Revisión del estado actual de la resonancia magnética en el cáncer de mama

Breast magnetic resonance imaging is an imaging technique that has been consolidated over time and has shown greater sensitivity in the diagnosis of breast cancer. It is, however, a complex technique because various clinical scenarios must be thoroughly studied for a better application.This article reviews the main clinical indications and the technical points of magnetic resonance imaging.It should be noted that magnetic resonance imaging is still improving technologically, with tools and software gradually emerging that will undoubtedly contribute to the accurate diagnosis of both benign and malignant breast disease.     

Impacto de la infección materna asintomática por SARS-CoV-2 sobre el crecimiento fetal

IntroductionThe impact of asymptomatic infection by SARs-CoV-2 on foetal growth has not been described. The purpose of our study is to determine whether there is an increased risk of foetal growth restriction in pregnancies in which asymptomatic or mild infection by SARS-CoV-2 has been detected.Material and methodsRetrospective case-control study with a subset of pregnant women with a small for gestational age foetus. Groups were established according to birth weight percentile. Previous SARS-CoV-2 infection was defined by positive antibodies obtained on admission to hospital for delivery.ResultsNo statistically significant differences between controls and cases were recorded in terms of positive IgG antibodies (11.5 vs. 8.8%). There were no premature births or significant differences in the date or type of delivery.ConclusionsAsymptomatic infection by SARs-CoV-2 during pregnancy does not seem to affect foetal growth.     

Fracasos de la embolización en el tratamiento del mioma uterino

Uterine artery embolization has been described as an effective and safe treatment for women with symptomatic uterine leiomyomata. We report three cases of women with symptomatic myomatous uterus and their treatment by this approach. In these three cases, hysterectomy was required due to complications following the embolizations. We also describe other complications of this therapeutic approach that came to light in the literature review.     

Uso de inhibidores de la aromatasa en el tratamiento del dolor pélvico asociado a endometriosis: revisión sistemática

ObjectiveTo know the effect of the use of aromatase inhibitors (AI) in the treatment of endometriosis-associated pelvic pain (EAPP).Material and methodsSystematic review of the literature.Results173 articles were identified of which 25 were valid for the review, of which 4 were randomized clinical trials, 3 were non-randomized clinical trials, 10 were prospective non-comparative studies and 8 were clinical case reports. In most of the studies and/or case reports (24 of 27) the use of AI was associated with an improvement in EAPP. Important biases were identified that may influence the efficacy analysis, primarily the combined use of AI with other drugs widely used in the treatment of endometriosis.ConclusionsDespite the existence of numerous articles presenting and/or analysing the effect of AIs in the control of EEAP, the biases in the interpretation of their results, together with the side effect profile of this group of drugs, mean that their use has not become widespread, and they continue to be considered an experimental treatment for endometriosis. To date, there is insufficient evidence of sufficient quality to recommend the use of AI in the treatment of EEAP in routine clinical practice.     

Guía de actuación para el manejo de la infección por COVID-19 durante en el embarazo

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) has caused a large global outbreak and has had a major impact on health systems and societies worldwide. The generation of knowledge about the disease has occurred almost as fast as its global expansion. Very few studies have reported on the effects of the infection on maternal health, since its onset. The mother and foetus do not seem to be at particularly high risk. Nevertheless, obstetrics and maternal-foetal medicine practice have made profound changes in order to adapt to the pandemic. In addition, there are aspects specific to COVID-19 and gestation that should be known by specialists. In this review an evidenced-based protocol is presented for the management of COVID-19 in pregnancy.     

Validez diagnóstica del ratio sFlt-1/PlGF en la identificación de la preeclampsia: una revisión sistemática

Pre-eclampsia (PE) is a multisystem disorder that occurs during pregnancy. It involves alterations that lead to high morbidity and mortality in mother and newborn. It has been shown that the aetiology of PE is linked to angiogenic and anti-angiogenic factors, specifically the serum levels of soluble tyrosine kinase 1 similar to fms (s-Flt1) are elevated in pregnant women with PE, while the circulating levels of the free placental growth factor decrease.In this work, a systematic review of the literature has been carried out to evaluate the validity of the s-Flt1 / placental growth factor ratio for the diagnosis of PE.Seven studies have been selected: one meta-analysis, 4 prospective studies, 2 case-control studies and 2 cohort studies; and 2 retrospective studies.The conclusion of this review is that the sFlt-1 / placental growth factor ratio has a moderate diagnostic accuracy, and is useful as a support technique in the diagnosis and follow-up of pregnant women with suspected PE, especially to rule it out.     

