Immune tolerance at the maternal-placental interface in healthy pregnancy and pre-eclampsia.

AIM: The objective of this review is to describe the immunological mechanisms which facilitate maternal tolerance at the maternal-placental interface, and to discuss how these mechanisms are disrupted in pre-eclampsia. METHODS: A literature review was performed based on the analysis of papers available on PubMed. The most important and relevant studies regarding the immunological mechanisms which facilitate maternal tolerance in healthy pregnancy and pre-eclampsia are presented in this article. RESULTS: The maternal-placental interface is the site where the immune tolerance begins and develops. Within the innate immunity, natural killer cells, macrophages and dendritic cells play a pivotal role in tolerance through regulation of inflammation. On the other hand, within the adaptive immunity, the correct increase of regulatory T cells is crucial for ensuring immune tolerance toward placental cells. Disturbances in maternal tolerance can lead to the appearance of pregnancy complications such as pre-eclampsia, which has a considerable impact on perinatal morbidity and mortality. CONCLUSION: Our partial knowledge of immunological mechanisms involved in tolerance at the maternal-placental interface indicates that pre-eclampsia is characterized by alterations of this maternal immune tolerance, which could represent the origin of the disease.

Placental Proinflammatory State and Maternal Endothelial Dysfunction in Preeclampsia.

OBJECTIVE: To evaluate the placental and decidual gene expression and maternal and umbilical serum concentrations of tumor necrosis factor alpha, interleukin 6 (IL-6), IL-8, IL-10, IL-1 receptor antagonist (IL-1RA), intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 (VCAM-1), along with the proinflammatory/anti-inflammatory cytokine ratios in women with preeclampsia (PE) vs. women with normal pregnancy (NP), and to analyze PE classified as early- (EO) and late-onset (LO). METHODS: This cross-sectional study was performed with 50 women with PE (EO n = 30, LO n = 20) and 50 women with NP. Tissue gene expression levels were measured by real-time RT-PCR. Cytokines and adhesion molecules serum concentrations were measured by immunoassays. RESULTS: In PE, placental expression of IL-10 and IL-1RA was lower, while placental IL-8/IL-1RA ratio and maternal concentrations of VCAM-1 were higher vs. NP. In EO, placental expression of IL-10 was lower, while placental IL-8/IL-10 and IL-8/IL-1RA ratios were higher than LO and NP. Maternal concentrations of IL-6 were higher in LO than EO and NP. Throughout PE, maternal VCAM-1 concentrations were higher vs. NP. No significant differences were observed in the decidual expression and umbilical concentrations of the markers between the groups. CONCLUSION: PE associates with a proinflammatory placental state; however, EO associates with a proinflammatory placental state, while LO associates with systemic maternal inflammation. Both subtypes associated with maternal endothelial dysfunction.

La esteroidogénesis en el síndrome de ovarios poliquísticos.

Polycystic ovary syndrome is the most common endocrine disease in reproductive age, characterized by menstrual alterations, clinical or biochemical hyperandrogenism, and ultrasound-identified ovarian cysts. The neuroendocrine and metabolic alterations that accompany this condition involve the desensitization of the hypothalamus-pituitary-ovary axis, steroidogenesis and hyperandrogenism; recently, the role of insulin resistance has been explored. Hyperandrogenism has been established to be the main cause of polycystic ovary syndrome, due to enzymatic alterations in the steroidogenic pathway that cause luteinizing hormone over-stimulation because of quick pulses generated by gonadotropin-releasing hormones. Various growth factors of and cytokines inhibit the conversion of androgens into estrogens; activin and prostaglandins are also involved, even high levels of insulin participate in the characteristic deregulation of this syndrome.

