Una mirada biológico-social en las características clínicas de adultos cubanos infectados por el virus SARS CoV2.

Introduction: Initial reports of SARS CoV2 virus infections identified the male sex with the highest incidence and lethality and in women the pregnancy was particularized. Social isolation has an impact on men and women. In Cuba  persons with COVID19 disease have a similar distribution according sex, it would be necessary to identify what occurs in middle-aged women where the biological changes of menopause and the burden of their social work must influence the behavior of the disease. Objective: To describe the incidence and lethality of adults with SARS - Cov2 infection with an emphasis on middle-aged women. Subjects and methods: from the reports of Cuban Ministry of Health the total number of people aged between 20-50 years was extract, grouped into 20-39; 40-49; 50-59 years that according to the cycle llife of the woman  were considered reproductive years, years of transition to menopause and posmenopausal years. We calculated incidence rate and lethality according sex and age subgropus. Results: Adults aged 20-59 years were the ones with the highest incidence among patients with active disease, with higher rate in women between 50-59 years. Mortalitty with higher in the male sex and in postmenopausal women. Alcoholism was present in the mortality in men aged 20-29 years. Conclusions: It is necessary to visualize the influence between the biological changes associated with menopause and gender overload on the behavior of COVID19 in middle-aged women.Introducción: Reportes iníciales de la infección por virus SARS CoV2 identificaron el sexo masculino con mayor riesgo de incidencia y letalidad, y en la mujer se particularizo el embarazo. El aislamiento social tiene impacto en hombres y mujeres. En Cuba, las personas con la enfermedad COVID 19 tienen distribución similar según sexos, seria pertinente identificar  que ocurre en la mujer de edad mediana, donde los cambios biológicos de la menopausia y la sobrecarga  de su labor social, deben  influir en el comportamiento de la enfermedad. Objetivo: Describir la incidencia y letalidad de los adultos con infección por el virus SARS-CoV2 con énfasis en la mujer de edad mediana. Metodología: De los reportes del Ministerio de Salud Pública de Cuba se extrajeron: total de personas de ambos sexos con edades entre 20-59, agrupadas 20-39; 40-49 y 50-59 años, que según el ciclo de vida de la mujer fueron considerados años: reproductivos, en transición a la menopausia y de posmenopausia respectivamente. Se calcularon: la tasa de incidencia y la letalidad según sexo,  y  subconjunto de edades. Resultados: Los adultos entre 20 y 59 años fueron los de mayor incidencia entre los pacientes activos. La  tasa, superior en las mujeres con edades entre  50- 59 años. La letalidad fue mayor en el sexo masculino,  y en las mujeres en el grupo de posmenopausia. El alcoholismo estuvo presente en  la mortalidad en varones entre 20- 29 años. Conclusiones: se requiere visualizar la  influencia entre los cambios biológicos asociados con la menopausia  y la sobrecarga de género en el comportamiento de la COVID19  en la mujer de edad mediana

Gender Conditioning and Socio-economical Condition: its Association with Some Risk Factors for Atherosclerosis

Introduction: the process which determine health-disease processes do not affect similarly women and men. These gender differences have a determinant impact in peoples’ health. Objective: to determine the association between gender conditioning and socio-economical condition and some atherosclerosis risk factors in middle aged women. Method: a cross observational study was carried out in two doctors’ offices with socio-economical characteristics supposedly different belonging to the Polyclinic 19 de Abril at the municipality of Plaza de la Revolution, from January 2012 to June 2013. A group of 251 women from 40 to 59 of age was studied. The variables analyzed were atherosclerosis risk factors (arterial hypertension, diabetics mellitus type II, smoking habit, total obesity, abdominal obesity) socio-economical and gender overloading. An exploratory factorial analysis was realized through the method of maximum likelihood estimation aimed at the global evaluation of the association among the three basic dimensions of this research. Results: the increase of gender overloading was associated to the smoking habit. The better the socio-economical situation the higher gender conditioning. Conclusion: dimensions, socio-economical conditions, atherosclerosis risk factors and gender conditioning are mutually independent or more exactly, they have a very low possibility of association

Body mass index and bone mass in postmenopausal women: a dilemma in clinical practice

