Obesity and female sexual dysfunctions: A systematic review of prevalence with meta-analysis.

Obesity represents a major global health challenge. Female sexual dysfunctions have a negative impact on quality of life and overall health balance. A higher rate of female sexual dysfunctions in obese women has been suggested. This systematic review summarized the literature on female sexual dysfunction prevalence in obese women. The review was registered (Open Science Framework OSF.IO/7CG95) and a literature search without language restrictions was conducted in PubMed, Embase and Web of Science, from January 1990 to December 2021. Cross-sectional and intervention studies were included, the latter if they provided female sexual dysfunction rate data in obese women prior to the intervention. For inclusion, studies should have used the female sexual function index or its simplified version. Study quality was assessed to evaluate if female sexual function index was properly applied using six items. Rates of female sexual dysfunctions examining for differences between obese vs class III obese and high vs low quality subgroups were summarized. Random effects meta-analysis was performed, calculating 95% confidence intervals (CI) and examining heterogeneity with I2 statistic. Publication bias was evaluated with funnel plot. There were 15 relevant studies (1720 women participants in total with 153 obese and 1567 class III obese women). Of these, 8 (53.3%) studies complied with >4 quality items. Overall prevalence of female sexual dysfunctions was 62% (95% CI 55-68%; I2 85.5%). Among obese women the prevalence was 69% (95% CI 55-80%; I2 73.8%) vs 59% (95% CI 52-66%; I2 87.5%) among those class III obese (subgroup difference p=0.15). Among high quality studies the prevalence was 54% (95% CI 50-60%; I2 46.8%) vs 72% (95% CI 61-81%; I2 88.0%) among low quality studies (subgroup difference p=0.002). There was no funnel asymmetry. We interpreted that the rate of sexual dysfunctions is high in obese and class III obese women. Obesity should be regarded as a risk factor for female sexual dysfunctions.

Tratamiento farmacológico en tiempos de incertidumbre: uso de la hidroxicloroquina/cloroquina en el tratamiento de COVID-19 / Pharmacological treatment in uncertainty times: hydroxychloroquine/chloroquine use in the COVID-19 treatment

ANTECEDENTES Y OBJETIVOS: En los momentos de extrema gravedad en los que nos encontramos, y ante la incertidumbre acerca de los tratamientos más eficaces en la lucha contra la enfermedad COVID-19 y con el objetivo de conocer las evidencias que pueden sostener la recomendación de utilización de cloroquina/hidroxicloroquina en el COVID 19, se realizó una revisión sistemática de estudios publicados y EC puestos en marcha con fecha hasta 28 de abril 2020. MATERIAL Y MÉTODOS: Se realizó una búsqueda sistemática en PubMed con las palabras clave COVID-19 y sus sinónimos y cloroquina/hidroxicloroquina. La selección y extracción de los datos aparecidos en dicha búsqueda fue realizada por dos investigadores de forma independiente. Los resultados se discutieron con un grupo clínico de médicos de Atención Primaria y se sintetizaron los resultados mediante tablas de GRADE. RESULTADOS: Se encontró una revisión sistemática de buena calidad que incluye artículos con elevado riesgo de sesgos. Y 8 EC puestos en marcha que arrojarán resultados más allá de mayo de 2020. CONCLUSIONES: Aunque las conclusiones de la revisión sistemática generan una baja confianza en los resultados, y las variables clínicas que muestran beneficio son variables intermedias, los efectos secundarios son asumibles y podrían ser minimizados con el uso de herramientas de riesgo de alargamiento del QT, por lo que se podría hacer una recomendación débil a favor del uso de cloroquina/hidroxicloroquina en pacientes con COVID-19 en estadio leve-moderado

