[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.

Modificación de la composición corporal con la terapia hormonal parenteral y oral en la menopausia / Changes in body composition with the use of parenteral and oral hormone therapy in the menopause

Resumen Antecedentes: La menopausia se relaciona con cambios en la composición corporal que el uso de terapia hormonal (TH) puede revertir. Objetivo: Determinar el efecto de la TH parenteral y oral sobre la composición corporal en la menopausia. Material y métodos: Se realizó un estudio retrolectivo que incluyó a 86 mujeres de 45 a 55 años, con FSH > 20 Ul/ml, antecedente de histerectomía y sintomatología vasomotora, a las cuales se les administró TH por vía oral (44 pacientes) o parenteral (42 pacientes) durante seis meses. Se les realizó impedancia bioeléctrica antes y después del tratamiento. Resultados: La TH por vía oral se asoció con una disminución de diferentes parámetros de la composición corporal entre los que destaca la disminución de la grasa visceral (p < 0.05). La TH parenteral no mostró modificación en la composición corporal. Conclusión: La TH por vía oral modifica de manera positiva la composición corporal, lo cual puede contribuir a regular el estado metabólico.

Abstract Background: Menopause is associated with changes in body composition that the use of hormone therapy (HT) can reverse. Objective: To determine the effect of parenteral and oral HT on body composition in menopause. Material and methods: A retrolective study was carried out in 86 women aged 45 to 55 years old, with FSH > 20 Ul/ml, a history of hysterectomy and vasomotor symptoms. The participants received oral HT (44 patients) or parenteral (42 patients) for six months. Bioelectrical impedance was performed before and after treatment. Results: Oral HT was associated with a decrease in different parameters of body composition, among which the decrease in visceral fat stands out (p < 0.05). Parenteral HT did not show changes in body composition. Conclusion: Oral HT positively modifies body composition, which can help regulate the metabolic state.

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.

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.

Coronavirus disease 2019 and pregnancy. / Enfermedad por coronavirus 2019 y embarazo.

Historically, viral respiratory infections in pregnant women have shown an increase in the risk of morbidity and mortality. With regards to COVID-19, information is limited and a greater risk of severe morbidity or mortality has not been shown, when compared to general population; however, pregnant women with comorbidities such as obesity, type 2 diabetes mellitus and hypertension have shown a greater severity of the disease, consistent with the general population with these comorbidities. The risk of vertical transmission appears to be low: it has not been demonstrated in any case during the current outbreak of COVID-19 in China, nor in previous epidemics of similar coronaviruses (SARS-CoV and MERS-CoV). Existing studies have not demonstrated the presence of the virus in genital fluid, amniotic fluid or maternal milk. Described cases of infection in newborns probably come from horizontal transmission, which suggests breastfeeding with respiratory hygiene measures. Given that COVID-19 is a new disease that has extended around the world and that current knowledge is still insufficient, it is mandatory the continued accumulation of data to discover in depth the action mechanisms of SARS-CoV-2 virus, responsible for the disease, and constant update of means of prevention and handling of the disease.

Históricamente, las infecciones respiratorias virales en mujeres embarazadas han mostrado un incremento en el riesgo de morbilidad y mortalidad. En relación con el COVID-19 la información es limitada y no ha mostrado un mayor riesgo de morbilidad severa o mortalidad en comparación con la población en general; sin embargo, las mujeres embarazadas con comorbilidades como obesidad, diabetes mellitus tipo 2 e hipertensión arterial han presentado una mayor severidad de la enfermedad de manera más consistente a lo que ocurre en la población general con esas comorbilidades. El riesgo de transmisión vertical parece bajo: no se ha podido demostrar en ningún caso durante el brote actual de COVID-19 en China, ni tampoco en epidemias previas por otros coronavirus similares (SARS-CoV y MERS-CoV). Los estudios existentes no han evidenciado presencia del virus en fluidos genitales, líquido amniótico, ni tampoco en la leche materna. Los casos descritos de infección en recién nacidos provienen probablemente de transmisión horizontal, por lo que se sugiere la lactancia materna con medidas de higiene respiratoria. Debido a que la enfermedad por coronavirus se ha extendido a nivel mundial y el conocimiento actual es aún insuficiente, es imperativo el cúmulo de evidencia y profundizar en los mecanismos de acción del virus SARS-CoV-2, responsable de la enfermedad, y también que se actualicen constantemente las medidas de prevención y manejo de la enfermedad.

