Preterm birth (PTB) is a worldwide health problem and remains the leading cause of perinatal morbidity and mortality. Systemic and local intrauterine infections have been implicated in the pathogenesis of preterm labor and delivery. Common pathways between PTB, premature rupture of ovular membranes (PROM) and altered molecular routes of inflammation have been proposed. There is evidence to support a genetic component in these conditions. Lipopolysaccharide (LPS), a component of the cell wall of Gram-negative bacteria, is thought to play a key role in eliciting an inflammatory response. LPS is recognized by proteins of the innate immune system, including Toll-like receptor 4 (TLR4). Individuals from some European countries carrying the variant alleles resulting in an amino acid substitution (Asp299Gly) are at increased risk of Gram-negative infections and premature birth. The objective of this study was to determine if preterm newborns have different allele frequency of the Asp299Gly TLR4 variant from healthy term neonates in Uruguay. The impact of PROM was also examined. There was an increase in the risk for fetuses carrying the Asp299Gly substitution in TLR4 of being severely premature (<33 weeks) and to present PROM at the same time.

There is evidence for a link between MHC and squamous cell carcinoma of the cervix (SCCC), and different patterns of association in different patient cohorts have been reported. To investigate this subject in the Spanish population, HLA class I, -II serotypings and HLA-DQB1 oligogenotypings of 142 patients and 138 healthy sex-age-matched controls were performed. Comparative analysis of the DR2-DQ3-stratified phenotypes demonstrated a strong association between DR2 and DQ3 in SCCC (Pc9 < 7 x 10(-8)). However, no interaction was observed between the two HLA factors, which seem to confer two weak and independent risks. Thus, phenotypes with DR2 and/or DQ3 (patients, 79%, controls, 60%; P < 5 x 10(-4)) were over-represented, while the less common DR2/DQ3-negative phenotypes with the HLA class I A2 antigen were found to confer the highest risk (EF = 62%, Pc84 < 1 x 10(-2)) of SCCC. Comparative analysis of allele frequencies revealed two weakly significant increases, one for DQB1*0301 (P < 1 x 10(-2)) in low-moderate dysplasias (CINI,II), and the other for DQB1*0402 (P < 3 x 10(-2)) in severe dysplasia in situ (CINIII/CIS), and a trend for an increase of DQB1*0302 among CINIII/CIS and invasive SCCC (ISCCC). With regard to DQB1 genes encoding the DR2-associated DQ serotypes, there was no significant deviation in patients. In contrast, the frequency of DQB1*0603 was found to be weakly decreased in CINI,II (P < 5 x 10(-2)) and ISCCC (P < 3 x 10(-2)), indicating a protective effect for this DR13 serotype-associated allele. No significant association could be shown between HLA and HPV infective status. However, there is circumstantial evidence that HPV-infected lesions may have been misassigned in some cases, and the sample size was small, so a role for DQB alleles in modifying the course of HPV-induced diseases cannot be excluded. The observations in this study suggest A2, DR2, DQB1*0301, DQB1*0402 and DQB1*0603 as independent factors associated with SCCC and as relevant targets in HLA-restricted peptide presentation. Our results are consistent with the theory that HLA loci may have different contributions in susceptibility and resistance to low-moderate dysplasias, CIS and invasive SCCC.

During pregnancy, a series of physiological changes are determined at the molecular, cellular and macroscopic level that make the mother and fetus more susceptible to certain viral and bacterial infections, especially the infections in this and the companion review. Particular situations increase susceptibility to infection in neonates. The enhanced susceptibility to certain infections increases the risk of developing particular diseases that can progress to become morbidly severe. For example, during the current pandemic caused by the SARS-CoV-2 virus, epidemiological studies have established that pregnant women with COVID-19 disease are more likely to be hospitalized. However, the risk for intensive care unit admission and mechanical ventilation is not increased compared with nonpregnant women. Although much remains unknown with this particular infection, the elevated risk of progression during pregnancy towards more severe manifestations of COVID-19 disease is not associated with an increased risk of death. In addition, the epidemiological data available in neonates suggest that their risk of acquiring COVID-19 is low compared with infants (<12 months of age). However, they might be at higher risk for progression to severe COVID-19 disease compared with older children. The data on clinical presentation and disease severity among neonates are limited and based on case reports and small case series. It is well documented the importance of the Zika virus infection as the main cause of several congenital anomalies and birth defects such as microcephaly, and also adverse pregnancy outcomes. Mycoplasma infections also increase adverse pregnancy outcomes. This review will focus on the molecular, pathophysiological and biophysical characteristics of the mother/placental-fetal/neonatal interactions and the possible mechanisms of these pathogens (SARS-CoV-2, ZIKV, and Mycoplasmas) for promoting disease at this level.