BACKGROUND AND OBJECTIVES: In this moments, of extreme gravity in which we find ourselves, and in the uncertainty face about the most effective treatment against COVID-19 disease and with the aim of find the evidence that support the chloroquine/hydroxychloroquine use recommendation to treat COVID-19 disease, a systematic review of published studies and RCT studies publishes until April 28, 2020 was carried out. MATERIAL AND METHODS: A systematic search was carried out in PubMed with the keywords COVID-19 and their synonyms and hydroxychloroquine/chloroquine. The data selection and extraction was elaborated by two researchers, independently. The results were discussed with a Primary Care physicians clinical group and the results were synthesized using GRADE methodology. RESULTS: A good quality systematic review was found that includes articles with a high risk of bias. And 8 EC launched that will produce results beyond May 2020. CONCLUSIONS: Although the conclusions of the systematic review generate a low confidence in the results, and the clinical variables that show benefit are intermediate variables, the side effects are acceptable and could be minimized with the use of QT lengthening risk tools, so it is could make a weak recommendation in favor of the use of chloroquine/hydroxychloroquine in patients with mild-moderate stage COVID-19

[Pharmacological treatment in uncertainty times: Hydroxychloroquine/chloroquine use in the COVID-19 treatment]. / Tratamiento farmacológico en tiempos de incertidumbre: uso de la hidroxicloroquina/cloroquina en el tratamiento de COVID-19.

BACKGROUND AND OBJECTIVES: In this moments, of extreme gravity in which we find ourselves, and in the uncertainty face about the most effective treatment against COVID-19 disease and with the aim of find the evidence that support the chloroquine/hydroxychloroquine use recommendation to treat COVID-19 disease, a systematic review of published studies and RCT studies publishes until April 28, 2020 was carried out. MATERIAL AND METHODS: A systematic search was carried out in PubMed with the keywords COVID-19 and their synonyms and hydroxychloroquine/chloroquine. The data selection and extraction was elaborated by two researchers, independently. The results were discussed with a Primary Care physicians clinical group and the results were synthesized using GRADE methodology. RESULTS: A good quality systematic review was found that includes articles with a high risk of bias. And 8 EC launched that will produce results beyond May 2020. CONCLUSIONS: Although the conclusions of the systematic review generate a low confidence in the results, and the clinical variables that show benefit are intermediate variables, the side effects are acceptable and could be minimized with the use of QT lengthening risk tools, so it is could make a weak recommendation in favor of the use of chloroquine/hydroxychloroquine in patients with mild-moderate stage COVID-19.

Development of a DGGE method to explore Legionella communities.

Legionella risk assessment is nowadays based on the presence and concentration of either Legionella pneumophila or Legionella spp. Many species of Legionella can cause Legionnaires' disease, indeed about half of the known species have been associated with infection. The aim of this work was to develop a method to assess the composition of the Legionella species community in an environmental sample in order to have a better understanding of the contamination of the ecosystem by pathogenic strains. The method is based on the comparison of PCR-DGGE profile of DNA sample with a database consisting in DGGE profiles of Legionella species. Such a database includes all pathogenic Legionella strains. In order to homogenize and normalize the different DGGE fingerprint, a reference marker has been built and added during DGGE gel analysis. This study gives a valuable advance in the methods available for the understanding of Legionella contamination of water environments.

[Do we adequately prescribe antiplatelet treatment to type 2 diabetic patients?]. / Antiagregamos adecuadamente a los pacientes diabéticos tipo 2?

OBJECTIVE: To estimate how many type 2 diabetic patients receive antiplatelet therapy according to the American Diabetes Association (ADA) guidelines on primary and secondary prevention. DESIGN: A descriptive, cross-sectional study based on information in medical records. A random sample of 170 type 2 diabetics seen in an urban Health Centre was studied. MEASUREMENTS: The data collected including, age, sex, antiplatelet therapy according to the ADA, antiplatelet therapy indicated, cardiovascular risk factors, cardiovascular disease, and other clinical parameters. RESULTS: Of the subjects analysed, 56.9% were males, and the mean age was 67.8 years. The majority of patients (71.2%) were on primary prevention, and 44.4% of the diabetics were receiving adequate antiplatelet therapy according to the ADA. Among the subjects on secondary prevention, 90.9% received adequate antiplatelet therapy, while only 25.7% of those on primary prevention received it, which was significant. The most used antiplatelet drug was acetylsalicylic acid (ASA). CONCLUSIONS: A large proportion of diabetes on primary prevention does not receive adequate antiplatelet therapy, according to the ADA. However, patients on secondary prevention receive sufficient antiplatelet treatment. The benefits of ASA in reducing cardiovascular disease are well documented in patients with cardiovascular disease. On the other hand, the role of antiplatelet therapy in diabetics on primary prevention is not clear and is the subject of discussion. From 2006 to 2011, the ADA has modified the recommendation level of primary prevention antiplatelet therapy, thus decreasing the percentage of patients that may be given antiplatelet therapy with ASA, to the extent that it increases the cardiovascular risk calculation required for its indication.

