Sensorial innovation for non-invasive breast cancer detection. / La innovación sensorial para detección no invasiva del cáncer de mama.

Breast cancer represents a great challenge due to the context of gender, social and cultural aspects, as well as of the possibility of making accessible early detection methods. Currently, detection mostly relies on image tests (invasive procedures). However, due to new and numerous cases detected in young women, and detected in such advanced stages that only palliative care may be offered, there is opportunity to develop new, innovative and promising detection tests. In order to find solutions to the organizational process of tumor cells, and adapt them for early detection, biomimesis eases the development of new non-invasive approaches and innovative designs. Nowadays, the volatile organic compounds detection (also called volatolome) emitted by tumoral cells can be detected with the use of biological and/or artificial intelligent noses. This approach may represent a real opportunity for the early detection of cancer and several pathologies. There is no doubt that novel test for early detection of different diseases will be soon reality.

El cáncer de mama representa un gran reto por el contexto de género, su "look", el contexto social y cultural, así como la probabilidad de que la detección oportuna sea de fácil acceso. Si bien en la actualidad contamos con pruebas de imagen para su detección, los nuevos y numerosos casos detectados tanto en mujeres jóvenes como en etapas avanzadas de la enfermedad, cuando no hay más que ofrecer que cuidados paliativos, abren oportunidad para desarrollar nuevos y prometedores sistemas de detección. Tratando de buscar soluciones al proceso organizativo de las células tumorales y adaptarlas para su detección oportuna, la biomimesis abre la oportunidad para nuevos enfoques no invasivos y desarrollos innovadores. En la actualidad, la detección de compuestos orgánicos volátiles (llamado también volatoloma), emitidos por las células tumorales mediante narices biológicas y narices con inteligencia artificial, podrían representar una realidad para la detección oportuna del cáncer y otras enfermedades. Es posible que una prueba de detección oportuna para las enfermedades incluyendo al cáncer esté pronta.

[Clinical practice guideline. Diagnosis and treatment of postmenopausal and perinemopausia]. / Guía de práctica clínica. Diagnóstico y tratamiento de la perimenopausia y la posmenopausia.

Post-menopause is the period of life where a deep decline occurs in circulating estrogen levels, inducing the appearance of psycho and somatic symptoms. The classification to understand the chronology of reproductive aging in women (known as STRAW) determines the clinical and endocrine changes contemplating menstrual cycles, symptoms, measurements of FSH, LH, inhibin B, anti-Mullerian hormone , and follicular account. The diagnosis of menopause is established by the absence of menstruation for 12 months or more. The most frequent clinical manifestations of the climacteric syndrome transition to menopause are menstrual disorders, vasomotor symptoms (flushes and/or sweats) and genitourinary manifestations. The assessment of women in the peri- or postmenopause aims to develop: cervicovaginal cytology , lipid profile , serum glucose, basal Mammography at least a year before, pelvic ultrasound, urinalysis, serum TSH, Densitometry in patients older than 60 years if there is no recourse can be applied and FRAX. Drug therapy for the treatment of disorders of the transition to menopause or menopause is divided into: hormone therapy (HT) based estrogens and progestin hormone not being the most recommended the serotonin reuptake inhibitors and norepinephrine, clonidine, gabapentin or veralipride.

La posmenopausia es el periodo de la vida en el que ocurre un profundo descenso en las concentraciones circulantes de estrógenos, lo cual induce la aparición de los síntomas psico y somáticos. La clasificación para entender la cronología del envejecimiento reproductivo en la mujer (reconocida como STRAW) determina los cambios clínicos y endocrinos a partir de examinar los ciclos menstruales, los síntomas, las mediciones de FSH, LH, inhibina B, hormona antimulleriana y la cuenta folicular. El diagnóstico de menopausia se establece por la ausencia de menstruación por 12 meses o más. Las manifestaciones clínicas más frecuentes del síndrome climatérico o transición a la menopausia son los trastornos menstruales, los síntomas vasomotores (bochornos o sudoraciones) y las manifestaciones genitourinarias. La evaluación de la mujer en la peri o la postmenopausia contempla la realización de citología cervicovaginal, perfil de lípidos, glucosa sérica, mastografía basal (por lo menos un año antes), ultrasonido pélvico, examen general de orina, TSH sérica, densitometría (ver la Guía de práctica clínica de osteoporosis) en pacientes mayores de 60 años (y si no se cuenta con el recurso se puede aplicar el FRAX). El tratamiento farmacológico para las alteraciones de la menopausia (o de la transición a esta) se divide en: tratamiento hormonal (TH) con base en estrógenos o progestágenos, y tratamiento no hormonal; los más recomendados son los inhibidores de recaptura de serotonina y norepinefrina, clonidina, gabapentina o veraliprida.