Introducción: Los cursos de Ginecología y Obstetricia se dictan en el penúltimo año de la carrera de Doctor en Medicina y representan el primer contacto curricular de los estudiantes con la disciplina. El perfil del egresado del plan de estudios vigente se orienta a la formación de medico generalista, por lo que el egresado debe ser competente en un numero básico de destrezas en el área ginecobstétrica. Objetivos: El objetivo del presente trabajo es introducir el uso de simuladores en la enseñanza del pregrado de ginecología y obstetricia. Metodología: En el transcurso del curso de ginecología del año 2003 los estudiantes fueron divididos en forma aleatorizada en dos grupos, uno de los cuales realizó su entrenamiento con simuladores. Se realizó un seguimiento del aprendizaje por medio de planillas de verificación. Resultados: De los resultados surge que los estudiantes del grupo que realizó su entrenamiento con simuladores tuvieron mas oportunidades de realizar las maniobras sobre todo aquellas que implican mayor dificultad como ser la colocación del especulo y el examen vaginal. Conclusiones: De acuerdo a esto se podría afirmar que la utilización de simuladores constituye una buena herramienta para la adquisición de destrezas en el área gineco obstétrica, y pueden ser una alternativa para la enseñanza a nivel del pregrado Introduction: The courses in gynaecology and obstetrics are given during the seventh year of the medicine career and represent the students' first contact with the discipline. Most graduates from our medical school eventually become GPs, so they must be trained in a number of basic skills in obstetrics and gynaecology. Aims: To introduce the use of medical simulators in undergraduate courses of obstetrics and gynaecology. Methodology: During the gynaecology course in the 2003 academic year, students were randomly divided into two groups. The experimental group did their training with medical simulators. Their learning was followed up using a checklist for pelvic examination. Results: The results show that the students that did their training with simulators had more opportunities to perform the manoeuvres, especially those involving greater difficulty like vaginal examination and " speculum" introduction. Conclusions: The use of medical simulators constitutes a good tool for the acquisition of skills in the obgyn area. Simulators provide a useful alternative in undergraduate education.

Los cursos de Ginecología y Obstetricia se dictan en el penúltimo año de la carrera de Doctor en Medicina y representan el primer contacto curricular de los estudiantes con la disciplina. El perfil del egresado del plan de estudios vigente se orienta a la formación de medico generalista, por lo que el egresado debe ser competente en un numero básico de destrezas en el área ginecobstétrica. Objetivos: El objetivo del presente trabajo es introducir el uso de simuladores en la enseñanza del pregrado de ginecología y obstetricia. Metodología: En el transcurso del curso de ginecología del año 2003 los estudiantes fueron divididos en forma aleatorizada en dos grupos, uno de los cuales realizó su entrenamiento con simuladores. Se realizó un seguimiento del aprendizaje por medio de planillas de verificación. Resultados: De los resultados surge que los estudiantes del grupo que realizó su entrenamiento con simuladores tuvieron mas oportunidades de realizar las maniobras sobre todo aquellas que implican mayor dificultad como ser la colocación del especulo y el examen vaginal. Conclusiones: De acuerdo a esto se podría afirmar que la utilización de simuladores constituye una buena herramienta para la adquisición de destrezas en el área gineco obstétrica, y pueden ser una alternativa para la enseñanza a nivel del pregrado