents the establishment of a series of specific care guidelines.(AU)

Three-dimensional photographic analysis of the face in European adults from southern Spain with normal occlusion: reference anthropometric measurements.

BACKGROUND: Recent non-invasive 3D photography method has been applied to facial analysis, offering numerous advantages in orthodontic. The purpose of this study was to analyze the faces of a sample of healthy European adults from southern Spain with normal occlusion in order to establish reference facial soft tissue anthropometric parameters in this specific geographic-ethnic population, as well as to analyze sexual dimorphism. METHODS: A sample of 100 healthy adult volunteers consisting of 50 women (mean age, 22.92 ± 1.56 years) and 50 men (mean age, 22.37 ± 2.12 years) were enrolled in this study. All participants had normal occlusion, skeletal Class I, mesofacial pattern, and healthy body mass index. Three-dimensional photographs of the faces were captured non-invasively using Planmeca ProMax 3D ProFace®. Thirty landmarks related to the face, eyes, nose, and orolabial and chin areas were identified. RESULTS: Male displayed higher values in all vertical and transversal dimensions, with the exception of the lower lip height. Larger differences between sexes were observed in face, mandible, and nose. Male also had higher values in the angular measurements which referred to the nose. No sex differences were found in transverse upper lip prominence or transverse mandibular prominence. No differences were found in the ratio measurements, with the exception of intercantal width/nasal width, which was higher in women than in men. CONCLUSIONS: Reference anthropometric measurements of facial soft tissues have been established in European adults from southern Spain with normal occlusion. Significant sexual dimorphism was found, with remarkable differences in size between sexes.

Electromyographic activity of the jaw muscles and mandibular kinematics in young adults with theoretically ideal dental occlusion: Reference values.

BACKGROUND: A necessary step to use neuromuscular analysis as diagnostic tool is to establish normal reference values for the physiological range in a healthy population. Surface electromyographic (sEMG) activity of the jaw muscles and mandibular kinematics were measured in young adults with theoretically ideal dental occlusion to determine normal reference values during different tasks. Differences between the sexes were evaluated. MATERIAL AND METHODS: Forty young adults (20 men, 20 women; mean age 22.8 ± 3.9 years) with theoretically ideal dental occlusion were selected using very restrictive criteria. sEMG activity of the anterior temporalis (AT), posterior temporalis, masseter (MA), and suprahyoid muscles were evaluated in the rest position and during swallowing, mastication, and clenching. Mandibular kinematics in the rest position and during maximum excursions were assessed. Asymmetry, activity, and torque indices and MA/AT ratios were calculated. RESULTS: For all muscles, sEMG values were 1.01-3.57 µV at rest, 3.50-10.85 µV during swallowing, and 41.04-86.59 µV during mastication. During clenching, values were 230.08-243.55 µV for the AT and MA muscles. Mean total asymmetry, activity, and torque indices at rest were 20.34 %, -15.04 %, and 19.02 %, respectively; during clenching, these values were 6.14 %, -2.62 %, and 4.46 %. MA/AT ratios were near 1. Kinematic measurements during lateral excursion, protrusive and maximum opening were 7.54, 8.44, and 37.38 mm respectively; lateral mandibular shift was 1.41 mm; free way and lateral displacement at rest were 1.40 and 0.26 mm. Right MA activity during mastication and clenching was higher in men than women. CONCLUSIONS: Reference values for sEMG activity and mandibular kinematics were determined. Some muscular asymmetry and torque were observed.

[Prevalence of peripheral artery disease evaluated by ankle brachial index in patients with metabolic syndrome. MERITO I study]. / Prevalencia de enfermedad arterial periférica estimada mediante el índice tobillo-brazo en pacientes con síndrome metabólico. Estudio MERITO I.

INTRODUCTION: Patients with Metabolic Syndrome have high cardiovascular morbidity and mortality rate above that expected when using accepted scales for risk stratification. Ankle brachial index (ABI) is an available, straightforward and reproducible method for the detection of peripheral vascular disease and for improving risk stratification in this population. Our study aimed to evaluate the prevalence of low ABI in patients with metabolic syndrome older than 50 years and to study the risk factors associated with its development. PATIENTS AND METHODS: 1519 subjects between 50 and 85 years, 935 of them with metabolic syndrome (Adult Treatment Panel III [ATP III] criteria), in primary prevention, without symptoms of intermittent claudication and who gave their consent to have an ABI measurement in internal medicine offices were included in the study. Cardiovascular risk factors were evaluated in all participants. An ABI < 0.9 was considered low. RESULTS: The prevalence of a low ABI in subjects with metabolic syndrome was 27.7 (95% CI: 24.8-30.5). Factors associated with low and a pathological ABI were age, higher serum creatinine levels and presence of proteinuria. After multivariate adjustment, only age (OR: 1.07; 95% CI: 1.04-1.09) and active tobacco use (OR: 1.45; 95% CI: 1.10-1.92) continued to be significant. CONCLUSION: Prevalence of a low ABI is elevated in subjects with metabolic syndrome without known cardiovascular disease and related with age and active tobacco use.

