Construction of a Mycoviral Infectious Clone for Reverse Genetics in Botrytis cinerea.

The most important advances in our understanding of the viral life cycle, such as genome replication, packaging, transmission, and host interactions, have been made via the development of viral infectious full-length clones. Here, we describe the detailed protocols for the construction of an infectious clone derived from Botrytis virus F (BVF), a mycoflexivirus infecting the plant pathogenic fungus Botrytis cinerea, the determination of the complete sequence of the cloned mycovirus, the preparation of fungal protoplasts, and the transfection of protoplasts using transcripts derived from the BVF infectious clone.

Usefulness of a low-cost simulation model for teaching internal manual aortic compression. A survey-based mannequin evaluation.

OBJECTIVE: To evaluate the users' opinion on internal manual aortic compression (IMAC) training, using a low-cost simulation model. METHODS: An educational strategy was designed to teach IMAC, which included: (1) guided reading of educational material and viewing an explanatory video of IMAC; (2) an introductory lecture with the anatomical considerations, documentation of the cessation of femoral arterial flow during IMAC, and real clinical cases in which this procedure was used; and (3) simulated practice of IMAC with a new low-cost manikin. The educational strategy was applied during three postpartum hemorrhage workshops in three Latin American countries and the opinions of the participants were measured with a survey. RESULTS: Almost all of the participants in the IMAC workshop, including the simulation with the low-cost mannikin, highlighted the usefulness of the strategy (scores of 4/5 and 5/5 on the Likert scale) and would recommend it to colleagues. CONCLUSION: We present a low-cost simulation model for IMAC as the basis of an educational strategy perceived as very useful by most participants. The execution of this strategy in other populations and its impact on postpartum hemorrhage management should be evaluated in further studies.

Bonjesta: nuevo tratamiento de las náuseas y vómitos del embarazo con liberación inmediata / Bonjesta: New Treatment for Nausea and Vomiting of Pregnancy with Immediate Release

Las náuseas y los vómitos en el embarazo son dos de los síntomas más frecuentes durante la gestación. Se estima que hasta el 85 % de las mujeres experimentan algún grado de náuseas con o sin vómitos durante la gestación. (AU)

Fused Cells between Human-Adipose-Derived Mesenchymal Stem Cells and Monocytes Keep Stemness Properties and Acquire High Mobility.

Human-adipose-derived mesenchymal stem cells (hADMSCs) are multipotent stem cells which have become of great interest in stem-cell therapy due to their less invasive isolation. However, they have limited migration and short lifespans. Therefore, understanding the mechanisms by which these cells could migrate is of critical importance for regenerative medicine. Methods: Looking for novel alternatives, herein, hADMSCs were isolated from adipose tissue and co-cultured with human monocytes ex vivo. Results: A new fused hybrid entity, a foam hybrid cell (FHC), which was CD90+CD14+, resulted from this co-culture and was observed to have enhanced motility, proliferation, immunomodulation properties, and maintained stemness features. Conclusions: Our study demonstrates the generation of a new hybrid cellular population that could provide migration advantages to MSCs, while at the same time maintaining stemness properties.

Overcoming tumor resistance mechanisms in CAR-NK cell therapy.

Despite the impressive results of autologous CAR-T cell therapy in refractory B lymphoproliferative diseases, CAR-NK immunotherapy emerges as a safer, faster, and cost-effective approach with no signs of severe toxicities as described for CAR-T cells. Permanently scrutinized for its efficacy, recent promising data in CAR-NK clinical trials point out the achievement of deep, high-quality responses, thus confirming its potential clinical use. Although CAR-NK cell therapy is not significantly affected by the loss or downregulation of its CAR tumor target, as in the case of CAR-T cell, a plethora of common additional tumor intrinsic or extrinsic mechanisms that could also disable NK cell function have been described. Therefore, considering lessons learned from CAR-T cell therapy, the emergence of CAR-NK cell therapy resistance can also be envisioned. In this review we highlight the processes that could be involved in its development, focusing on cytokine addiction and potential fratricide during manufacturing, poor tumor trafficking, exhaustion within the tumor microenvironment (TME), and NK cell short in vivo persistence on account of the limited expansion, replicative senescence, and rejection by patient's immune system after lymphodepletion recovery. Finally, we outline new actively explored alternatives to overcome these resistance mechanisms, with a special emphasis on CRISPR/Cas9 mediated genetic engineering approaches, a promising platform to optimize CAR-NK cell function to eradicate refractory cancers.

