[Effects of statins in cancer]. / Efectos de las estatinas en cáncer: ¿potencial rol en terapéutica y prevención?

This review explores the evidence supporting a potential benefit of statins in cancer. In particular, the lipophilic forms (i.e. lovastatin, simvastatin, or similar) would have a therapeutic but not a preventive role. The pleiotropic effects that statins possess mainly explain this phenomenon, influencing the natural history of disease and the response to currently available therapies. By inhibiting the mevalonate pathway, statins would have a systemic effect, similar to that observed in atherosclerosis, reducing the inflammatory stimuli present in the tumor micro-environment and inhibiting the activation of intracellular signaling cascades critical for proliferation, migration/invasion and metastasis of the cancer cell. Despite all this evidence, randomized trials are needed to confirm the benefit of statins on cancer, before promoting their widespread use as a therapeutic or preventive strategy for this condition.

Efectos de las estatinas en cáncer: ¿potencial rol en terapéutica y prevención? / Effects of statins in cancer

This review explores the evidence supporting a potential benefit of statins in cancer. In particular, the lipophilic forms (i.e. lovastatin, simvastatin, or similar) would have a therapeutic but not a preventive role. The pleiotropic effects that statins possess mainly explain this phenomenon, influencing the natural history of disease and the response to currently available therapies. By inhibiting the mevalonate pathway, statins would have a systemic effect, similar to that observed in atherosclerosis, reducing the inflammatory stimuli present in the tumor micro-environment and inhibiting the activation of intracellular signaling cascades critical for proliferation, migration/invasion and metastasis of the cancer cell. Despite all this evidence, randomized trials are needed to confirm the benefit of statins on cancer, before promoting their widespread use as a therapeutic or preventive strategy for this condition.

Intrahepatic cholestasis of pregnancy: an intriguing pregnancy-specific disorder.

OBJECTIVE: To review animal and human data available regarding the etiology, maternal and fetal impact, and treatment of intrahepatic cholestasis of pregnancy (ICP). METHODS: Pertinent studies on human and animal models of ICP were selected through a MEDLINE database search, focusing on etiology and clinical impact of the disease. Analytic and descriptive studies were included, and the data were analyzed looking for crude numbers. RESULTS: Intrahepatic cholestasis of pregnancy is a pregnancy-specific disorder. Its prevalence is higher in Chile and Sweden compared with any other population. Its etiology is largely unknown, although endocrine, genetic, and environmental factors have been postulated as responsible for the appearance of the disease. Maternal effects of ICP are mild; however, there is a clear association between ICP and poor perinatal outcome, including a higher frequency of fetal distress, preterm labor and delivery, and unexplained fetal death. The treatment is mainly symptomatic. Recent data suggest that oral use of ursodeoxycholic acid improves maternal condition and might prevent the fetal complications of ICP. CONCLUSIONS: Intrahepatic cholestasis of pregnancy should be considered a high-risk condition, and careful fetal assessment and appropriate medical intervention might improve perinatal outcome.

Comparación del índice lecitina/esfingomielina versus fosfatidilglicerol en la evaluación de la madurez pulmonar fetal / Comparison of the lecitina/esfingomielina index versus fosfatidilglicerol in the evaluation of pulmonary fetal maturity

Reportamos el manejo y evolución de tres embarazadas cuyo estudio de índice de madurez pulmonar en el líquido amniótico mostró lecitina/esfingomielina (L/E) inmaduro (<2) con fosfatidilglicerol presente. Agregamos una revisión respecto de la capacidad de ambos test de predecir madurez pulmonar. Se ha descrito que cuando el fosfatidilglicerol está presente, aquellas paciente con un índice de L/E > 2 tiene una probabilidad cercana a cero de presentar enfermedad de membrana hialina neonatal. Por el contrario aquellos casos en los que el índice L/E presenta entre 1,5 y 1,9 la probabilidad de desarrollar la enfermedad es de un 3,4 por ciento. Para este último grupo recomendamos que, si la condición fetal y materna lo permite, la interrupción del embarazo sea diferida en una semana

Amplificación de genes bacterianos con reacción de polimerasa en cadena (PCR) para la detección de invasión microbiana de la cavidad amniotica (IMCA) y predicción de parto prematuro / Amplification of bacterial genes with polimerase chain reaction (PCR) for the detection of microbial invasion of amniotic cavity and prediction of premature labor

Se realizaron PCR y cultivos en líquido amniótico (LA) obtenido por amniocenteáis en 50 embarazadas con trabajo de parto prematuro sin rotura de membranas, y en 13 pacientes con embarazo de término, sin trabajo de parto, en quienes se realizó amniocentesis para evaluar madurez pulmonar fetal antes de la interrupción electiva de la gestación. Las pacientes fueron controladas hasta la resolución del embarazo. Se determinó el valor diagnóstico de los exámenes para predecir parto prematuro y complicaciones neonatales. PCR fue positivo en 23 casos, siendo E coli el germen más frecuentemente detectado (13). El cultivo fue positivo en 6 casos, coincidiendo el germen con PCR en 4 de ellos. La evolución a parto prematuro fue diferente entre los grupos PCR + y PCR-. PCR demostró sensibilidad mayor que los cultivos (40 vs 13 por ciento), y especificidad menor (45 vs 90 por ciento) para predecir parto prematuro menor a 37 semanas. La sensibilidad y especificidad para predecir parto prematuro menor a 34 semanas resultó aún mayor (64 y 59 por ciento, respectivamente). Ninguna de las 13 pacientes de término, candidatas a operación cesárea electiva, resultó positiva para PCR o cultivo