Kinesiographic study of the mandible in young patients with unilateral posterior crossbite.

It is generally assumed that children with posterior crossbites have abnormal mandibular movements; however, this assumption has not been clearly evaluated. The purpose of this investigation was to study the movements and the resting position of the mandible in 2 samples of 30 subjects, one aged 10 to 14 years with right posterior crossbite, the other aged 10 to 15 years with normal occlusion. Subjects in both groups exhibited a Class I skeletal relationship and mesofacial growth pattern. A mandibular kinesiograph was used to record both the mandibular resting position and dynamic movements. Mandibular movements were recorded during (1) maximum excursions (opening-closing, protrusion, right and left excursions), (2) swallowing, and (3) mastication. The results showed no differences between groups in the extension of the movements during closing and protrusion. However, crossbite patients exhibited a significant lateral shift during these movements. Right and left excursions were also similar between groups. The dimension of the freeway space was similar between groups, but the lateral shift found in centric occlusion was also present in the crossbite group when the mandible was at rest. The crossbite group more frequently showed a pattern of abnormal swallowing. No differences were found in any of the parameters studied during the masticatory cycle. There was no relationship between the side of the crossbite and the masticatory preference side. In conclusion, posterior crossbite patients showed a lateral shift in some movements that persisted when the mandible was at rest.

Effect of unilateral posterior crossbite on the electromyographic activity of human masticatory muscles.

Studies dealing with the electromyographic activity of masticatory muscles in patients with unilateral posterior crossbite are infrequent. The purpose of this study was to assess the electromyographic pattern of masticatory muscles at rest position, during swallowing, and during mastication, in 30 subjects with right posterior crossbite and to compare them to 30 normocclusive subjects. The 2 groups were matched according to age, gender, skeletal Class I, and mesofacial growth pattern. Electromyographic activity of right and left anterior temporalis, posterior temporalis, masseter, and anterior digastric muscles was recorded at rest position, while swallowing water, and while chewing. Disposable bipolar surface electrodes were used in both groups. Data were compared between groups and between right and left sides within each group. The results revealed that the posterior temporalis of the non-crossbite side was more active than that of the same side in subjects with crossbite at rest position and during swallowing. The activity of both anterior digastrics was higher in the crossbite subjects during swallowing. During chewing the right masseter muscle was less active in the crossbite patients than in normocclusive subjects. The results obtained during chewing indicate a bilateral masticatory pattern in both groups.

Impact of V beta 8+/+ T cells on the development of increased airway reactivity and IgE production in SJL mice.

SJL mice have been extensively characterized as "low-responder" animals in terms of IgE-dependent immediate-type hypersensitivity responses. Since these mice are genetically deficient in certain TCR Vbeta gene segments, we asked whether this might be the reason for the "low-responder" status. Specifically in H-2d mice the TCR-Vbeta8.2 gene element has been shown to play an important role in Th2 immune responses to ovalbumin (OVA). Utilizing a TCR Vbeta8. 2-transgenic SJL (SJL Vbeta8+/+) mouse, we examined whether the H-2s -bearing "low-responder" mouse could be converted into a "high-responder" animal. Remarkably, non-sensitized SJL Vbeta8+/+ mice demonstrated strongly elevated levels of total IgE antibody. Mitogen-stimulated T cells from these mice released high amounts of IL-4 as compared to SJL wild-type (wt) mice. In addition, sensitization to OVA via the airways resulted in the development of increased airway responsiveness in SJL Vbeta8+/+ mice, but not in SJL wt animals. The results indicate that the capacity to produce IgE and IL-4 and to develop increased airway responsiveness can be restored in SJL wt mice by introducing the Vbeta8.2 gene segment into the TCR repertoire.

The relevance of murine animal models to study the development of allergic bronchial asthma.

Bronchial asthma (BA) develops on the basis of a genetic predisposition and involves a characteristic sequence of changes in immune functions. In the immunopathogenesis, several phases can be distinguished: the initial stage is defined as the development of allergic sensitization. This step is dependent on: (i) T cell activation; (ii) IL-4 production; (ii) IgE synthesis; and (iv) mediator release by effector cells. The second phase of allergic inflammation as a consequence of the T cell dependent sensitization is characterized by IL-5 production and eosinophil activation and recruitment. Airway mucosa remodelling is the consequence of chronic inflammatory processes and represents the final stage of BA. In this article animal models will be discussed with regard to their relevance for these different phases in development of chronic allergic BA.