Colorectal Cancer Stem Cells Fuse with Monocytes to Form Tumour Hybrid Cells with the Ability to Migrate and Evade the Immune System.

BACKGROUND: The cancer cell fusion theory could be one of the best explanations for the metastasis from primary tumours. METHODS: Herein, we co-cultured colorectal cancer (CRC) stem cells with human monocytes and analysed the properties of the generated tumour hybrid cells (THCs). The presence of THCs in the bloodstream together with samples from primary and metastatic lesions and their clinical correlations were evaluated in CRC patients and were detected by both FACS and immunofluorescence methods. Additionally, the role of SIGLEC5 as an immune evasion molecule in colorectal cancer was evaluated. RESULTS: Our data demonstrated the generation of THCs after the in vitro co-culture of CRC stem cells and monocytes. These cells, defined as CD45+CD14+EpCAM+, showed enhanced migratory and proliferative abilities. The THC-specific cell surface signature allows identification in matched primary tumour tissues and metastases as well as in the bloodstream from patients with CRC, thus functioning as a biomarker. Moreover, SIG-LEC5 expression on in vitro generated THCs has shown to be involved in the mechanism for immune evasion. Additionally, sSIGLEC5 levels correlated with THC numbers in the prospective cohort of patients. CONCLUSIONS: Our results indicate the generation of a hybrid entity after the in vitro co-culture between CRC stem cells and human monocytes. Moreover, THC numbers present in patients are related to both prognosis and the later spread of metastases in CRC patients.

Construction and Characterization of a Botrytis Virus F Infectious Clone.

Botrytis virus F (BVF) is a positive-sense, single-stranded RNA (+ssRNA) virus within the Gammaflexiviridae family of the plant-pathogenic fungus Botrytis cinerea. In this study, the complete sequence of a BVF strain isolated from B. cinerea collected from grapevine fields in Spain was analyzed. This virus, in this work BVF-V448, has a genome of 6827 nt in length, excluding the poly(A) tail, with two open reading frames encoding an RNA dependent RNA polymerase (RdRP) and a coat protein (CP). The 5'- and 3'-terminal regions of the genome were determined by rapid amplification of cDNA ends (RACE). Furthermore, a yet undetected subgenomic RNA species in BVF-V448 was identified, indicating that the CP is expressed via 3' coterminal subgenomic RNAs (sgRNAs). We also report the successful construction of the first BVF full-length cDNA clone and synthesized in vitro RNA transcripts using the T7 polymerase, which could efficiently transfect two different strains of B. cinerea, B05.10 and Pi258.9. The levels of growth in culture and virulence on plants of BVF-V448 transfected strains were comparable to BVF-free strains. The infectious clones generated in this work provide a useful tool for the future development of an efficient BVF foreign gene expression vector and a virus-induced gene silencing (VIGS) vector as a biological agent for the control of B. cinerea.

NKG2D-CAR-transduced natural killer cells efficiently target multiple myeloma.

CAR-T-cell therapy against MM currently shows promising results, but usually with serious toxicities. CAR-NK cells may exert less toxicity when redirected against resistant myeloma cells. CARs can be designed through the use of receptors, such as NKG2D, which recognizes a wide range of ligands to provide broad target specificity. Here, we test this approach by analyzing the antitumor activity of activated and expanded NK cells (NKAE) and CD45RA- T cells from MM patients that were engineered to express an NKG2D-based CAR. NKAE cells were cultured with irradiated Clone9.mbIL21 cells. Then, cells were transduced with an NKG2D-4-1BB-CD3z-CAR. CAR-NKAE cells exhibited no evidence of genetic abnormalities. Although memory T cells were more stably transduced, CAR-NKAE cells exhibited greater in vitro cytotoxicity against MM cells, while showing minimal activity against healthy cells. In vivo, CAR-NKAE cells mediated highly efficient abrogation of MM growth, and 25% of the treated mice remained disease free. Overall, these results demonstrate that it is feasible to modify autologous NKAE cells from MM patients to safely express a NKG2D-CAR. Additionally, autologous CAR-NKAE cells display enhanced antimyeloma activity demonstrating that they could be an effective strategy against MM supporting the development of NKG2D-CAR-NK-cell therapy for MM.

Zn-Mg and Zn-Cu alloys for stenting applications: From nanoscale mechanical characterization to in vitro degradation and biocompatibility.

