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INTRODUCTION/AIMS: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with a higher incidence in men suggesting an influence of sex steroids. Our objective was to investigate past exposure to endogenous and synthetic steroids in female ALS patients and controls. METHODS: We administered a questionnaire to 158 postmenopausal women (75 ALS patients and 83 controls). We calculated reproductive time span (RTS), lifetime endogenous estrogen (LEE) and progesterone exposures (LPE), oral contraceptive pill (OCP) use, and reproductive history. RESULTS: ALS patients showed shorter LEE and LPE, a lower proportion of breast cancer, and 11% showed no history of pregnancies vs. 4% of controls. Odds ratios (ORs) showed that <17 y of LEE and a delayed menarche (>13 y) constitute risk factors for ALS [OR = 2.1 (95% confidence interval {CI}, 1.08-4.2); and OR = 2.4 (95% CI, 1.1-5.1) respectively]. According to Cox survival analysis, for each year the LEE increased over 17 y, it was independently associated with longer survival [hazard ratio (HR) = 0.37 (95% CI, 0.16-0.85)] after adjusting for smoking, age and site of onset. Multivariate regression analysis demonstrated that for each month using OCP for longer than 40 mo increased the risk of ALS [adjusted OR = 4.1 (95% CI, 1.2-13.8)]. DISCUSSION: Thus, longer exposure to endogenous female sex steroids increased survival and reduced ALS susceptibility. In contrast, longer exposure to synthetic sex steroids showed a negative impact by reducing the production of endogenous female sex steroids or due to crossover with other steroid receptors. Given the neuroprotective effects of sex steroids, we suggest that abnormalities of neuroendocrine components may alter motor function in women with ALS.

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COVID-19 coronavirus disease is an often-severe illness caused by the SARS-CoV-2 virus. The pandemic has demanded a great organization and redistribution of infrastructure and medical resources for the care of patients with cancer. The Gynecology service of the Oncology Hospital of the City of Buenos Aires is a monovalent center dependent on the City of Buenos Aires. It is part of the network of 33 public hospitals in the City of Buenos Aires and receives referrals from other hospitals in the network and from hospitals in the Province of Buenos Aires. As of March 20, 2020, when decree 260/20 came into force, which established social, preventive and compulsory isolation, a new modality was started for the care and benefits of our hospital. In our Service of the Hospital de Oncología de la Ciudad de Buenos Aires we have developed recommendations for the management of gynecological tumors during the COVID-19. The guide we developed is based on up-to-date data and available resources and provides suggestions and tools for decision-making in order to reduce the morbidity and mortality of patients with gynecological cancer during the Coronavirus pandemic (COVID-19).

La enfermedad por coronavirus COVID-19 causada por el virus SARS-CoV-2 es en muchos casos grave. La pandemia ha demandado una gran organización y redistribución de infraestructura y recursos médicos para la atención de pacientes con cáncer. El servicio de Ginecología del Hospital de Oncología Marie Curie es un centro monovalente dependiente del Gobierno de la Ciudad de Buenos Aires. Forma parte de la red de 33 hospitales públicos de la Ciudad y recibe derivaciones de otros hospitales de la red y de hospitales de la Provincia de Buenos Aires. A partir del 20 de marzo de 2020, cuando entró en vigor el decreto 260/20 que dispuso el aislamiento social, preventivo y obligatorio, se inició una nueva modalidad para la atención y prestaciones de nuestro hospital. En el Servicio de Ginecología del Hospital Marie Curie hemos desarrollado recomendaciones para el manejo de los tumores ginecológicos durante la pandemia por COVID-19. Elaboramos una guía basada en los datos actualizados y recursos disponibles entre los que se encuentran la guía del International Journal of Gynecological Cancer, la guía de la Sociedad Británica del Cáncer Ginecológico, las recomendaciones de la Asociación Argentina de Ginecología Oncológica, y la Guía de la Sociedad de Ginecología Oncológica Americana que proveen sugerencias y herramientas para la toma de decisiones con el objeto de reducir la morbilidad y mortalidad de las pacientes con cáncer ginecológico durante la pandemia por Coronavirus (COVID-19).