 ABSTRACTIntroduction: Low weight and obesity are risk factors for osteoporosis in postmenopausal women; however, the influence of its change on a therapeutic response to biophosphonates for the prevention of fractures has not been defined yet. Objective:To describe the association between the body mass index (BMI) and bone mass in postmenopausal women, as well as to identify changes in weight and BMI during the treatment with biophosphonates. Material and methods: Weight, height, and BMI was determined in 296 women who came consecutively to the Climateric and Osteoporosis Clinic (ClimOS) in Havana from 2009 to 2014 (n=103), and to the Department of Metabolic Bone Diseases, Jiménez Díaz Foundation, Madrid (n=193); also, bone mineral density in lumbar spine and hip was measured by DXA.  The influence of initial body weight and its temporal variation with the use of biophosphonates (BPS) was evaluated in 80 of them. Statistical analysis: standard statistical average for qualitative variables, frequencies for the qualitative variables, Student´s t-Tests, and X2 test for differences among them.  Pearson´s correlation to specify the influence of the initial weight and BMI, and their differences in the response to biophosphonates. Besides, p&lt;0,05 value was used for statistical significance. Results: Low weight was identified 4/296; more than half of them were overweight or obese. Women who were evaluated in ClimOs, presented a worse bone status on the hip. Neither association of body weight nor BMI was found on the response to treatment with (BPS). Conclusions: The influence of body weight on a new fracture was controversial; it is suggested to include ponderal variation as part of the treatment for osteoporosis.Keywords:  menopause, osteoporosis, body mass index, biophosphonates, body composition.</p

Calidad del hueso en mujeres de edad mediana con hipertiroidismo subclínico farmacológico Bone quality in middle age women presenting with pharmacological subclinical hyperthyroidism

INTRODUCCIÓN: las hormonas tiroideas en niveles suprafisiológicos y el hipoestrinismo son factores que pueden inducir baja masa ósea. OBJETIVO: determinar la calidad de hueso en mujeres en etapa de climaterio que reciben tratamiento con dosis supresivas con hormonas tiroideas. MÉTODOS: estudio de casos y controles realizado entre marzo de 2006 y diciembre de 2008. Incluye 113 mujeres con edades entre 40-59 años que asisten a la consulta externa de los Institutos Nacionales de Endocrinología y Oncología y Radiobiología, de ellas 43 recibían tratamiento con hormonas tiroideas (grupo estudio) y 70 no (grupo control). Mediante absorciometría dual de rayos x de columna lumbar y antebrazo, se precisó la densidad mineral ósea en g/cm² y el puntaje T, a fin de identificar la presencia de osteopenia o baja masa ósea y osteoporosis. RESULTADOS: la densidad mineral ósea de columna lumbar y antebrazo fue de 0,9229 vs. 0,8856 (p>0,05) y de 0,536 vs. 0,6226 (p0,05 entre grupos). CONCLUSIONES: el uso de hormonas tiroideas en dosis supresiva disminuyó el contenido mineral óseo del antebrazo, sin incrementar el riesgo de fractura.INTRODUCTION: thyroid hormones at supraphysiological levels and the hypothyroidism are factors that may to induce a low bone mass. OBJETIVE: to determine the bone quality in climacteric women under treatment with suppressive doses with thyroid hormones. METHODS: the case-control study conducted between March, 2006 and December, 2008 includes 113 women aged 40-59 seen in external consultation of National Institutes of Endocrinology, Oncology and Radiobiology where 43 of them were under treatment with thyroid hormones (study group) and 70 not (control group). Using dual beam absorptiometry of lumbar spine and the forearm, it was possible to determine the bone mineral density in g/cm² and the T pointing to identify the presence of osteopenia or a low bone mass and osteoporosis. RESULTS: the bone mineral density of lumbar spine and forearm was of 0,9229 vs. 0,8856 (p<0,05) and of 0,536 vs. 0,6226 (p<0,05) for patients of study group. With treatment using thyroid hormones there was less mineral content in both anatomical sites, although the involvement if greater in the forearm (p<0,05). Fracture risk (osteopenia+osteoporosis) in lumbar spine was of 44,1 % and of 50 % and in the forearm was of 44,8 and 42,7 %, respectively for women from both groups. CONCLUSIONS: the use of thyroid hormones in suppressive doses decreased the bone mineral content in forearm with no increase of facture risk