In the recent decades, zinc (Zn) and its alloys have been drawing attention as promising candidates for bioresorbable cardiovascular stents due to its degradation rate more suitable than magnesium (Mg) and iron (Fe) alloys. However, its mechanical properties need to be improved in order to meet the criteria for vascular stents. This work investigates the mechanical properties, biodegradability and biocompatibility of Zn-Mg and Zn-Cu alloys in order to determine a proper alloy composition for optimal stent performance. Nanoindentation measurements are performed to characterize the mechanical properties at the nanoscale as a function of the Zn microstructure variations induced by alloying. The biodegradation mechanisms are discussed and correlated to microstructure, mechanical performance and bacterial/cell response. Addition of Mg or Cu alloying elements refined the microstructure of Zn and enhanced yield strength (YS) and ultimate tensile strength (UTS) proportional to the volume fraction of secondary phases. Zn-1Mg showed the higher YS and UTS and better performance in terms of degradation stability in Hanks' solution. Zn-Cu alloys presented an antibacterial effect for S. aureus controlled by diffusion mechanisms and by contact. Biocompatibility was dependent on the degradation rate and the nature of the corrosion products.

Chagas disease reactivation in rheumatologic patients: association with immunosuppressive therapy and humoral response.

Evidence for Chagas disease reactivation (CDR) in rheumatologic patients under rheumatologic treatments (RTs) is scarce. To screen and follow-up patients with rheumatic diseases and concomitant Chagas disease under RT to detect CDR and to describe a possible relationship between CDR and specific RT. An observational, longitudinal, prospective, consecutive study was carried out between 2018 and 2020. Included patients were evaluated during the follow-up for clinical and laboratorial manifestations of CDR. Direct blood parasitological examination (Strout method) and polymerase chain reaction (PCR) were employed to diagnose CDR. The dynamic of anti-T. cruzi-specific antibodies was also assessed by IHA and ELISA (total IgG and Anti-SAPA). Fifty-one patients were included (86% women). Rheumatoid arthritis was the predominant disease (57%). Classic DMARDs (86.3%) and corticosteroids (61%) were the most frequent RT. CDR was developed in 6 patients (11.7%), exhibiting both positive Strout and PCR. Symptomatic reactivation of CD (fever, asthenia, arthralgias, myalgias) occurred in two patients who had previously been diagnosed with it. Regardless of the different RT, all patients who experienced CDR had previously received more than ≥ 20 mg/day of prednisone equivalent. Despite immunosuppression, patients with CDR exhibited increased levels of specific anti-T. cruzi and anti-SAPA antibodies, which decreased after anti-parasitic treatment. CDR is possible in rheumatologic patients, especially after receiving high doses of corticosteroids. Since CDR symptoms may mimic rheumatic disease activity, monitoring of Chagas disease is highly recommended before, during and after immunosuppression. Key Points • Chagas disease reactivation (CDR) in the context of rheumatological treatment was associated to high doses of corticosteroids. • CDR was associated with an increase in anti-T. cruzi antibodies despite the immunosuppressive treatment. • Suspecting and anticipating CDR is mandatory in this patient population to diagnose and treat it.

Brain manifestations secondary to auricular myxoma.

Cardiac myxoma is the most common benign tumor of the heart. In most cases, it is in the left atrium, which can generate neurological embolization; that can manifest as an ischemic event, aneurysm formation and less frequently as brain metastases. This is a case report of a 56-year-old male patient with cerebral embolisms secondary to a left cardiac myxoma. In these patients, the role of neurologic imaging is to detect the firsts complications and avoid secondary complications.

Conocimientos y prácticas de las agentes educativas y condiciones de salud bucal de niños del municipio de Santa Rosa de Cabal, Colombia / Knowledge and practices of educational agents and oral health conditions of children in the municipality of Santa Rosa de Cabal, Colombia