[Usefulness and risks of routine mammography for the detection of breast cancer]. / Utilidad y riesgos de la mamografía rutinaria para detectar cáncer de mama.

It has been accepted that preclinicall detection of breast cancer by means of the routine practice of mammography could discover the disease at its initial stage; therefore, practicing a mammography annually became widespread as a preventive health measure to diagnose the disease and prevent death due to breast cancer. Over time, the benefit of detection tests has been questioned and demonstration of their benefit, as well as that of the undesirable effects they might cause, has been demanded. There is recent information with regard to an absence of difference in terms of breast cancer mortality as final index between women with or without routine mammography. Additionally, a 20 % frequency has been observed in false-positive diagnoses, with high numbers of women undergoing unnecessary diagnostic procedures due to suspicion of a non-clinically apparent presumed cancer. In Mexico, from 2004 on, the popularity of mammography to detect and effectively cure cancer has increased. Acceptance can be attributted to how easily detection campaigns can be promoted, since most women accept that mastography can offer the opportunity of receiving an early treatment that reduces dissemination and prevents early mortality. The age at which it is convenient to perform the first mammography, how frequently it should be repeated and even the age for its discontinuation is still under debate and no consensus has been reached.

Se ha aceptado que la detección preclínica del cáncer de mama mediante la práctica rutinaria de mamografía podría descubrir el cáncer en su etapa inicial, por lo que se generalizó hacer anualmente una mamografía como medida de salud preventiva para diagnosticar e impedir la muerte por cáncer mamario. Con el tiempo se ha cuestionado el beneficio de las pruebas de detección y se exige que se demuestre el beneficio y los efectos indeseables que pudieran causar. Existe información reciente respecto a que no hay diferencia en cuanto a la mortalidad por cáncer de mama como índice final entre las mujeres con o sin mamografía rutinaria. También se ha observado 20 % de frecuencia de diagnósticos falso-positivos, por los cuales numerosas mujeres han sido sometidas a procedimientos diagnósticos innecesarios por la sospecha de un supuesto cáncer que no es clínicamente aparente. En México, a partir de 2004 se incrementó la popularidad de la mamografía para detectar y curar efectivamente el cáncer, sin embargo, la mortalidad por cáncer de mama no ha variado. La aceptación se puede atribuir a la facilidad para promover las campañas de detección, ya que la mayoría de las mujeres acepta que la mamografía puede ofrecer la oportunidad de recibir oportunamente un tratamiento que reduzca la propagación e impida una pronta mortalidad. Aún se discute y no se ha alcanzado un consenso en cuanto a la edad en la que es conveniente realizar la primera mamografía, la frecuencia de repetirla e, incluso, la edad para suspenderla.

[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.

[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.

[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.

[Acceptable quality cervical cytology taking: comparison of Cervex-brush and Cervex-mex methods]. / Comparación de la toma de citología cervical con calidad satisfactoria con el método Cervex-brush o Cervex-mex.

BACKGROUND: In cervical cytology taking there has been used several devices (swab, spatula, paintbrushes, and brushes) to reduce false negative results and the necessity to exfoliate more epithelial cells from squamous columnar joint and endocervix. OBJECTIVE: To compare the quality of cervical cytology taken with Cervex-brush and with Cervex-mex, utilizing the system of Bethesda. MATERIAL AND METHOD: Transversal and comparative study, carried out during a period of two years, that included women from 15 to 85 years old which responded spontaneously to Papanicolaou screening as part of the permanent program of opportune diagnosis of cervical-uterine cancer. Two groups of study were formed with patients assigned in random form, in group 1 was taken cervical cytology with Cervex-brush and in group 2 with Cervex-mex; all samples were manipulated under habitual procedure and cytology were read by hospital's pathologist in blinded form. RESULTS: There were included 1 658 patients, sample was taken with Cervex-brush in 821, and with Cervex-mex in 837. Thirty-four percent of patients have its first cervical cytology ever. Good quality cytology samples frequency was obtained with Cervex-brush in 48.5%, and with Cervex-mex in 50.4%, with statistical difference (p < 0.05). CONCLUSIONS: Cervex-mex design permits a better taking of endocervical cells, what reduces the number of inadequate cytologies and increases the possibility of detecting endocervical alterations.