El síndrome de ovarios poliquísticos es la enfermedad endocrina más frecuente en la edad reproductiva; se caracteriza por alteraciones menstruales, hiperandrogenismo clínico o bioquímico e identificación ultrasonográfica de quistes ováricos. Las alteraciones neuroendocrinas y metabólicas que lo acompañan implican desensibilización del eje hipotálamo-hipófisis-ovario, esteroidogénesis e hiperandrogenismo. Recientemente se ha explorado el papel de la resistencia a la insulina. Se ha establecido que la principal causa del síndrome de ovarios poliquísticos es el hiperandrogenismo, debido a alteraciones enzimáticas en la vía esteroidogénica, por lo que existe sobreestimulación por parte de la hormona luteinizante a causa de los pulsos rápidos generados por la hormona liberadora de gonadotropinas. Diversos factores de crecimiento y citocinas inhiben la conversión de andrógenos a estrógenos. En la desregulación característica de este síndrome también están involucradas la activina y las prostaglandinas e, incluso, altos niveles de insulina.

Treatment of menopausal symptoms with three low-dose continuous sequential 17ß-estradiol/progesterone parenteral monthly formulations using novel non-polymeric microsphere technology.

OBJECTIVE: To analyze the short-term efficacy and safety over menopausal symptoms of three low-dose continuous sequential 17ß-estradiol (E)/progesterone (P) parental monthly formulations using novel non-polymeric microspheres. METHODS: This was a multicenter, randomized, single blinded study in which peri- and postmenopausal women were assigned to receive a monthly intramuscular injection of 0.5 mg E + 15 mg P (Group A, n = 34), 1 mg E + 20 mg P (Group B, n = 24) or 1 mg E + 30 mg P (Group C, n = 26) for 6 months. Primary efficacy endpoints included mean change in the frequency and severity of hot flushes and the effect over urogenital atrophy symptoms at 3 and 6 months. Safety variables included changes in the rate of amenorrhea, endometrial thickness and histopathology, and local and systemic adverse events. RESULTS: Compared to baseline at month 6, the three treatment schemes significantly decreased the rate of urogenital atrophy symptoms and the frequency (mean number per day) and severity (mean number graded as moderate and severe per month) of hot flushes. No differences in studied efficacy parameters were observed between studied groups at baseline or at the end of the study. For all groups the most frequent adverse event was pain at the injection site; however they were all rated as mild. At the end of the study peri- and postmenopausal women displayed no significant changes in endometrial thickness or histopathology in all treated groups. The rate of amenorrhea at the end of the study decreased for all studied groups yet was less evident among postmenopausal women as compared to perimenopausal ones. CONCLUSIONS: The three low-dose continuous sequential intramuscular monthly treatments of E/P using novel microsphere technology were effective at reducing menopausal symptoms at short-term with a low rate of adverse events. More long-term and comparative research is warranted to support our positive findings.

[Perinatal complications and serotonin level (5-HT) associated with low birth weight]. / Complicaciones perinatales y concentración de serotonina (5-HT) en recién nacidos asociadas con bajo peso al nacimiento.

BACKGROUND: Studies in human and in experimental models suggest that interaction among the adverse prenatal and postnatal environment increases susceptibility for chronic diseases. This environment could induce changes in the metabolism balance. OBJECTIVE: To analyze how the low birth weight (LBW) influences on the perinatal complications and serotonin serum concentration associated with the possible changes in the alimentary behavior. MATERIAL AND METHODS: A prospective, longitudinal and descriptive study was made during 6 months of the obstetric events to know the frequency and complications of LBW. To evaluate if these complications could have some relationship with the serotonin concentration we measured through their metabolite 5-hidroxitriptamina (5-HT) and the possible chronic illnesses of the adult life. RESULTS: From 1,418 obstetric events attended during the study period, 506 patients with viable pregnancies and met the inclusion criteria were included, 26.8% had LBW and the immediate clinical complications were presented in 52.2% of them and serum concentration 5-HT of 362.2 ± 21.8 vs 82.1 ± 13.6 ng/mL. CONCLUSION: Low birth weight, besides causing perinatal complica- tions, also conditions permanent changes in the expression of satiety neurotransmitters and some tissues, that alter the regulation mechanisms to maintain the energy balance leading to metabolic stability, which is needed to the proper endocrine functioning in the adult life of these individuals.