Resumen Introducción: La prevalencia modificada de caries en la primera infancia es de 61,92%, el desconocimiento en salud bucal por parte de cuidadores es una de las causas reportadas. Objetivo: Determinar conocimientos y prácticas de las agentes educativas y condiciones de salud bucal de niños de los hogares comunitarios y Centros de Desarrollo Infantil del Instituto Colombiano de Bienestar Familiar de Santa Rosa de Cabal 2016. Materiales y métodos: Estudio cuantitativo, descriptivo y transversal. Se aplicó encuestas de caracterización a 198 niños y 20 agentes educativas, de Conocimientos Actitudes y Prácticas e índices odontológicos. Se aplicó estadística univariada y Chi2. Resultados: El 90% de las agentes reconocen la caries como la enfermedad más frecuente, 50% realizan cepillado de los infantes sin utilizar seda dental. Se evidenció prevalencia modificada de caries en 63,6% y promedio de índice O'Leary 61,3%. Existe asociación entre el índice ceo-d (cariados, extraídos, obturados), área de residencia y estrato socioeconómico con valor p<0,05. Conclusiones: Las agentes evidencian vacíos conceptuales que requieren abordaje de educación por parte de odontólogos. El estado de salud bucal de la primera infancia indica un porcentaje por encima de la prevalencia modificada de caries a nivel nacional y el índice O'Leary riesgo de enfermedades bucodentales.

Abstract Introduction: The modified prevalence of caries in early childhood is 61.92%. Ignorance in oral health on the part of caregivers is one of the reported causes. Objective: To determine knowledge and practices of educational agents and oral health conditions of children in community households and child development centers of the Colombian Family Welfare Institute (ICBF) in Santa Rosa de Cabal in 2016. Materials and methods: A quantitative, descriptive and transversal study was made. Characterization surveys were applied to 198 children and 20 educational agents about knowledgeable attitudes and practices and dental indices. Univariate and Chi2 statistics were applied. Results: 90% of the agents recognize caries as the most frequent disease, 50% perform brushing of children without using dental floss. Modified caries prevalence was demonstrated in 63.6% and 61.3% average O'Leary index. There is an association between the CEO-D Index, area of residence and socioeconomic strata with p<0.05 value. Conclusions: Agents demonstrate conceptual gaps that require an education approach by dentists. The state of oral health of early childhood indicates a percentage above the modified prevalence of caries at the national level and the index O'Leary risk of oral diseases.

Bi-layered silane-TiO2/collagen coating to control biodegradation and biointegration of Mg alloys.

Magnesium alloys have shown high potential as biodegradable implants for bone repair applications. However, their fast degradation in physiological media demands tuning their corrosion rate to accompany the natural tissue healing processes. Here, a new bi-layered silane-TiO2/collagen coating efficient in stabilizing and biofunctionalizing the surface of AZ31 and ZE41 Mg alloys is presented. Corrosion tests performed in cell culture medium over 7 weeks showed that the bi-layered coating promotes the formation of a stable layer of Mg(OH)2/MgCO3/CaCO3 that provides effective protection to the alloys at advanced immersion stages. The intrinsic reactivity of each alloy plus formation of transitory calcium phosphate phases, resulted in distinct corrosion behavior in the short term. Cell experiments showed that the bi-layered coating improved osteoblasts and fibroblasts proliferation compared to bare and silane-TiO2-coated alloys. Different responses in terms of cell adhesion could be related to the intrinsic corrosion rate of each alloy and some toxicity from the alloying elements. The results evidenced the complex interplay between alloy nature, coating-alloy combination and cell type. The silane-TiO2/collagen coating showed to be a promising strategy to improve cell response and viability and to control degradation rate of Mg alloys in the long term.

Caracterización clínica de los pacientes con síncope / Clinical profile of patients with syncope

Resumen Introducción: Se hizo una caracterización clínica de los pacientes con síncope en un Hospital Universitario en Bogotá. Objetivo: Describir las características clínicas de los pacientes con síncope que consultaron al Hospital Militar Central en Bogotá en el período 2012-2015, y analizar la contribución de las ayudas diagnósticas y de las escalas EGSYS y OESIL para orientar el diagnóstico etiológico. Métodos: Se realizó un estudio observacional, descriptivo, de pacientes mayores de 18 años que ingresaron a urgencias del Hospital Militar Central por síncope; se analizaron características clínicas, estudios solicitados y puntajes de las escalas EGSYS y OESIL. Resultados: Se evaluaron 705 historias clínicas, de las cuales 116 fueron excluidas por datos faltantes; la edad promedio fue 58 años y el 46,52% eran mujeres. El 41,6% tenía hipertensión arterial y el 21% enfermedad cardiaca previa. Según el diagnóstico etiológico, 75% fueron clasificados como síncope no cardiaco, 23% como síncope cardiaco y en 2% no se identificó la etiología. El examen más solicitado fue el electrocardiograma (79%), seguido por troponina (63%) y TAC cerebral (58%). Al aplicar las escalas, 60% de los pacientes tuvo un puntaje menor a 3 (EGSYS) y 2 puntos (OESIL), lo que sugería que eran de etiología no cardiogénica/bajo riesgo de mortalidad respectivamente. Conclusiones: La etiología del síncope en la mayoría de los casos fue no cardiaca. El electrocardiograma debe ser solicitado a todos los pacientes con síncope. El uso rutinario de las escalas de riesgo puede contribuir a disminuir la solicitud de estudios no indicados, optimizar el uso de recursos y reducir los días de hospitalización.