¿Antiagregamos adecuadamente a los pacientes diabéticos tipo 2? / Do we adequately prescribe antiplatelet treatment to type 2 diabetic patients?

Objetivo. Estimar cuántos pacientes diabéticos tipo 2 deberían recibir tratamiento antiagregante, según las directrices de la Asociación Americana de Diabetes (ADA) en prevención primaria y secundaria. Diseño. Estudio descriptivo transversal, basado en información de historias clínicas. Muestra aleatoria de 170 diabéticos tipo 2 atendidos en el año 2006, en un centro de salud urbano. Mediciones. Edad, sexo, antiagregación según ADA, antiagregante indicado, factores de riesgo cardiovascular, eventos cardiovasculares, parámetros clínicos. Resultados. De los sujetos analizados, 56,9% eran varones, con edad media de 67,8 años. El 71,2% de los pacientes estaban en prevención primaria. El 44,4% de los diabéticos estaban adecuadamente antiagregados, según la ADA. Entre los sujetos en prevención secundaria están adecuadamente antiagregados el 90,9%, mientras que solamente lo están el 25,7% de los de prevención primaria, lo que es significativo. Cuando se antiagrega, el ácido acetilsalicílico (AAS) es el fármaco más usado. Conclusiones. Una gran proporción de diabéticos en prevención primaria no está adecuadamente antiagregada, según la ADA. Sin embargo existe una correcta antiagregación en los pacientes de prevención secundaria. El beneficio del AAS en la reducción de eventos cardiovasculares está correctamente documentado en pacientes con enfermedad cardiovascular. En cambio, el papel de la antiagregación en diabéticos de prevención primaria es poco conciso y objeto de discusión. Desde 2006 a 2011, la ADA ha modificado el grado de recomendación de antiagregación en prevención primaria, disminuyendo el porcentaje de pacientes susceptibles de recibir tratamiento antiagregante con AAS a medida que aumenta el cálculo del riesgo cardiovascular necesario para la indicación (AU)

Objective. To estimate how many type 2 diabetic patients receive antiplatelet therapy according to the American Diabetes Association (ADA) guidelines on primary and secondary prevention. Design. A descriptive, cross-sectional study based on information in medical records. A random sample of 170 type 2 diabetics seen in an urban Health Centre was studied. Measurements. The data collected including, age, sex, antiplatelet therapy according to the ADA, antiplatelet therapy indicated, cardiovascular risk factors, cardiovascular disease, and other clinical parameters. Results. Of the subjects analysed, 56.9% were males, and the mean age was 67.8 years. The majority of patients (71.2%) were on primary prevention, and 44.4% of the diabetics were receiving adequate antiplatelet therapy according to the ADA. Among the subjects on secondary prevention, 90.9% received adequate antiplatelet therapy, while only 25.7% of those on primary prevention received it, which was significant. The most used antiplatelet drug was acetylsalicylic acid (ASA). Conclusions. A large proportion of diabetes on primary prevention does not receive adequate antiplatelet therapy, according to the ADA. However, patients on secondary prevention receive sufficient antiplatelet treatment. The benefits of ASA in reducing cardiovascular disease are well documented in patients with cardiovascular disease. On the other hand, the role of antiplatelet therapy in diabetics on primary prevention is not clear and is the subject of discussion. From 2006 to 2011, the ADA has modified the recommendation level of primary prevention antiplatelet therapy, thus decreasing the percentage of patients that may be given antiplatelet therapy with ASA, to the extent that it increases the cardiovascular risk calculation required for its indication (AU)

The intestinal anti-inflammatory effect of dersalazine sodium is related to a down-regulation in IL-17 production in experimental models of rodent colitis.