[Cornual ectopic pregnancy]. / Embarazo ectópico cornual. Reporte clinic.

This paper reports the case of a 16-year old patient, with menstrual delay of 9 weeks, with positive pregnancy test, who went to the hospital due to expulsion of organized material, as well as pain colic type in hypogastrium. It was carried out laparotomy, finding ectopic pregnancy in right horn, being carried out miometrial incision and trophoblast aspiration, with presence of multiple endometriosic focuses in later face of uterus. In later pregnancies, there are not studies about the solidity of the scar after the horn resection and uterine breaks have been described in the second and third trimester.

[Convenience clinic redefine polycystic ovary syndrome (Stein-Leventhal)]. / Conveniencia clínica de redefinir al síndrome de poliquistosis ovárica (Stein-Leventhal).

In 1935 during a medical meeting behalf in New Orleans was presents a study that included seven cases of women that suffered menstrual dysfunctions, hirsutism and sterility, for laparotomy the description of the ovaries had a pearly white color and it was hypertrophic, the cuneiform resection in both ovaries resulted in correction of the menstrual dysfunction and two of them got pregnancy later on, receiving the name of polycystic ovary syndrome (PCOS). The technological advance facilitates the hormonal analyses demonstrating the hyperandrogenism existence and the mechanism of the anovulation, the PCOS showed to be heterogeneous, reason why it was hindered to define it, this advanced the current trend to question the existence of the PCOS and to accept the convenience, either to change the name or to redefine it, leaving it as a simple syndrome with several phenotypes. The endocrine component includes abnormal secretion of insulin and consequently outlying resistance to this hormone, likewise is hyperandrogenism, dislipoproteinemia and obesity. The hormonal exams are unnecessary for the diagnostic and treatment; it is convenient to demonstrate for sonography the ovarian growth. Other dysfunctions like the congenital suprarenal hyperplasia, hyperprolactinemia and hypotiroidism should be discarded. The treatment should be individualized with relationship to the reason of the consultation and the patients age. It has not been demonstrated that the sensibilitizers use to the insulin avoids long term cardiovascular illness and diabetes. Therefore, the phenotype is heterogeneous with a fickle metabolic component and for it has arisen the restlessness of a better definition of the SPO.

[Incidence of preterm births in the IMSS (2007-2012)]. / Incidencia de nacimientos pretérmino en el IMSS (2007-2012).

BACKGROUND: The birth of a premature child implies an expense raised for the families and the systems of health for the possibilities of visual, auditory disability and problems of learning. The rate of premature births, according to the WHO, goes from 5 to 18 %, for what it was found that it will have to diminish. OBJECTIVE: Knows the behavior of the incident of the childbirth pretérmino in the Mexican Institute of the Social Insurance (IMSS) during the period 2007-2012 in the hospitals of the second and third level of attention ginecoobstétrica. MATERIAL AND METHOD: Descriptive and retrospective study in which there was analyzed the existing information of the cases brought of birth pretérmino in the IMSS (2007-2012). Proved: the total of births was of born 3,135,755 alive, of this 7.7 % they were pretérmino in all the conditions of the Republic, which on having differed with the second level of attention existed 188,715 (6.8%) born pretérmino and the third level of attention (Medical Units of Alta Especialidad, UMAES) with 51,635 (13.7%) born pretérmino (p < 0.05). RESULTS: The total of births was of born 3,135,755 alive, of this 7.7% they were pretérmino in all the conditions of the Republic, which on having differed with the second level of attention existed 188,715 (6.8%) born pretérmino and the third level of attention (Medical Units of Alta Especialidad, UMAES) with 51,635 (13.7%) born pretérmino (p < 0.05). CONCLUSIONS: The strategies to approach the problem of the prematurez are the prevention of the childbirth and the care perinatal to diminish the mortality of the baby and to increase his quality of life for what it is necessary to reinforce the contraceptive Council in the teenagers, to spread the births, as well as the detection and treatment of the infections genitourinarias.