Abstract Introduction: A clinical profile was constructed on patients with syncope in a Bogota University Hospital. Objective: To describe the clinical characteristics of patients with syncope that were seen in the Hospital Militar Central in Bogota in the period 2012-2015, as well as to analyse the contribution of diagnostic aids and the Evaluation of Guidelines in Syncope Study (EGSYS) and the Lazio epidemiological syncope Observation (OESIL) scores in order to determine the aetiological diagnosis. Methods: A descriptive observational study was performed on patients over 18 years admitted to the Emergency Department of the Hospital Militar Central due to syncope. An analysis was carried out on the clinical characteristics, examinations requested, and the scores on the EGSYS and OESI L scales. Results: A total of 705 clinical histories were evaluated, of which 116 were excluded due to lack of data. The mean age was 58 years, and 46.52% were women. Arterial hypertension was observed in 41.6%, and 21% had a previous heart disease. According to the aetiological diagnosis, 75% were classified as non-cardiac syncope, 23% as cardiac syncope, and 2% of unknown origin. The most requested examination was the electrocardiogram (79%), followed by troponin (63%), and a computed tomography brain scan (58%). On applying the scales, 60% of the patients had a score of less than 3 (EGSYS) and 2 points (OESIL), which suggested that they were of non-cardiogenic origin/low mortality risk, respectively. Conclusions: The origin of syncope in the majority of cases was non-cardiac. An electrocardiogram must be requested on all patients with syncope. The routine use of risk scales can contribute to reducing the number of non-indicated examinations, as well as optimise the use of resources and reduce hospital stay.

New Insights into Antibiofilm Effect of a Nanosized ZnO Coating against the Pathogenic Methicillin Resistant Staphylococcus aureus.

ZnO nanoparticles (NPs) are arising as promising novel antibiotics toward device-related infections. The surface functionalization of Zn, a novel resorbable biomaterial, with ZnO NPs could present an effective solution to overcome such a threat. In this sense, the antibacterial and antibiofilm activity of nano- and microsized ZnO coatings was studied against clinically relevant bacteria, methicillin resistant Staphylococcus aureus (MRSA). The bacterial viability of planktonic and biofilm cells together with the corresponding biofilm structures revealed that only the nanosized ZnO coating had an antibiofilm effect. To elucidate this effect, a novel approach was taken: preconditioning of bacteria with this ZnO coating followed by exposure to subinhibitory concentrations of antibiotics with well-known modes of actions. This approached revealed (i) a decreased biofilm formation in combination with gentamycin, targeting protein synthesis, and (ii) an increased biofilm formation in the presence of rifampicin and vancomycin, acting on RNA and cell wall biosynthesis, respectively. The increased bacteria resistance to these two antibiotics gave new insights into the antibiofilm effect of this nanosized ZnO coating. The synergistic effect observed for gentamycin opened new perspectives for the design of effective solutions against implant-related infections. During the in vitro degradation of this nanosized ZnO-coated Zn, a specific corrosion product, hopeite [Zn3(PO4)2], was depicted. Interestingly, the increased deposition of hopeite-derived compounds on MRSA cells surface seemed to be related to unhealthy and dead bacterial cells. This observation suggested that hopeite may well play a key role in this antibiofilm activity. The results obtained herein shed light on the possible antibacterial effect of a nanosized ZnO coating, and strengthened its antimicrobial (antibacterial and antifungal) potential, therefore providing a potentially effective material to overcome the growing trend of implant-related infections.

Modulation of endothelial function by Toll like receptors.