[Assessment of the treatment with imiquimod in persistent infection by human papillomavirus with the polimerase chain reaction method]. / Evaluación del tratamiento con imiquimod en infección persistente por el virus del papiloma humano con el método de reacción en cadena de la polimerasa.

BACKGROUND: Molecular studies have shown that oncogenic genotypes of human papillomavirus (HPV) are the main risk factor for cervical cancer development. Sub-clinical wound does not cause symptoms and is diagnosed by colposcopy or histology, in addition the latent infection is associated with the presence of DNA of the HPV, but when clinical and histological abnormalities are not presented only molecular techniques can detect this infection. OBJECTIVE: To determine if complementary processing with imiquimod, recent medicament with powerful antiviral activity in vitro as in vivo, reduces the cervical persistence of HPV. PATIENTS AND METHODS: This study was carried out with 87 patients, who had antecedents of HPV cervical and intraepithelial wound with low degree. Patients were divided as follows: treated with cryotherapy, cervical loop electrosurgical and imiquimod, all with diagnosis by cervical cytology, colposcopy and polymerase chain reaction (PCR) for HPV. At 3, 6 and 12 months after the processing, PCR, cervical cytology and colposcopy control were carried out again. RESULTS: Out of the 87 patients studied, 11% (10) patients treated with cervical cytology were positive for VPH; with colposcopy 8% (7) of patients and with PCR 40% (34) of patients; decreased persistence with combined methods of loop and imiquimod was obtained in 29% (5) patients; however, when utilized imiquimod alone, there were 55% (11) patients with persistence determined by PCR method. DISCUSSION: Imiquimod appears to be beneficial in 45% of the patients, in contrast with efficacy reported until 85% in genitals and annals warts, in addition, the capacity of eliminating the viruses has been shown, therefore it is possible that its potential effect could be observed long-time. It is evident that the percentages of viral detection are improved for PCR method, compared with indirect methods as cervical cytology and colposcopy, which is favorable when virus serotypes are of high degree of transformation and ablative methods should be conservatives due to fertility motives.

[Endometriosis in delayed scarring of postpartum eutocic episiorrhaphy. Integral aspects and a case report]. / Endometriosis en cicatriz tardía de episiorrafia posparto eutócico. Aspectos integrales y reporte de un caso.

Endometriosis remains a mystery because it has not yet been shown why these cells are viable in the abdominal cavity, although it has been thought that the immune system plays a role in implantation outside the intrauterine cavity by abasement in the regulatory capacity of natural killer cells, as well as peripheral and peritoneal immunologic cells. Among methods used to recognize this illness are laparoscopy, laparotomy, ultrasound, antibodies, and the histologic study. It has been observed that surgical scars can present cyclical inflammation and pain when affected with this pathology. We present the case of a patient with a second delivery who arrived at the Gynecology Service due to referring intense pain in the episiorrhaphy scar as well as superficial dyspareunia. One year after performance of the surgical procedure, pain did not allow the patient was unable to sit normally; in addition, during the last 3 months the area of the cicatrix augmented in volume during menstruation. Under peridural block and with surgical spindle excision, the abnormal tissue was dissected without complications; the surgery showed brittle tissue and with abundant new vascularity. The histologic diagnosis reported vulvar-tissue endometriosis. Was initiate complementary treatment was initiated with gestrinon once a week for 4 weeks, as well as danazol daily for 2 months to avoid possible persistence of endometrial tissue. The scar at present is minimal and is observed along the borders of the surgical union line, without an increase in size nor discomfort on digital pressure. We consider it necessary to assure cleaning of the episiotomy before initiating surgical suturing to diminish presence of endometriosis, despite the fact that incidence of this disturbance is low (0.03%). Advancement in knowledge of the physiopathology process will permit elimination of the remaining endometrial tissue with new therapeutic strategies, as well as clearing up the mechanism of ectopic implantation of endometrial cells.