[Hematocervix, a new variety of hematometra. A case report]. / Hematocervix, una nueva variedad del hematómetra. Reporte de caso.

The hematometra should be suspected in a patient with amenorrhea and recurrent pain in low stomach. It is conditioned by anatomical obstruction of the exit way from menstrual bled, that can release the presentation forms described as hematocolpos, hematometra and hematosalpinx. Report does not exist where alone the cervix is affected, for what the case is described with connotation of hematocervix. Patient of 32 years, regular menstruation, begins symptoms 25 days later to the menstruation, characterized by intense abdominal pain, for what goes to the service of gineco-obstetrics urgencies, where it is hospitalized under diagnose of abdominal painful syndrome. The transvaginal sonographic reports long cervix and with distention for a collection liquidates, the intern cervical hole open, the external minimally dehiscent, scarce flow of the contained endocervical toward the vaginal way through the external hole, for its ecographic aspect compatible with hematic material. The diameters anteroposterior and transverse of the cervix of 2.50 and 4.57 cm respectively. Was passed to surgical room, CEH with fibrosis that hindered the open dilation, for what were take both lips of the cervix and proceeded to dilation with Hegar until number 6, begin glide of dark and dense blood approximately in 60 mi. The evolution was good, since later to the anesthetic event, she referred remission of the pain and the sonographic control demonstrated cervix of normal anatomical characteristic, inclusive until year of follow. A wide diversity of symptoms and clinical data have been demonstrated that should have present for the hematometra diagnosis, among those that are the urinary retention, tennesmus and presence of painful pelvic mass, but the recurrent abdominal pain is the constant in all the cases.

[Decreased insulin resistance with amino acids, extracts and antioxidants in patients with polycystic ovary syndrome]. / Disminución de la resistencia a la insulina con aminoácidos, extractos y antioxidantes en pacientes con síndrome de ovarios poliquísticos.

BACKGROUND: The polycystic ovary syndrome (PCOS) it is a metabolic disorder with insulin resistance associated. Have been recently described contributor factors in the presence of insulin resistance that need to be studied. These factors can be the nutrients in the daily diet, final products of the advanced glycated end-products (AGEs), reactive derivatives of non enzymatic glucose-protein reactions either produced endogenously or ingested from dietary sources. The aim was to modifies the food intake to know the contribution on improve insulin resistance. OBJECTIVE: Compare different diets and changes in insulin resistance in patients with polycystic ovary syndrome. MATERIAL AND METHODS: As longitudinal, prospective and descriptive study, were included women with age among 18 to 40 years who received a compound with amino acids, extracts and anti-oxidants to dose of 660mg every 8 hours for 6 months. The inclusion approaches included the insulin resistance presence HOMA-IR > 2.6, elevated LH, and presence of ovaries with cysts by ultrasound. Statistical analysis with ANOVA one way to p <0.05. RESULTS: Were included a total of 30 patients, of which 28 patients had improvement in the insulin resistance from the 3 months, but until the 6 months they had significant difference (p<0.05), compared with 24 women from control group. CONCLUSION: With this result is demonstrated that it is necessary to modify the diet and to offer alimentary support to avoid the oxidative stress that takes impairment the insulin signaling with the subsequent insulin resistance.

[Conservative treatment of subcapsular hematoma in preeclampsia and HELLP syndrome: a case report]. / Tratamiento conservador del hematoma hepático subcapsular en pacientes con preeclampsia y síndrome de HELLP coexistentes: reporte de caso y revisión bibliográfica.