BACKGROUND AND PURPOSE: Dersalazine sodium (DS) is a new chemical entity formed by combining, through an azo bond, a potent platelet activating factor (PAF) antagonist (UR-12715) with 5-aminosalicylic acid (5-ASA). DS has been demonstrated to have anti-inflammatory effects on trinitrobenzene sulphonic acid (TNBS)-induced colitis in rats and recently in UC patients in phase II PoC. There is Increasing evidence that Th17 cells have an important role in the pathogenesis of inflammatory bowel disease (IBD). The aim of this study was to further characterize the anti-inflammatory effects of DS. EXPERIMENTAL APPROACH: Effect of DS (10 or 30 mg·kg(-1) b.i.d.) on TNBS-induced colitis in rats was studied after 2 and 7 days with special focus on inflammatory mediators. Additionally, its anti-inflammatory properties were analysed in two different models of dextran sodium sulphate (DSS)-induced colitis, BALB/c and C57BL/6 mice, the latter being dependent on IL-17. KEY RESULTS: DS, when administered for 7 days, showed intestinal anti-inflammatory effects in TNBS-induced colitis; these effects were observed both macroscopically and through the profile of inflammatory mediators (TNF, IL-1ß, IL-6 and IL-17). Although the 2 day treatment with DS did not induce intestinal anti-inflammatory effects, it was sufficient to reduce the enhanced IL-17 expression. DS showed beneficial effects on DSS-induced colitis in C57BL/6 mice and reduced colonic pro-inflammatory cytokines IL-1ß, IL-6 and IL-17. In contrast, it did not exert intestinal anti-inflammatory effects on DSS-induced colitis in BALB/c mice. CONCLUSIONS AND IMPLICATIONS: DS exerts intestinal anti-inflammatory activity in different rodent models of colitis through down-regulation of IL-17 expression.

A probiotic strain of Escherichia coli, Nissle 1917, given orally exerts local and systemic anti-inflammatory effects in lipopolysaccharide-induced sepsis in mice.

BACKGROUND AND PURPOSE: Escherichia coli Nissle 1917 is a probiotic strain used in the treatment of intestinal immune diseases, including ulcerative colitis. The aim of the present study was to test if this probiotic bacterium can also show systemic immunomodulatory properties after oral administration. EXPERIMENTAL APPROACH: The probiotic strain was administered to rats or mice for 2 weeks before its assay in two experimental models of altered immune response, the trinitrobenzenesulphonic acid (TNBS) model of rat colitis, localized in the colon, and the lipopolysaccharide (LPS) model of systemic septic shock in mice. Inflammatory status was evaluated both macroscopically and biochemically after 1 week in the TNBS model or after 24 h in the LPS shock model. In addition, splenocytes were obtained from mice and stimulated, ex vivo, with concanavalin A or LPS to activate T or B cells, respectively, and cytokine production (IL-2, IL-5 and IL-10) by T cells and IgG secretion by B cells measured. KEY RESULTS: E. coli Nissle 1917 was anti-inflammatory in both models of altered immune response. This included a reduction in the pro-inflammatory cytokine tumour necrosis factor-alpha both in the intestine from colitic rats, and in plasma and lungs in mice treated with LPS. The systemic beneficial effect was associated with inhibited production of the T cell cytokines and by down-regulation of IgG release from splenocyte-derived B cells. CONCLUSIONS AND IMPLICATIONS: The anti-inflammatory effects of E. coli Nissle 1917 given orally were not restricted to the gastrointestinal tract.

Aplicaciones terapéuticas de los probióticos / Therapeutic applications of probiotics

En los últimos años han comenzado a desarrollarse nuevos conceptos en nutrición como fruto de la preocupación por una elevada calidad de vida de la sociedad desarrollada. Esto ha promovido la aparición del término “alimento funcional”, que se puede definir como aquel producto, alimento modificado o ingrediente alimentario, que puede proveer beneficios a la salud superiores a los ofrecidos por los alimentos tradicionales. Las bacterias probióticas quedan incluidas dentro del campo de los alimentos funcionales, existiendo evidencias de su eficacia en ciertas patologías, y suficientes estudios experimentales en otras para justificar posibles mecanismos de acción que faciliten el desarrollo de microorganismos más efectivos, así como para definir los límites de su efectividad (AU)