Incidencia de mutaciones genéticas en pacientes con cáncer de mama y ovario con patrón de origen hereditario / Incidence of genetic mutations in patients with breast cancer and ovarian cancer with hereditary pattern

Resumen OBJETIVO: Determinar las mutaciones genéticas en el cáncer de mama de patrón hereditario y demostrar si existe alguna asociación significativa entre las más comunes en población mexicana y el riesgo de padecerlo. MATERIALES Y MÉTODOS: Estudio transversal y observacional efectuado en el Hospital Ángeles México en coordinación con el Instituto Nacional de Medicina Genómica. Criterios de inclusión: pacientes con cáncer de mama y uno o más familiares de primer grado afectados por esta enfermedad y pacientes con cáncer de ovario. Criterios de exclusión: pacientes sin antecedentes de cáncer de mama ni ovario, o con algún familiar en el protocolo. Se empleó la técnica de rearreglos en placas RT2 Profiler para Master-Mix Quantinova probe PCR kit. Para el análisis estadístico se utilizó el programa SPSS versión 22 y Epi Info versión 7. RESULTADOS: Se estudiaron 39 pacientes con edad promedio de 53.2 ± 12.1 años. Los receptores de progesterona y estrógeno no mostraron diferencia entre grupos. Hubo mayor tendencia para BRCA1. Al estudiar las mutaciones con significación estadística, en las que sobresalieron los casos de BRCA2 versus sin significación y los casos negativos, no hubo diferencia estadística significativa, pero con una tendencia a mayor frecuencia de BCRA1. Al evaluar las estirpes de cáncer de mama y los grados nucleares comparados por edad, los tres grupos de grado nuclear comparados por edad mostraron diferencias. CONCLUSIÓN: Los datos obtenidos muestran que en la población mexicana el gen BRCA2 es el de mayor incidencia de cáncer hereditario, en edad de aparición más temprana y mayor grado nuclear al momento del diagnóstico.

Abstract OBJECTIVE: To determine the genetic mutations in hereditary pattern breast cancer and demonstrate whether there is a significant association between the most common in the Mexican population and the risk of suffering it. MATERIALS AND METHODS: Cross-sectional and observational study conducted at the Hospital Angeles México in coordination with the National Institute of Genomic Medicine. Inclusion criteria: patients with breast cancer and one or more first-degree relatives affected by this disease and patients with ovarian cancer. Exclusion criteria: patients without a history of breast or ovarian cancer, or with a family member in the protocol. The RT2 Profiler plate rearrangement technique was used for Master-Mix Quantinova probe PCR kit. The SPSS version 22 program and Epi Info version 7 were used for the statistical analysis. RESULTS: 39 patients with an average age of 53.2 ± 12.1 years were studied. Progesterone and estrogen receptors showed no difference between groups. There was a greater trend for BRCA1. When studying the mutations with statistical significance, in which the cases of BRCA2 versus without significance and the negative cases stood out, there was no significant statistical difference, but with a tendency to higher frequency of BCRA1. When evaluating breast cancer lines and nuclear grades compared by age, the three nuclear grade groups compared by age showed differences. CONCLUSION: The data obtained show that in the Mexican population the BRCA2 gene has a higher incidence in hereditary cancer, at an age of earlier onset and greater nuclear grade at the time of diagnosis.

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.

La esteroidogénesis en el síndrome de ovarios poliquísticos / Steroidogenesis in polycystic ovary syndrome

Resumen 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.

Abstract 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.

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.