BACKGROUND: Liver hematoma is a rare and serious complication of pregnancy associated with preeclampsia-eclampsia and HELLP syndrome. CASE REPORT: 27 years old patient with two pregnancies, first pregnancy with eclampsia, admitted with 36.5 weeks of gestation, blood pressure of 140-100 mmHg, epigastric pain, shoulder pain without peritoneal irritation and increased tendon reflexes. The requested preeclamptic profile supports the diagnosis of severe preeclampsia and HELLP syndrome. It was decided to terminate the pregnancy by abdominal route. Male product was obtained alive, 2,060 g, Apgar 8/9, gestational age of 38.2 weeks Capurro. A review did not report liver parenchymal. The evolution during mediate puerperium was torpid, the patient presented epigastric pain and shoulder pain, and there was a rise in transaminases (AST 687 U/L, ALT 813 U/L), progressive thrombocytopenia (113, 103/ pL), decreased hemoglobin, proteinuria and hypovolemic shock. Abdominal CT scan was requested, and it confirmed a heterogeneous liver image (117 x 85 x 104 mm) with a volume of 694 cc, suggesting hepatic hematoma. Serialized control of abdominal CT indicated liver hematoma resorption after 25 days of hospitalization. Seven days after discharge transaminase levels were normal. CONCLUSION: To consider in the diagnosis of preeclampsia and HELLP syndrome the likelihood of liver hematoma as an acute complication; early treatment improves the prognosis.

[Estimate of the variability in the evaluation of semen analysis]. / Estimación de la variabilidad en la evaluación del análisis seminal.

BACKGROUND: Masculine Infertility diagnosis continues depending in a great number of cases of the analysis of the semen. However, appropriate interpretation of the seminal analysis implies to consider two factors, the dependability of the laboratory and the medical knowledge about the meaning of the seminal alterations. OBJECTIVE: Compare the results of the semen analysis among clinical laboratories. MATERIAL AND METHODS: It was used the semen samples of the patients that need a semen analysis for their study. The sample was collected in the biological fluids assessment laboratory (A) and was evaluated the sperm count, morphology and motility. They were distributed to the other laboratories, andrology laboratory (B) and Assisted Reproduction laboratory (C). It was calculated the coefficients of variation intra-observer and inter-observer and descriptive statistics. RESULTS: It was analyzed 28 semen samples by one technician in laboratory A, one in laboratory B and four in the laboratory C, using the World Health Organization (WHO) recommendations for reporting sperm count, motility and morphology. There is an inter-laboratory variability of the parameters studied in the sperm morphology with statistical difference (p < 0.001). The observed mean coefficients of variation intraobserver (CVs) were 3.6% for sperm count, 20.3%for motility and 9.4% for sperm morphology. The mean CVs inter- laboratory results were as follows: 25.7% for sperm concentration, 52.2% for sperm motility and 82.6% for sperm morphology. CONCLUSIONS: There is an inter-laboratory variability for the analysis of the semen samples between the 3 laboratories studied for the semen parameters studied.

[Pap test used for detection of cellular changes associated with human papillomavirus]. / El Papanicolaou para detectar cambios celulares por el virus del papiloma humano.

Human papilloma virus can infect any mucous of the body and can cause cancer of the uterine cervix. This suggests recommending the Papanicolaou smear combined with a test for detection of human papillomavirus with a frequency interval of 3 years, since it grants greater information and fidelity to the result. The detection studies should begin at the age of 21 years and should stop at 65 years age. Until recently specific treatments did not exist to treat human papilloma virus, but recently some drugs that have demonstrated good effectiveness in curing the infection of human papilloma virus. One example is glycirrhicinic acid, which has demonstrated fewer adverse effects, as well as the possibility that its systemic employment allows treatment of lesions that are difficult to approach. The medical recommendations should be in constant revision, since a clinical trial can modify the interpretation of what is necessary to individualize each patient's treatment.

