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Introduction & objectives Liver cirrhosis is a major cause of mortality worldwide. Adequate diagnosis and treatment of decompensating events requires of both medical skills and updated technical resources. The objectives of this study were to search the demographic profile of hospitalized cirrhotic patients in a group of Latin American hospitals and the availability of expertise/facilities for the diagnosis and therapy of decompensation episodes. Methods A cross sectional, multicenter survey of hospitalized cirrhotic patients. Results 377 patients, (62% males; 58 ± 11 years) (BMI > 25, 57%; diabetes 32%) were hospitalized at 65 centers (63 urbans; 57 academically affiliated) in 13 countries on the survey date. Main admission causes were ascites, gastrointestinal bleeding, hepatic encephalopathy and spontaneous bacterial peritonitis/other infections. Most prevalent etiologies were alcohol-related (AR) (40%); non-alcoholic-steatohepatitis (NASH) (23%), hepatitis C virus infection (HCV) (7%) and autoimmune hepatitis (AIH) (6%). The most frequent concurrent etiologies were AR + NASH. Expertise and resources in every analyzed issue were highly available among participating centers, mostly accomplishing valid guidelines. However, availability of these facilities was significantly higher at institutions located in areas with population > 500,000 (n = 45) and in those having a higher complexity level (Gastrointestinal, Liver and Internal Medicine Departments at the same hospital (n = 22). Conclusions The epidemiological etiologic profile in hospitalized, decompensated cirrhotic patients in Latin America is similar to main contemporary emergent agents worldwide. Medical and technical resources are highly available, mostly at great population urban areas and high complexity medical centers. Main diagnostic and therapeutic approaches accomplish current guidelines recommendations.

Psychosocial stress contributes to placental oxidative stress. Mitochondria are vulnerable to oxidative stress, which can lead to changes in mitochondrial DNA copy number (mtDNAcn). We examined associations of maternal lifetime stress, current negative life events, and depressive and posttraumatic-stress-disorder symptom scores with placental mtDNAcn in a racially/ethnically diverse sample (n = 147) from the Programming of Intergenerational Stress Mechanisms (PRISM) study (Massachusetts, March 2011 to August 2012). In linear regression analyses adjusted for maternal age, race/ethnicity, education, prenatal fine particulate matter exposure, prenatal smoking exposure, and the sex of the child, all measures of stress were associated with decreased placental mtDNAcn (all P values < 0.05). Weighted-quantile-sum (WQS) regression showed that higher lifetime stress and depressive symptoms accounted for most of the effect on mtDNAcn (WQS weights: 0.25 and 0.39, respectively). However, among white individuals, increased lifetime stress and posttraumatic stress disorder symptoms explained the majority of the effect (WQS weights: 0.20 and 0.62, respectively) while among nonwhite individuals, lifetime stress and depressive symptoms accounted for most of the effect (WQS weights: 0.27 and 0.55, respectively). These analyses are first to link increased maternal psychosocial stress with reduced placental mtDNAcn and add to literature documenting racial/ethnic differences in the psychological sequelae of chronic stress that may contribute to maternal-fetal health.

La cirugía laparoscópica ha ido incursionando en la ginecología oncológica desde los años 80. Aunque su aplicabilidad aún es controversial, la evidencia de los últimos años permite una fuerte consideración de la técnica sin dejar de reflexionar sobre los posibles efectos adversos y las consecuencias de un manejo inadecuado. Métodos: Se ha revisado la literatura para mencionar los datos respecto a indicaciones, resultados a largo plazo, estudios comparativos y avances. Presentamos nuestra casuística. Resultados: La literatura resalta la factibilidad y3 ventajas de la laparoscopia sobre la laparotomía respecto a sangrado intraoperatorio, dolor postoperatorio, días de hospitalización posquirúrgicos y la reincorporación a las actividades diarias. Los resultados de sobrevida son similares. La linfadenectomía aórtica extraperitoneal es una nueva herramienta útil en el manejo de neoplasias ginecológicas. La laparoscopia está siendo ampliamente usada en el manejo del cáncer de cuello uterino, endometrio y ovario, así como nuevas técnicas están surgiendo como la exenteración pélvica o la quimioterapia intraperitoneal con hipertermia por laparoscopia. Conclusiones: La literatura demuestra el creciente interés de la técnica en el mundo y debería ser parte de las habilidades del ginecólogo oncólogo. La morbilidad y el riesgo de recurrencia no deberían ser afectados. El valor costoeficacia puede estar representado por la disminución de la hospitalización postoperatoria, aunque el tiempo operatorio aumente inicialmente. Es importante, además, una adecuada preparación para evitar el manejo subóptimo de las neoplasias ginecológicas.