Over recent years new concepts in nutrition have been arising in consequence of some of the negative aspects of modern lifestyles in today’s highly developed societies. This has brought about the appearance of the term “functional foods”, which can be defined as a modified foodstuff or ingredient that can promote better health benefits than those offered by traditional foods. Probiotic bacteria have been included within the concept of functional foods, given that there is sufficient evidence to suggest their effectiveness in combating certain pathologies. Furthermore, numerous experimental studies have identified the action mechanisms that facilitate the development of the most effective microorganisms, whileat the same time establishing the limits of their effectiveness (AU)

Terapéutica en Atención Primaria. Uso de los opioides en pacientes con dolor oncológico / Therapy in Primary Health Care. Use of opioids in cancer patients with pain

Los opioides representan la mejor arma terapéutica para el control del dolor en el paciente oncológico. Más de la mitad de los pacientes con dolor oncológico precisarán, a lo largo de su seguimiento, tratamiento con opioides del 3.er escalón de la Organización Mundial de la Salud (OMS) para ser controlados. El tipo de interacción con los receptores opioides determina las distintas acciones farmacológicas y sus efectos adversos. Pero además las sustancias opioides pueden interaccionar sobre otros sistemas de neurotransmisores y otros receptores. La codeína y el tramadol constituyen el segundo nivel de la escala de la OMS, eficaces en dolor moderado. Se caracterizan por tener techo analgésico. Dentro de este grupo se incluye a la buprenorfina. La morfina, la oxicodona, el fentanilo y la metadona son igual de eficaces para el control del dolor. La selección de uno u otro depende de la vía de administración, el coste del fármaco y los efectos secundarios. La morfina es el opioide mayor de elección aunque no existen estudios concluyentes. El tratamiento del dolor oncológico debe incluir siempre dosis de opioides de rescate para control del dolor irruptivo. Debemos de tener siempre en cuenta los efectos secundarios de los opioides y prevenirlos. La rotación o el cambio de opiáceos es una alternativa terapéutica para mejorar la relación entre la eficacia analgésica y la aparición de efectos secundarios de tratamiento opi

Opioids are the best therapeutic armamentarium for the control of pain in the oncology patient. More than half of the cancer patients with pain will need treatment with opioid treatment (WHO step 3) during their follow-up to be controlled. The type of interaction with the opioid receptors determines the different drug actions and their adverse effects. However, opioid substances can also interact on other neurotransmitter systems and other receptors. Codeine and tramadol make up the second level on the WHO scale, and are effective in moderate pain. They are characterized by having an analgesic ceiling effect. Buprenorphine are included within this group. Morphine, oxycodone, phentanyl and methadone are as effective to control pain. Choosing one or the other depends on the administration route, drug cost, side effects. Morphine is the opioid of choice, although there are no conclusive studies. Treatment of cancer pain should always include rescue opioid dose to control irruptive pain. We should always keep the side effects of opioids in mind and prevent them. Rotation or change of opiates is a therapeutic alternative to improve the relationship between analgesic efficacy and appearance of side effects of opiate treatment

BsmI vitamin D receptor polymorphism and pathogenesis of parathyroid adenoma.

INTRODUCTION: The role of vitamin D receptor (VDR) gene polymorphism in the pathogenesis of hyperparathyrodism is not clear yet. The aim of this study was to examine the role of BsmI VDR gene polymorphism in patients with primary hyperparathyrodism (PHP) secondary to adenomas. MATERIAL AND METHODS: Fifty-two postmenopausal women with PHP, mean age 64.5 years, were compared with a normal age-matched female population (n = 81). RESULTS: Distribution of BsmI polymorphism in PHP group was: Bb 54% (28/52); BB 21% (11/52); bb 25% (13/52). In the control group, the distribution in PHP group as follows: Bb 49% (40/81); BB 16% (13/81); bb 35% (28/81). No statistical differences were found between the two groups. In the PHP group, no statistical associations were found between different allelic distribution and age, creatinine, hematocrit, phosphorus, alkaline phosphatase (ALP), total calcium, serum parathyroid hormone (PTH), or gland weight. This data suggest that at least in this group, BsmI VDR gene polymorphism appears to be without relevance in clinical presentation and possibly tumorigenesis in PHP secondary to adenomas.

Lack of relationship between BsmI vitamin D receptor polymorphism and primary hyperparathyroidism in a Spanish female population.