El virus del papiloma humano puede infectar cualquier mucosa del cuerpo y causar cáncer del cuello uterino. La última recomendación sugiere realizar la prueba de Papanicolaou combinada con una prueba para detección del virus del papiloma humano aproximadamente cada tres años. Los estudios de detección deben iniciarse a los 21 años de edad y debe detenerse el seguimiento a los 65 años si no existen factores de riesgo asociados que indiquen lo contrario. Hasta hace poco no existían tratamientos específicos contra el papiloma, pero han surgido algunos fármacos que han demostrado buena efectividad como el ácido glicirricínico, con menos efectos adversos y posibilidad de su empleo sistémico para combatir las lesiones difíciles. Cuando no son tratadas, las lesiones por el virus del papiloma humano pueden tener implicaciones sobre la reproducción, la recurrencia de infecciones genitales oportunistas y la anatomía. La identificación y modificación de los cofactores son de suma importancia ya que con ello se modula la persistencia y la progresión de la infección del virus del papiloma humano a neoplasia. Las recomendaciones médicas deben estar en constante revisión, ya que el juicio del clínico puede modificar la interpretación, por lo que es necesario personalizar el tratamiento a cada paciente.

[Clinical practice guideline. Traumatic urethral stenosis in males]. / Guía de práctica clínica. La estenosis de uretra postraumática en el hombre.

The incidence of urethral stenosis in Mexico had not been documented. At the Centro Médico Nacional La Raza, during the year 2010, 629 patients with urethral stenosis were attended as outpatient consultation: 85 % with previous urethral stenosis and 15 % with urethral treatment complication. Urethral stenosis is a chronic illness, with multiple etiological origins and the handling is controversial. It has a great negative impact for the patients and the recurrence reaches 85 %. The treatment consisted of an invasive approach (urethral dilations, endoscopy procedure) and open surgery (urethroplasty). The World Health Organization and World Alliance take the world challenge about the urinary tract infections associated with the attention of patients, focused on urethral stenosis. The objective of the following clinical guide is to offer to the health professional a clinical tool for making decisions in the handling of the hardship or masculine urethral stenosis, based on the best available evidence, carrying out in systematized form with bibliographical research using validated terms of the MeSH: urethral structures, in the databases Trip database, PubMed, Guideline Clearinghouse, Cochrane Library and Ovid.

En México no está documentada la incidencia de la estenosis de uretra en forma consistente. En 2010, en el Centro Médico Nacional La Raza se reportaron 629 pacientes en consulta externa, 85 % de uretra anterior y 15 % de uretra posterior. La estenosis uretral es una enfermedad crónica, de etiología variada y manejo controvertido, con gran impacto negativo para los pacientes y recurrencia hasta de 85 %. El tratamiento puede ser instrumentado (dilataciones, cirugía endoscópica) y por cirugía abierta (uretroplastia). La Organización Mundial de la Salud y Alianza Mundial la consideran un reto de la atención de la salud. El objetivo de la siguiente guía es ofrecer al profesional de la salud, una herramienta clínica para la toma de decisiones en la atención de la estenosis uretral masculina, basada en la mejor evidencia identificada mediante la búsqueda bibliográfica sistematizada en las bases de datos Tripdatabase, PubMed, Guideline Clearinghouse, Cochrane Library y Ovid.

[Associating prognostic factors with clinical results in locally advanced breast cancer]. / Asociando factores pronósticos con resultados clínicos en cáncer de mama localmente avanzado.

Background: Breast cancer is the most frequent malignant tumor in women. Objective: To identify clinico-pathological and molecular markers as predictors of survival in patients with locally advanced breast cancer (LABC). Methods: Retrospective and observational study. The clinical factors of clinico-pathological and molecular predictors in relation with overall survival (OS) were assessed by the survival function, baseline hazard with smoothing and Cox regression. Results: 126 patients were assessed. OS at five years was significantly superior in patients with clinical stage IIIA (87%; p < 0.001), grade 2 tumor (81%; p < 0.001), pathological node stage (ypN0: 90%; p < .001), low-risk Nottingham prognostic index (86%; p < 0.001) and luminal A subtype (88%; p = 0.022). Baseline hazard with smoothing exhibited an increase in the mortality rate at 50 months for the luminal B/ HER2+ subtype compared with other subtypes. The multivariate analysis ascertained that the stage ypN2-3 (hazard ratio [HR] = 7.3; 95% confidence interval [95% CI]: 2.2 to 23.9) and the HER2+ nonluminal (HR = 7.8; 95% CI: 2 to 29.6) and triple negative (HR = 5.4; 95% CI: 1.7 to 17.2) subtypes were associated with a poor OS. Conclusions: The comprehensive evaluation of the molecular marker and clinico-pathological factors provides more accurate predictive and prognostic information. The nodal stage and molecular subtype are suitable clinical parameters on survival for LABC patients.