El cáncer de endometrio es una de las neoplasias ginecológicas más frecuentes. En nuestro país representa la tercera neoplasia ginecológica, luego del cáncer de cuello uterino y del cáncer de ovario. La mayoría de pacientes se presenta en estadios tempranos de la enfermedad, puesto que la ginecorragia es una manifestación precoz de la neoplasia. Entre los tipos de abordaje del cáncer de endometrio, la laparotomía mediana permite el estadiaje quirúrgico. El abordaje vaginal, en casos de marcada obesidad, tiene limitaciones. La laparoscopia se ha desarrollado como una técnica con creciente interés, con incremento de la evidencia en la literatura sobre su factibilidad y ventajas.

Introduction: Changes in mitochondrial DNA (mtDNA) can serve as a marker of cumulative oxidative stress (OS) due to the mitochondria's unique genome and relative lack of repair systems. In utero particulate matter ≤2.5 μm (PM2.5) exposure can enhance oxidative stress. Our objective was to identify sensitive windows to predict mtDNA damage experienced in the prenatal period due to PM2.5 exposure using mtDNA content measured in cord blood. Material and methods: Women affiliated with the Mexican social security system were recruited during pregnancy in the Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS) study. Mothers with cord blood collected at delivery and complete covariate data were included (n = 456). Mothers' prenatal daily exposure to PM2.5 was estimated using a satellite-based spatio-temporally resolved prediction model and place of residence during pregnancy. DNA was extracted from umbilical cord leukocytes. Quantitative real-time polymerase chain reaction (qPCR) was used to determine mtDNA content. A distributive lag regression model (DLM) incorporating weekly averages of daily PM2.5 predictions was constructed to plot the association between exposure and OS over the length of pregnancy. Results: In models that included child's sex, mother's age at delivery, prenatal environmental tobacco smoke exposure, birth year, maternal education, and assay batch, we found significant associations between higher PM2.5 exposure during late pregnancy (35–40 weeks) and lower mtDNA content in cord blood. Conclusions: Increased PM2.5 during a specific prenatal window in the third trimester was associated with decreased mtDNA content suggesting heightened sensitivity to PM-induced OS during this life stage. Keywords: Particulate matter, Mitochondrial DNA, Distributive lag models, Prenatal exposure

La cirugía mínimamente invasiva (CMI) en el manejo de las neoplasias ginecológicas se ha incrementado considerablemente en la última década. La posibilidad de realizar los procedimientos quirúrgicos necesarios para tratar el cáncer ginecológico ha mejorado el cuidado y la calidad de vida de las pacientes. En el presente artículo se revisa las innovaciones en CMI y se discute las aplicaciones así como la experiencia del Instituto Nacional de Enfermedades Neoplásicas de Perú en el manejo del cáncer de cérvix, endometrio y ovario. Minimally invasive surgery in the management of gynecologic malignancies has increased considerably in the last decade. The ability to perform minimally surgical procedures has revolutionized care and quality of life outcomes for patients. In this article, we review innovations in minimally invasive surgery and its applications are discussed as well as the experience at National Institute of Neoplasic Diseases of Peru in the treatment of cervical, endometrial and ovarian cancer.

Altres ajuts: ANSES/A06-018-2 Border disease virus (BDV) causes high mortality in Pyrenean chamois (Rupicapra pyrenaica) on the French and Spanish sides of the Pyrenees Mountains. We investigated the pathology induced by BDV in pregnant chamois via experimental infection. Three females were inoculated during the second third of pregnancy with a BDV-4 subgroup strain isolated from a wild Pyrenean chamois during an acute epizootic. A fourth pregnant chamois and one nonpregnant ewe were kept as negative controls. Animals were monitored to assess clinical signs, hematology, viremia, and serology. Postmortem examinations included necropsy, histopathology, and quantification of viral RNA in organs. Pregnancy was unsuccessful in all inoculated animals. One died 24 days postinoculation (dpi) without showing any precursory clinical signs. The second animal had profuse diarrhea from 13 dpi to its death at 51 dpi. The third aborted at 46 dpi and was euthanized at 51 dpi. All animals were viremic from 4 dpi until death. Neutralizing antibodies against BDV-4 were detected from 12 dpi. Necropsies showed generalized lymphadenomegaly, associated in one case with disseminated petechial hemorrhages in the digestive tract. Seventy-eight of 79 organs from inoculated adults and their fetuses had detectable viral RNA. The main histologic lesions in adults were mild lymphohistiocytic encephalitis associated with moderate or moderately severe lymphoid depletion. Control animals remained negative for virus (in blood and organs), antibody, and lesions upon postmortem examination. BDV infection during pregnancy in Pyrenean chamois causes severe disease leading to abortion, then death. Despite 100% fetal death following inoculation, viral RNA was recovered from all organs of infected fetuses, suggesting that persistently infected offspring could be born. Our results may help explain the reported decrease in chamois populations in several areas and suggest that great care must be taken when interpreting infection status for wildlife.