Evolución del estrógeno en la anticoncepción hormonal combinada: del etinilestradiol al estetrol pasando por el estradiol

The objective of this article was to analyse the available evidence on the efficacy and safety of a new oral contraceptive containing estetrol (E4) and drospirenone (DRSP). We conducted a literature review that included published studies on this new contraceptive formulation. Phase 2 and phase 3 clinical trials have shown that the E4 15 mg/DRSP 3 mg combination is effective in preventing pregnancy, is well accepted by women, and does not produce clinically significant changes in coagulation parameters. To confirm the results obtained in phase 2 and 3 trials, a phase 4 study is necessary to reveal the behaviour of this new contraceptive in real life.     

Efectos del ejercicio en la depresión durante el embarazo y el posparto. Una revisión sistemática

The aim of this paper is to evaluate the current scientific literature on the effects of exercise on depression during pregnancy and postpartum. A search was conducted in the Medline, Web of Science and Scopus databases using the MeSH terms “depression”, “pregnancy”, “postpartum” and “exercise”. Fifteen studies were analysed in which the most commonly used intervention protocol was supervised structured aerobic exercise, strength, stretching, relaxation, and pelvic floor exercise. Non-regulated physical activity based on activities of daily living such as walking was also applied. Significant improvements were observed in variables indicative of depression and other factors of psychological well-being. Therefore, exercise has been shown to be a valid method to improve depression during pregnancy and postpartum. The findings in this work could represent a further method of treatment for depression during these stages.     

Efectos maternos y neonatales del parto en el agua. Una revisión sistemática

The objective of this literature review is to determine the maternal and neonatal effects of immersion in water during childbirth. A literature review was carried out in the PubMed, Medline, Scopus, and Cinahl databases. The search terms used were: “Water”, “Delivery”, “Obstetrics”, “Labour”, “Parturition”, and “water birth”. A total of 526 results published in the last 5 years were obtained, of which 13 articles were selected according to the inclusion and exclusion criteria. The studies aimed to evaluate maternal and / or neonatal outcomes after immersion in water during childbirth, although some of them only focus on one of these two aspects. In conclusion, immersion in water provides a reduction in pain and in the duration of labour at maternal level. At neonatal level, no adverse effects are found in newborns.     

Asociación de la infección por SARS-CoV-2 y la administración de las vacunas contra la COVID-19 con alteraciones en el ciclo menstrual. Revisión de la literatura

A number of factors can affect a woman's menstrual cycle, including diseases or drugs, such as COVID-19 disease and vaccinations. The aim of this review is to explore the studies published to date that have studied the presence of alterations that may be related to COVID-19 or vaccination against the SARS-CoV-2 virus.We conducted a review in the PubMed database, selecting 10 articles in which the menstrual cycle of adult women of childbearing age was studied, 3 of them in which the participants had been diagnosed with COVID-19 and 7 in which the participants had been vaccinated against the SARS-CoV-2 virus.Regarding COVID-19-related disturbances, 16%-47.2% of the participants presented a prolongation of their cycle, which was more frequent in those who reported more COVID-19 symptoms, and which normalised after 1-2 cycles.Regarding the alterations described after SARS-CoV-2 vaccination, 45%-78% of participants reported menstrual cycle alterations, with disparate results for the different parameters analysed, except that the alterations resolved in about 2 months.Both COVID-19 disease and vaccination appear to be associated with the occurrence of menstrual disturbances, which are limited in time and not severe. However, studies are scarce to date, and it is important to continue to develop studies that provide scientific evidence.     

Expresión y significación clínica del pepsinógeno C y la colagenasa-3 en el carcinoma de endometrio

ObjectiveTo analyze pepsinogen C and collagenase-3 expression in endometrial adenocarcinoma and their relationship with patient and tumoral characteristicsSubjects And MethodsWe retrospectively analyzed 58 patients with endometrial adenocarcinomas through immunohistochemical assays using monoclonal antibodiesResultsPepsinogen C expression was found in 21 tumors (36%) and collagenase-3 expression was found in 30 (51%). Expression of these proteins was significantly associated with myometrial invasion. The deeper the myometrial invasion, the lesser the pepsinogen C expression and the greater the collagenase-3 expression (p < 0.005 and p < 0.02, respectively). The combined assays of pepsinogen C and collagenase-3 significantly predicted the depth of myometrial invasion (p < 0.001)ConclusionsPepsinogen C and collagenase-3 are expressed in a significant percentage of endometrial adenocarcinomas. These proteolytic enzymes behave differently in this type of tumor and might be useful in the preoperative diagnosis of myometrial invasion     

Resultados del programa de cribado prenatal de cromosomopatías en el área sanitaria sur de Sevilla,tras la implantación de la aplicación corporativa siPACAC

Introduction

Prenatal screening programmes for chromosomal abnormalities require software that allows the calculation of risk. The software is often commercial and linked to the biochemical reagents supplier. We present the results of the programme from the implementation of a new non-commercial, corporate software (siPACAC) and management improvements generated after its introduction.