Introducción: el cáncer de mama es el tumor maligno más frecuente en las mujeres. Objetivo: identificar marcadores clínico-patológicos y moleculares como predictores de la supervivencia en pacientes con cáncer de mama localmente avanzado (CMLA). Material y métodos: estudio retrospectivo y observacional. Los factores clínico-patológicos y moleculares fueron evaluados en relación con la supervivencia global (SG) mediante la función de supervivencia, riesgo basal con suavizamiento y regresión de Cox. Resultados: 126 pacientes fueron evaluadas. La SG a cinco años fue significativamente superior en pacientes con estadio clínico IIIA (87%; p < 0.001), tumor de grado 2 (81%; p < 0.001), ausencia de ganglios patológicos (ypN0: 90%; p < 0.001) y en el subtipo luminal A (88%; p = 0.022). El riesgo basal con suavizamiento exhibió un incremento en la tasa de mortalidad a los 50 meses para el subtipo luminal B/ HER2+ comparado con los otros subtipos. En el análisis multivariado, el estadio ypN2-3 (razón de riesgo [RR] = 7.3; intervalo de confianza del 95% [IC 95%]: 2.2 a 23.9) y los subtipos HER2+ (RR = 7.8; IC 95%: 2 a 29.6) y triple negativo (RR= 5.4; IC 95%: 1.7 a 17.2) se asociaron con una pobre SG. Conclusiones: la evaluación integral del marcador molecular y de los factores clínico-patológicos proporciona información predictiva y pronóstica más precisa. El estadio ganglionar y subtipo molecular son parámetros adecuados con un impacto pronóstico en la SG para las pacientes con CMLA.

[Infection therapeutic modalities in human papillomavirus]. / Terapéutica en infección por virus del papiloma humano.

Human papillomavirus (HPV) genital it can infect any mucous of the body and to cause cancer of the uterine cervix. Until recently specific treatments did not exist on this infection, for what had to destroy or to remove the injured tissue by diverse procedures, what could have obstetric repercussions in young women. Recently some surgical modalities and topical drugs have arisen, as well as of systemic employment that allow to arrive to the lesions difficult to approach, and have demonstrated good effectiveness to cure the infection for HPV, for what an analysis of the medical treatment of this infection type is made.

[Consensus conference of the Mexican Association for the Study of Climateric on veralipride prescription for patients with vasomotor symptoms]. / Consenso de la Asociación Mexicana para el Estudio del Climaterio para la indicación de veraliprida a pacientes con síntomas vasomotores.

Vasomotor symptoms are one of the main reasons for climateric women to consult a physician. Hormone therapy is the first treatment choice, but it is not indicated to all patients. Veralipride is an option for those who cannot or will not try hormone treatment. The Mexican Association for the Study of Climateric (AMEC) assembled an interdisciplinary group of medical experts so that they revised the medical literature on the subject and reached a consensus on veralipride indication, doses, counterindications and safety. The recommendations of the consensus conference on veralipride are: (1) Physicians must be familiar with its indication, side effects, pharmacokinetics and dosage. (2) Patients must be informed on other therapeutical options. (3) Patients' mental and neurological state must be evaluated, in particular to identify movement disorders, extrapyramidal symptoms (tremor or dystonia), anxiety and depression that can be mistaken for climateric symptoms. (4) Any adverse effect associated with the drug must be reported. (5) A random multicenter trial must be carried out in order to identify the frequency and severity of side effects, and (6) Written information on possible health risks when using the drug must be provided.

[Diagnosis of premature menopause measuring circulating anti-Müllerian hormone]. / Diagnóstico de menopausia prematura usando la medición de la hormona anti-mülleriana circulante.