Interrelación entre hormonas tiroideas y crecimiento: importancia clínica Interrelation between thyroid hormones and growth: clinical importance

En la práctica clínica correspondiente a la endocrinología pediátrica, los trastornos del crecimiento son motivo frecuente de consulta y es la hipofunción tiroidea su causa más común. Por esta razón nos propusimos revisar aspectos teóricos relacionados con la función tiroidea, que pudieran explicar el mecanismo mediante el cual las hormonas tiroideas intervienen en el desarrollo del cartílago de crecimiento y del sistema nervioso central. Se revisa brevemente el mecanismo de regulación de las hormonas tiroideas y del efecto de los factores de crecimiento, tanto en la vida intrauterina como en la etapa posnatal. Se expone una hipótesis para explicar cómo ocurre la interrelación entre hormonas tiroideas (factores de crecimiento). Al final se hace referencia al impacto clínico del déficit de hormonas tiroideas durante la infancia.<br>In the clinical practice of pediatric endocrinology, growth disorders is the most frequent reason to go to the doctor´s , being thyroid hypofunction the most common cause of this problem. For this reason, we intended to review theoretical aspects of thyroid function that could explain the mechanism by which thyroid hormones intervene in the development of growth cartilage and of the central nervous system. The regulating thyroid hormone mechanism along with the effect of growth factors on both intrauterine and postnatal life stages was briefly examined. A hypothesis of how the interrelation between thyroid hormones (growth factors) occurs was presented. Finally, reference was made on the clinical impact of thyroid hormone deficit in childhood

Efecto de la terapia hormonal de reemplazo sobre la mamografía: nuestra experiencia Effect of replacement hormone therapy on mammography: our experience in this field

Se realizó un estudio retrospectivo, cuyo objetivo fue describir el efecto de la terapia hormonal de reemplazo (THR) sobre las mamografías de mujeres de edad mediana que asistieron a la Clínica de Climaterio y Osteoporosis (ClimOs) entre enero de 1998 y diciembre de 2003. A cada mujer se le realizó mamografía (Mx) inicial y durante el uso de la THR, las cuales fueron informadas como: 1) mamografías sin alteraciones, 2) con cambios menores [densidad irregular y microcalcificaciones] y 3) con cambios mayores [nódulos, quistes u otra alteración]. Como tratamiento recibieron estrógenos solos (E), estrógenos y progestagenos combinados continuos (EP) y terapia no estrogénica (fitoestrógenos, tibolona). La muestra estuvo constituida por 112 mujeres, con edades entre 34 y 59 años. La Mx inicial mostró: no alteraciones en el 85,5 %, cambios menores en el 9,1 y cambios mayores en el 5,4. En la posTHR (tiempo promedio entre ambos estudios: 2,5 años), el 66 % continuó con mamografías normales, en el 29,0 hubo cambios menores (pA retrospective study was conducted, with the objective of describing the effect of hormone replacement therapy (HRT) on mammography performed on middle-aged females, who had been seen at climacterics and osteoporosis clinics from January 1998 to December 2003. Mammography had been performed on each woman at the beginning and during the use of the HRT, being the results as follows: 1) mammography showing no changes; 2) mammography with slight changes irregular density and microcalcification and 3) mammography with major changes nodules, cysts or any other change . As a treatment, they received estrogen (E), continuos combined estrogen and progestagen (EP) and nonestrogen therapy (phytoestrogen, tibolone). The sample was composed of 112 women aged 34 to 59 years. The initial Mx showed no changes in 85,5 %, slight changes in 9,1 and major changes in 5,4 of females. After the application of HRT (average time between both mammographic studies of 2,5 years), 66 % of females continued showing no changes, 29 and 5 % had slight (p<0,05) and major changes respectively. Continuos combined therapy exhibited the highest frequency of changes. Those females without estrogen therapy showed no changes in mammography breast pattern. On balance, the results achieved in our context were comparable to those reported in other parts of the world about the effect of hormone replacement therapy on mammography breast density