Inducción del parto tras la aplicación de gel de prostaglandina E2: análisis de los resultados en 1.067 gestantes

ObjectiveRetrospective study of the endocervical prostaglandin gel application during the pregnancy and evaluation of the results of the deliveries on gestant women classified according to the different induction indications of the deliveriesSubjects and methodsWe analyze the delivery characteristics after the E2 prostaglandin gel application on a population of 1067 gestant women at the General Yagüe hospital of Burgos during the period time going from January 1992 to December 1997ResultsThe greatest rate of gel indication occurred on primiparas with a 65.9% rate. The chronologically prolonged pregnancy was the induction indication with the greatest number of deliveries with 519 deliveries followed by the premature membrane breakThe greatest number of deliveries occurred between the 41 and 42 weeks of gestation with a 33.8%. One dose of gel totaled 86.8% of the inductions and the application of three doses the 2.5%. 24 hours was the period of time between gel dose applicationsConclusionsThe prostaglandine gel is a safe alternative method for the delivery induction and with little complications. This method also shortens the dilatation period and the cesareans rate     

Eficacia del ejercicio terapéutico en el síndrome del ovario poliquístico. Una revisión sistemática

Polycystic ovary syndrome is one of the most frequent hormonal problems in women of reproductive age, this syndrome presents many symptoms such as hormonal disorders, irregular menstrual cycles or amenorrhea, presence of masses in the ovaries, weight gain, hirsutism, acne, infertility, among other symptoms of hyperandrogenism. Physical exercise has been prescribed in these women with the aim of weight loss; however, it would be interesting to know the effects of exercise other than on weight loss. Therefore, the objective of this work is to know the effects that therapeutic exercise produces in women with this syndrome. A bibliographic search was conducted in February 2021 in the CINAHL, Medline and PubMed databases. Using the terms Medical Subject Heading (MeSH): “Exercise therapy”, “Polycystic Ovary Syndrome”, and “Therapeutic Exercise”. Clinical trials published in the last 10 years in Spanish or English were included. After application of the exclusion criteria, 10 clinical trials resulted from the analysis. In most of the publications, aerobic exercise and progressive resistance exercise are used, verifying the effects that are achieved at the end of the treatment. An improvement in anthropometric and hormonal parameters was observed.After analysing the different results of this review, we can conclude that therapeutic exercise has a benefit in polycystic ovary syndrome, especially for hormonal levels and the menstrual cycle.     

Tumor miofibroblástico inflamatorio tras cáncer de mama. Un reto en el diagnóstico diferencial. Revisión de la literatura

IntroductionInflammatory myofibroblastic tumour (IMT) is a benign mesenchymal tumour, with potential for malignant transformation. It can appear in multiple organs (lung, intestine…), the breast being an exceptional location.Clinical findingsWe present the case of a 53-year-old female patient with a history of right breast ductal infiltrating carcinoma, G2, Luminal A. She was treated with surgery, radiotherapy, and chemotherapy, achieving complete response. Nine years later, she was re-examined due to the appearance of a new suspicious tumour in the same breast, which measured three centimetres.Main diagnosis, therapeutic intervention, and outcomesA core needle biopsy was performed. The anatomopathological study was inconclusive, so it was decided to perform total excision of the lesion. The results of the anatomopathological analysis were: Inflammatory Myofibroblastic Tumour. The patient did not require further adjuvant treatment and is disease free at present.ConclusionsIMT is a rare entity, with few cases published to date. It represents a diagnostic challenge, both radiologically and anatomopathologically. Although it is a tumour with benign behaviour, wide and complete excision of the lesion is indicated, as its recurrence has been described in some cases, as well as some exceptional cases of metastatisation. Knowledge of its existence and behaviour is a key factor in guiding diagnosis and treatment.     

Estimación del riesgo de aneuploidías para los cromosomas sexuales en un paciente 46,XY/47,XXY candidato a fecundación in vitro con microinyección intracitoplasmática espermática

We report the case of a pregnancy after intracytoplasmic sperm injection of ejaculated spermatozoa in a mosaic Klinefelter patient. The percentage of mosaicism observed in premeiotic germ cells was inverted with respect to that observed in peripheral blood. From meiotic and fluorescent in situ hybridization (FISH) studies, we concluded that the patient's genetic risk of transition of sexual chromosomal abnormalities to ther offspring was similar to that in the control population. Therefore, a cycle of in vitro fertilization by intracytoplasmic sperm injection (IVF-ICSI) and prenatal diagnosis were recommended. Unfortunately, the pregnancy ended in miscarriage. Klinefelter patients should be exhaustively studied before IVF-ICSI treatment. Meiotic studies and FISH in ejaculated or testicular spermatozoa as well as prenatal diagnosis should be carried out in these patients. Preimplantation genetic diagnosis is advisable only in patients at high genetic risk