The production of anti-müllerian hormone for the ovarian follicles begins near the puberty and the circulating levels begin to descend progressively in the stage of the pre-menopause coinciding with the depletion follicular and in consequence the menstrual cycles become irregular, frequently anovulatories. Therefore, concentration of anti-müllerian hormone shows a close correlation with follicular reserve and reproductive capacity, more than FSH and estradiol measurements. We described two patients that developed premature ovarian failure without previous diagnosis and therefore just were treated pharmacologically with estrogen-progestagen to induce menstrual bleeding. In blood of both patients was found low levels (< or = 4 ng/mL) of anti-müllerian hormone, and by means of sonography the absence of follicles was demonstrated in the ovaries. Has intended that premature ovarian failure could be of a chromosomal dysfunction, similar to other gonadal dysgenesias, another explanation of the mechanism is that it could be for development of some autoimmunity dysfunction. Therefore, the combined hormonal substitution of estrogen with progestagen should stay during several years to avoid the complications for the lack of estrogens; in some cases, could be informed on offering the pregnancy possibility by means of the attended fertilization using ovules donor.

Maternal serum adipokines and inflammatory markers at late gestation and newborn weight in mothers with and without gestational diabetes mellitus.

OBJECTIVES: Maternal obesity increases the risk of gestational diabetes mellitus (GDM) and is positively correlated with neonatal obesity increasing the risk of adiposity in both young and adult offspring. Maternal secreted factors from adipose tissue such as adipokines and inflammatory cytokines may regulate fetal growth. This study investigated associations between maternal adipokines and inflammatory markers at late gestation, and neonatal anthropometric characteristics in mothers with and without GDM. MATERIAL AND METHODS: The study included 65 women with GDM and 65 pregnant women with normal glucose tolerance evaluated at the time of term elective Caesarean section. Adiponectin, leptin, resistin, adipsin, neutrophil gelatinase-associated lipocalin (NGAL), nerve growth factor (NGF), monocyte chemotactic protein-1 (MCP-1) and tumor necrosis factor-alpha (TNF-alpha) concentrations were measured in maternal serum by the multiplex immunoassay using Magpix technology. C-reactive protein (CRP) was measured with a particle-enhanced turbidimetric immunoassay and neonatal anthropometric variables were assessed. The association of birthweight with individual biomarkers was analyzed using multivariate logistic regression adjusted for maternal factors. RESULTS: Adiponectin, leptin, resistin, adipsin, NGAL and NGF were not significantly associated with higher birthweight. The maternal factors in association with higher birthweight observed in GDM were CRP, MCP-1 and TNF-alpha levels. Regression analysis showed that TNF-alpha was an independent risk factor for higher birthweight (p = 0.046). CONCLUSIONS: These results suggest an involvement of maternal inflammatory markers at late gestation and fetal growth in mothers with GDM, and that TNF-alpha could play a major role.

[Estrogen therapy in menopause. Clinical study in evolution (KEEPS) to explain the risk-benefit dispute to administration]. / Terapia con estrógenos en la menopausia. Estudio clínico en evolución (KEEPS) para explicar la controversia del riesgo-beneficio de su administración.

The Kronos Early Estrogen Prevention Study (KEEPS) is a randomized clinical and controlled study, with the objective of clarifying the controversy that arisen previous studies about the risk-benefit factor with use of estrogens in postmenopausal women. Healthy women aged 42-58 years who are within 36 months of their last menstrual period have been recruited to receive either oral estrogens or patches of estradiol; in addition both groups are given oral micronized progesterone for 11 days of each month. Outcomes will be carotid intimae medial thickness and the accrual of coronary calcium; collaterally subrogate outcomes will be lipoproteins concentrations, coagulation markers, bone densitometry, mammography, skin characteristics and cognitive evaluation. The hypothesis consists in the presence of a window of therapeutic opportunity for the use of estrogens in low dose in healthy women with recent menopause.