The role of vitamin D receptor (VDR) gene polymorphisms in the pathogenesis of hyperparathyroidism is uncertain. Controversial results have been reported. The aim of this study was to explore the relevance of BsmI VDR gene polymorphism in patients with primary hyperparathyroidism (PHPT) due to adenomas. For this purpose, 36 postmenopausal patients with PHPT, mean age 64 years, were compared with a normal age-matched female population (n = 81). BsmI polymorphism distribution in PHPT group was as follows: Bb 50% (18/36); BB 22% (8/36); bb 28% (10/36). In the control group, the distribution was Bb 49% (40/81); BB 16% (13/81); bb 35% (28/81). No statistical differences were found between the two groups. In the PHPT group, no statistical associations were found between different allelic distribution and age, creatinine, hematocrit, phosphorus, alkaline phosphatase (ALP), total calcium, serum parathyroid hormone (PTH), or gland weight. By contrast, levels of serum calcium and iPTH values positively correlated with the PT weight (r = 0.421 and 0.599, respectively, P = 0.0001). Our data suggest that at least in this group, BsmI VDR gene polymorphism appears to be of minor relevance in clinical presentation and possibly, tumorigenesis in PHPT due to adenomas.

[Treatment with interferon of chronic active hepatitis in patients with HIV infection]. / Tratamiento con interferón de la hepatitis crónica activa en pacientes con infección por VIH.

Clinical records of 14, CD4 cell counts > 400/mm3, mild symptoms or asymptomatic, HIV infected patients and with chronic active hepatitis (identified by hepatic biopsy) were under review. Four of them were infected with HBV, 8 with HCV, 1 with HDV and other one with HBV + HCV + HDV. They were treated with alpha interferon for 6 months. Effectiveness was evaluated. It was found that in 4 (50%) of HCV infected patients transaminases raised normal value two of them remained with normal values at the end of review (22 and 48 months of follow-up). All HBV infected patients (4) normalized transaminases. Three of them lost HBeAg, that persisted through 38 months of follow-up. It was found too, whose did not improved with 6 months treatment did not benefit with a longer treatment. Therefore, HIV infected patients uncompromised (CD4+ > 400/mm3) and with chronic active hepatitis were benefited by interferon treatment (57%). Reversal of HBeAg was remarkable.

[Edema as clinical manifestation of hyperthyroidism. Report of 2 cases]. / Edemas como manifestación clínica de hipertiroidismo. A propósito de dos casos.

We report two cases of hyperthyroidism clinically associated to edema, in which no usual causes for the latter were found. Correction of the hyperthyroidism state was associated with complete resolution of edema. The fact that one of the cases consisted of a farmacologically induced hyperthyroidism points to a direct effect of the thyroid hormone itself as the origin of this complication. The de novo occurrence of edema can be due to thyroid hyperfunction as the only underlying cause, the presence of other associated factors such as heart failure, hypoproteinemia or dermopathy not being necessary for its development.

[Descriptive study of 39 cases of hepatic abscess of pyogenic and amebic origin]. / Estudio descriptivo de 39 casos de abscesos hepáticos de origen piógeno (33) y amebiano (6).

Thirty nine cases of liver abscess--33 pyogenic (LAP) and 6 amebic (LAA)--attended in our hospital between 1980 and 1994, were reviewed. Mean patient age was 55.66 years (LAP) and 35.83 years (LAA), while the relation male/female was 2.3:1 and 5:1 respectively. The most usual underlying pathology in LAP was bile duct disease (39.39%). Four patients with LAA had travelled to endemic areas. Fever was the most frequent clinical finding (71.79%). Echography and/or CT scan confirmed the diagnosis in 32 patients (82.05%), with a sensitivity of 86.66 and 95.65% respectively. Positive cultures were found in 74.35% (39.13% polymicrobials), being E. Coli and K. Pneumoniae the most frequently isolated bacteria. In LAP pus cultures were positive in 73% and blood cultures in 55%. Diagnosis of LAA was made by wet mount smears/serology (3/3). Percutaneous drainage was performed in 41.02%, surgical drainage in 48.71 and 15.38% (all with LAP) received antibiotics exclusively. Four patients died (3 with LAP and 1 with LAA).