Relación entre ácido úrico y composición corporal, perfil metabólico, leptina y adiponectina en mujeres posmenopáusicas / Relationship between uric acid and body composition, metabolic profile, leptin and adiponectin in postmenopausal women

Resumen OBJETIVO: Evaluar la relación del ácido úrico con los parámetros metabólicos, antropométricos, leptina y adiponectina, en mujeres posmenopáusicas en quienes se incrementa el riesgo de enfermedad cardiovascular. MATERIALES Y MÉTODOS: Estudio transversal y descriptivo efectuado en mujeres posmenopáusicas. Parámetros de estudio: mediciones antropométricas (bioimpedancia eléctrica), concentraciones de glucosa, colesterol total, LDL-colesterol, HDL-colesterol, triglicéridos (por métodos enzimáticos), adiponectina, leptina e insulina (por radioinmunoensayo). Cálculo de la resistencia a la insulina por el método HOMA-IR. Descripción de variables con promedio y desviación estándar. Análisis estadístico, con prueba de correlación de Pearson, para determinación de la relación entre el ácido úrico y las variables de estudio y regresión múltiple para determinación de los parámetros con mayor influencia en el ácido úrico. RESULTADOS: Se estudiaron 90 mujeres posmenopáusicas de 55 a 84 años, con edad promedio de 63.7 años. La concentración promedio de ácido úrico de las participantes fue de 4.9 mg/dL. En el análisis bivariado los parámetros antropométricos, el LDL-c, los triglicéridos y la leptina se asociaron positivamente con el ácido úrico y el HDL-c y la adiponectina de forma negativa. En el análisis multivariado la grasa corporal se asoció con el ácido úrico, independientemente del peso corporal (beta = 0.592; p = 0.037). CONCLUSIONES: En mujeres posmenopáusicas, las concentraciones anormales de ácido úrico se relacionan con un perfil cardiometabólico adverso.

Abstract OBJECTIVE: To determine the relation between uric acid and metabolic and anthropometric parameters and adipokines leptin and adiponectin in post-menopausal women. MATERIALS AND METHODS: A descriptive cross-sectional study was performed in post-menopausal women. Anthropometric measurements were taken by electric bioimpedance, and fasting venous blood samples were taken to determine glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides by enzyme techniques, and levels of adiponectin, leptin and insulin were measured by radioimmunoassay. Insulin resistance was calculated using HOMA-IR. The variables were described with mean and standard deviation. Statistical analysis was performed by Pearson correlation test to evaluate the relation between uric acid and the study variables, and a multiple regression was performed to determine the parameters with greatest influence on uric acid. RESULTS: The study included 90 post-menopausal women aged 55 to 84 years. The average age of the participants was 63.7 years, and the average concentration of uric acid was 4.9 mg/dL. In bivariate analysis, anthropometric parameters, LDL-cholesterol, triglycerides and leptin showed positive association with uric acid, and HDL-cholesterol and adiponectin had a negative one. In multiple regression analysis, body fat associated with uric acid independent of body weight (beta=0.592, p=0.037). CONCLUSIONS: Uric acid relates with an adverse cardio-metabolic profile in post-menopausal women.

Evaluación de un gel antiséptico de aplicación intravaginal para pacientes con infecciones cervicovaginales multitratadas / Evaluation of an antiseptic gel of intravaginal application for multitreated patients for infectious cervicovaginitis