Endothelial cells (EC) are able to actively control vascular permeability, coagulation, blood pressure and angiogenesis. Most recently, a role for endothelial cells in the immune response has been described. Therefore, the endothelium has a dual role controlling homeostasis but also being the first line for host defence and tissue damage repair thanks to its ability to mount an inflammatory response. Endothelial cells have been shown to express pattern-recognition receptors (PRR) including Toll-like receptors (TLR) that are activated in response to stimuli within the bloodstream including pathogens and damage signals. TLRs are strategic mediators of the immune response in endothelial cells but they also regulate the angiogenic process critical for tissue repair. Nevertheless, endothelial activation and angiogenesis can contribute to some pathologies. Thus, inappropriate endothelial activation, also known as endothelial dysfunction, through TLRs contributes to tissue damage during autoimmune and inflammatory diseases such as atherosclerosis, hypertension, ischemia and diabetes associated cardiovascular diseases. Also TLR induced angiogenesis is required for the growth of some tumors, atherosclerosis and rheumatoid arthritis, among others. In this review we discuss the importance of various TLRs in modulating the activation of endothelial cells and their importance in immunity to infection and vascular disease as well as their potential as therapeutic targets.

Ganancia de peso para un parto sin complicaciones: límite de aumento ponderal según el índice de masa corporal previo / Weight gain for an uncomplicated birth: limit weight gain by body mass index prior

Objetivo: Establecer los límites de aumento de peso en el embarazo según el índice de masa corporal (IMC) antes de la semana 12 para evitar un parto complicado. Material y métodos: Estudio observacional y prospectivo sobre gestantes caucásicas primíparas, sin enfermedades, con una gestación única a término con presentación cefálica y peso del neonato de 2.500-4.000 g, atendida sen el Paritorio del Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, desde julio de 2009 hasta febrero de 2010. Se considera parto complicado el instrumentado o por cesárea, cuya causa es el aumento de peso durante el embarazo y teniendo en cuenta los posibles factores de confusión: edad, tabaquismo, educación maternal y administración de epidural. Los datos se resumen con estadígrafos apropiados al caso, y se comparan según sus características. Estratificando a las pacientes por categorías de IMC, se hallan los puntos de corte sensible-específicos de un aumento de peso seguro mediante análisis COR tipo II, y ajustándolos riesgos por factores de confusión mediante regresión logística. Resultados: Se incluyeron en el estudio 473 gestantes de 16-46 años de edad, un 12,7% con bajo peso, un 53,7% con normopeso, un23,3% con sobrepeso y un 10,4% obesas, con un aumento ponderal de 13,6 ± 5,3 kg. El 33,8% tuvo un parto complicado. Se establece en14,250 kg la ganancia de peso máxima para un parto sin complicaciones para un bajo peso, en 14,150 kg para un normopeso, en 12,750 kg para sobrepeso y en 10,200 kg para obesidad. El riesgo de sufrir un parto complicado por superar estos límites es de 1,9 (intervalo de confianza del 95%: 1,2-2,8), y la ganancia de peso es el único factor asociado al parto complicado. Conclusión: Para un parto sin complicaciones no debe sobrepasarse el aumento de peso establecido como seguro para su IMC (AU)

Objective: Establish limits of weight gain during pregnancy as body mass index (BMI) before the 12th week to avoid a complicated delivery. Material and methods: A prospective observational study in caucasian primiparous pregnant without underlying diseases, singleton pregnancies to term with cephalic presentation and birth weight of 2,500-4,000 g, assisted in the delivery room at University Hospital Nuestra Señora de la Candelaria, Tenerife, during2009/july-2010/february. It is considered complicated delivery instrumented or cesarean, its cause weight gain during pregnancy and potential confounders: age, smoking, maternal education and epidural administration. The data are summarized with appropriate statics, compare according to their characteristics, stratifying by categories of body mass index we found most sensitive-specific cut-off points for safe weight gain by COR typeII analysis and adjusting for risk factors confounding using logistic regression. Results: It includes 473 pregnant women between 16-46 years,12.7% for underweight, normal weight 53.7%, 23.3% overweight and 10.4% obese and a weight gain of 13.6 ± 5.3 kg, the 33.8% hada complicated delivery. Set to 14.250 kg weight gain for an uncomplicated delivery in the category of underweight, normal weight14.150 kg, overweight 12.750 kg and 10.200 kg for obesity. The risk to suffer a difficult delivery, to overcome these limits is 1.9 (95%CI:1.2 to 2.8), weight gain being the only factor associated with complicated delivery. Conclusion: For an uncomplicated birth pregnant women should not exceed the weight increase established as safe for your BMI (AU)