Resumen OBJETIVO: Evaluar la efectividad y seguridad de un gel intravaginal antiséptico, elaborado con agua electrolizada, en el tratamiento de infecciones cervicovaginales bacterianas, fúngicas, parasitarias o mixtas, y en el control de los síntomas típicos en pacientes multitratadas. MATERIALES y MÉTODOS: Estudio clínico, comparativo con el tratamiento convencional, de dos brazos, multicéntrico, al azar, con escalamiento de dosis efectuado en pacientes atendidas entre mayo de 2017 y mayo de 2018 en el servicio de Ginecología y Obstetricia del Hospital General de Ecatepec Las Américas, en el Estado de México y en el Centro Hospitalario Unión, de Colima. Grupo control: esquema convencional, antibiótico-antifúngico (7 días); grupos experimentales, gel antiséptico durante 3, 5 o 10 días. Seguimiento del pH vaginal, agente etiológico y síntomas. RESULTADOS: Se incluyeron 62 pacientes, con límites de edad de 18 y 42 años, con vaginitis bacteriana en 25 de 62, candidiasis 10 de 62, tricomoniasis 6 de 62 o infección mixta en 21 de 62, multitratadas. La aplicación del gel durante 5 o 10 días erradicó el agente etiológico en 14 de 15 y en 18 de 20 pacientes; con el tratamiento control lo lograron 8 de 14 pacientes (p = 0.021 y 0.030, respectivamente). El gel antiséptico aplicado durante 5 o 10 días fue casi 3 veces más eficaz que el tratamiento control para erradicar el agente infeccioso, eliminar los síntomas y normalizar el pH vaginal. CONCLUSIONES: El tratamiento durante 5 o 10 días con el gel antiséptico intravaginal fue casi 3 veces más efectivo que el convencional (antibiótico-antimicótico) en pacientes con cervicovaginitis infecciosa multitratada, útil en la eliminación de los síntomas típicos y bien tolerado.

Abstract OBJECTIVE: To evaluate the efficacy and safety of an intravaginal antiseptic gel, made of electrolyzed water, against bacterial, yeast, parasitic and mixed cervical infections, and to control typical symptoms in multi-treated patients. MATERIALS AND METHODS: Clinical study, comparative with conventional treatment, two arms, multicentric, randomized, with dose escalation carried out in patients attended between May 2017 and May 2018 in the gynecology and obstetrics service of the Hospital General de Ecatepec La Américas, in the Estado de Mexico and the Centro Hospitalario Unión, of Colima. Control group: conventional scheme, antibiotic-antifungal (7 days); Experimental groups, antiseptic gel for 3, 5 or 10 days. Monitoring of vaginal pH, etiologic agent and symptoms. RESULTS: 62 multi-treated patients (18-42 years old) were enrolled, presenting bacterial vaginosis 25/62, yeast infection 10/62, trichomoniasis 6/62 or mixed infection 21/62; bacteria and yeast). Treatment with antiseptic gel during 5 or 10 days eradicated etiological agent, respectively in 14/15 patients and 18/20 patients; control treatment did it in 8/14 patients (p = 0.021, p = 0.026, respectively). Additionally, gel treatment for 5 or 10 days was 3 times more effective than control treatment to eradicate the infection, control symptoms and to normalize vaginal pH. CONCLUSIONS: Intravaginal antiseptic gel (5-10 days) was almost 3 times more effective than conventional therapy (antibiotics/antimycotics) against multi-treated cervical infections; as well as useful to control typical symptoms and well tolerated.

In memory of Dr. Arturo Zárate Treviño, pioneer in the study of gynecological endocrinology in Mexico / In memoriam Dr. Arturo Zárate Treviño, pionero en el estudio de la endocrinología ginecológica en México

No abstract

Sin resumen

[Dienogest usefulness in pelvic pain due to endometriosis. A meta-analysis of its effectiveness]. / Evaluación de dienogest en el tratamiento del dolor pélvico asociado a la endometriosis. Un metaanálisis de su efectividad.

BACKGROUND: Endometriosis is the presence of functional endometrial tissue in the pelvic peritoneum and it affects several age groups. That is why the impact of endometriosis in quality of life is considerable. The objective of this study was to evaluate the effectiveness of dienogest in patients with pelvic pain associated to endometriosis (PPAE). METHODS: The evaluation of the effectiveness was carried out through a systematic review using the Cochrane methodology. It was used Markov model, which considers two states of health (with and without PPAE), with the possibility of weekly transition. Women between 18 and 45 years with PPAE were included, in a temporary horizon of 26 weeks. A level of statistical significance of 95% was used for a p < 0.05, with a multivariate probabilistic analysis of sensibility, as well as a univariate analysis of sensibility in several scenarios. RESULTS: The probability that the female patient did not experience PPAE with the initial treatment was 87.91% with dienogest, 80.07% with danazol, 84.93% with medroxyprogesterone (injectable and oral) and 89.17% with gosereline. The probability that the female patient abandoned her initial treatment was 9% with dienogest, 12.07% with danazol, 9.6 and 6.75% with medroxyprogesterone injectable and oral, respectively, and 10.8 and 3.6% 3-monthly and monthly with gosereline. CONCLUSION: Compared to danazol, medroxiprogesterone and gosereline, dienogest is the most efficient alternative to treat PPAE.

Introducción: La endometriosis es la presencia de tejido endometrial funcional en el peritoneo pélvico y afecta a varios grupos de edad, por lo que su impacto en la calidad de vida es considerable. El objetivo fue evaluar la efectividad del dienogest en pacientes con dolor pélvico asociado a endometriosis (DPAE), al compararlo con danazol, medroxiprogesterona y goserelina. Métodos: se hizo una revisión sistemática de la literatura con la metodología Cochrane. Se usó el modelo de Markov, que considera dos estados de salud: con y sin DPAE, con posibilidad de transición semanal. Se consideraron mujeres entre 18 y 45 años con DPAE, en un horizonte de 26 semanas; se utilizó un nivel de significación estadística de 95% (p < 0.05), con un análisis probabilístico multivariante de sensibilidad y uno univariante de sensibilidad en varios escenarios. Resultados: la probabilidad de que la mujer se encontrara sin DPAE con el tratamiento inicial fue de 87.91% para dienogest, 80.07% para danazol, 84.93% para medroxiprogesterona inyectable y oral y 89.17% para goserelina; la probabilidad de que la mujer abandonara su tratamiento inicial fue de 9% para dienogest, 12.07% para danazol, 9.6 y 6.75% para medroxiprogesterona inyectable y oral, respectivamente, y 10.8 y 3.6% para goserelina trimestral y mensual, respectivamente. Conclusiones: Comparado con el danazol, la medroxiprogesterona y la goserelina, el dienogest es la alternativa más eficiente para el DPAE.

[Persists the controversy concerning the rutinary use of diagnostic tests in asymptomatic persons]. / Persiste la controversia acerca del uso rutinario de pruebas de detección en personas asintomáticas.

Currently, in medicine there is an environment replete with controversy and debate, partially due to the popular concept Evidence-Based Medicine, and to the development of technological advances and, apparently, better therapeutic resources. This has led to the establishment of an over-diagnosis epidemic and to an excess of therapeutic interventions, which do not necessarily lead to a longer life expectancy. Some medical controversies, which have called the attention of physicians and even of common people are those related with dislipoproteinemias, pre-diabetes and detection of cancer in asymptomatic persons. The debate and the controversy will surely continue and that is why it is very important to emphasize that clinical practice should be personalized, taking into account risks and implied benefits.

En la actualidad existe en medicina un ambiente repleto de controversias y debates, en parte generado por la popularidad del concepto de medicina basada en evidencia y por la aparición de avances tecnológicos y aparentemente mejores recursos terapéuticos. Esto ha llevado a la instalación de una epidemia diagnóstica y a una excesiva politerapéutica que no se traducen en una más larga expectativa de vida. Algunas controversias médicas que han llamado la atención de los médicos e incluso del público en general son las relacionadas con los tópicos de dislipoproteinemia, prediabetes y detección de cáncer en personas asintomáticas. El debate y la controversia seguramente continuarán y por ello resalta la importancia de la práctica médica en la individualidad, tomando en cuenta los riesgos y los beneficios implicados.

[Debate persists over the use of mammogram in the detection of breast cancer in asymptomatic women]. / Persiste el debate del uso rutinario de la mamografía en la detección de cáncer de mama en mujeres asintomáticas.

In this opinion article, it is discussed the importance of questioning the use of mammogram in the detection of breast cancer in asymptomatic women.

En el presente artículo de opinión se discute acerca de la necesidad de cuestionar la práctica rutinaria del empleo de la mamografía para detectar cáncer de mama en mujeres asíntomáticas.

Hypercholesterolemia As a Risk Factor for Cardiovascular Disease: Current Controversial Therapeutic Management.

Cholesterol is a precursor of steroid hormones and an essential component of the cell membrane; however, altered regulation of the synthesis, absorption and excretion of cholesterol predispose to cardiovascular diseases of atherosclerotic origin. Despite the recognition of historical events for 200 years starting with Chevreul naming "cholesterine"; later on, Lobstein coining the term atherosclerosis and Marchand introducing it, Anichkov identifying cholesterol in atheromatous plaque, and Brown and Goldstein discovering LDL receptor (r-LDL), as well as the emergence of different drugs such as fibrates, statins and cetrapibs during this decade promising to increase HDL, and the most recent, ezetimibe and anti-PCSK9 to inhibit the degradation of r-LDL, morbidity has not been reduced in cardiovascular disease. To date, the controversy continues regarding the best and appropriate medical therapy for hypercholesterolemia; likewise, there is the recommendation of a healthy dietary content regarding the amount of sugar as well as the type of fats, either saturated or polyunsaturated. Together, control of circulating cholesterol, amelioration of hypertension, regulation of diabetes, and dietary recommendations might prevent atherosclerosis.

[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.

[Rapid Response obstetrics Team at Instituto Mexicano del Seguro Social,enabling factors]. / Equipo de Respuesta Inmediata obstétrico en el Instituto Mexicano del Seguro Social, factores facilitadores.

BACKGROUND: There are barriers and enablers for the implementation of Rapid Response Teams in obstetric hospitals. The enabling factors were determined at Instituto Mexicano del Seguro Social (IMSS) MATERIAL AND METHODS: An observational, retrospective study was conducted by analysing the emergency obstetric reports sent by mobile technology and e-mail to the Medical Care Unit of the IMSS in 2013. Frequency and mean was obtained using the Excel 2010 program for descriptive statistics. RESULTS: A total of 164,250 emergency obstetric cases were reported, and there was a mean of 425 messages per day, of which 32.2% were true obstetric emergencies and required the Rapid Response team. By e-mail, there were 73,452 life threatening cases (a mean of 6 cases per day). A monthly simulation was performed in hospitals (480 in total). Enabling factors were messagés synchronisation among the participating personnel,the accurate record of the obstetrics, as well as the simulations performed by the operational staff. The most common emergency was pre-eclampsia-eclampsia with 3,351 reports, followed by obstetric haemorrhage with 2,982 cases. DISCUSSION: The enabling factors for the implementation of a rapid response team at IMSS were properly timed communication between the central delegation teams, as they allowed faster medical and administrative management and participation of hospital medical teams in the process. CONCLUSION: Mobile technology has increased the speed of medical and administrative management in emergency obstetric care. However, comparative studies are needed to determine the statistical significance.

Morphological changes of red blood cells in peripheral blood smear of patients with pregnancy-related hypertensive disorders.

BACKGROUND AND AIMS: Pregnancy-related hypertensive disorders are complications in which risk factors are identified such as nulliparity, age, malnutrition, obesity and social issues. Those statements are explained by theories of abnormal placentation, immunological inadequacy, genetics and oxidative stress, but all theories converge in endothelial damage, which is able to mechanically deform and hemolyze erythrocytes as they pass through the capillaries. Given the effects of endothelial damage, the aim of the study was to determine erythrocyte alterations in peripheral blood smear of patients with hypertensive disorders of pregnancy that could be used as prognostic condition. METHODS: We performed a prospective, descriptive and observational study where all patients with hypertensive disorders admitted to the obstetrics and gynecology service of a specialty hospital were recruited. Patients who provided signed informed consent underwent peripheral blood smear. Results were tabulated in percentage graphics and analyzed with Cramer's V based on χ(2). The peripheral blood smear consisted of an extended drop of peripheral blood from the patient with subsequent hematological staining done with Romanowsky stain. RESULTS: A total of 119 samples were analyzed; 74% showed abnormal morphology of erythrocytes and the most frequent abnormality was the presence of schistocytes in up to 39% of samples. Descriptive analysis showed a degree of association to independent variables with Cramer's V = 0.41 value (p <0.05). CONCLUSIONS: A high percentage of patients with hypertensive disorders of pregnancy show some morphologic alterations of erythrocytes in peripheral blood smear.

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.