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Resumen La enfermedad por coronavirus COVID-19 causada por el virus SARS-CoV-2 es en muchos casos grave. La pandemia ha demandado una gran organización y redistribución de infraestructura y recur sos médicos para la atención de pacientes con cáncer. El servicio de Ginecología del Hospital de Oncología Marie Curie es un centro monovalente dependiente del Gobierno de la Ciudad de Buenos Aires. Forma parte de la red de 33 hospitales públicos de la Ciudad y recibe derivaciones de otros hospitales de la red y de hospitales de la Provincia de Buenos Aires. A partir del 20 de marzo de 2020, cuando entró en vigor el decreto 260/20 que dispuso el aislamiento social, preventivo y obligatorio, se inició una nueva modalidad para la atención y prestaciones de nuestro hospital. En el Servicio de Ginecología del Hospital Marie Curie hemos desarrollado recomendaciones para el manejo de los tumores ginecológicos durante la pandemia por COVID-19. Elaboramos una guía basada en los datos actualizados y recursos disponibles entre los que se encuentran la guía del International Journal of Gynecological Cancer, la guía de la Sociedad Británica del Cáncer Ginecológico, las recomendaciones de la Asociación Argentina de Ginecología Oncológica, y la Guía de la Sociedad de Ginecología Oncológica Americana que proveen sugerencias y herramientas para la toma de decisiones con el objeto de reducir la morbilidad y mortalidad de las pacientes con cáncer ginecológico durante la pandemia por Coronavirus (COVID-19).

Abstract COVID-19 coronavirus disease is an often-severe illness caused by the SARS-CoV-2 virus. The pandemic has demanded a great organization and redistribution of infrastructure and medical resources for the care of patients with cancer. The Gynecology service of the Oncology Hospital of the City of Buenos Aires is a monovalent center dependent on the City of Buenos Aires. It is part of the network of 33 public hospitals in the City of Buenos Aires and receives referrals from other hospitals in the network and from hospitals in the Province of Buenos Aires. As of March 20, 2020, when decree 260/20 came into force, which established social, preventive and compulsory isolation, a new modality was started for the care and benefits of our hospital. In our Service of the Hospital de Oncología de la Ciudad de Buenos Aires we have developed recommendations for the management of gynecological tumors during the COVID-19. The guide we developed is based on up-to-date data and available resources and provides suggestions and tools for decision-making in order to reduce the morbidity and mortality of patients with gynecological cancer during the Coronavirus pandemic (COVID-19).

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BACKGROUND: Huntington's disease (HD) is a devastating and fatal neurodegenerative disorder that leads to progressive disability, and over time to total dependence. The economic impact of HD on patients living in developing countries like Peru is still unknown. This study aims to estimate the economic burden by estimating direct and indirect costs of Huntington's disease in Peru, as well as the proportion of direct costs borne by patients and their families. METHODS: Disease-cost cross-sectional study where 97 participants and their primary caregivers were interviewed using a common questionnaire. Prevalence and human capital approaches were used to estimate direct and indirect costs, respectively. RESULTS: The average annual cost of HD reached USD 8120 per patient in 2015. Direct non-healthcare costs represented 78.3% of total cost, indirect costs 14.4% and direct healthcare costs the remaining 7.3%. The mean cost of HD increased with the degree of patient dependency: from USD 6572 for Barthel 4 & 5 (slight dependency and total independency, respectively) to USD 23,251 for Barthel 1 (total dependency). Direct costs were primarily financed by patients and their families. CONCLUSIONS: The estimated annual cost of HD for Peruvian society reached USD 1.2 million in 2015. The cost impact of HD on patients and their families is very high, becoming catastrophic for most dependent patients, and thus making it essential to prioritize full coverage by the State.

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Presentamos un caso de un paciente de 57 años de edad que presenta un tumor mixto mülleriano heterólogo 7 años post-radioterapia pelviana. Se efectuó anexohisterectomía total y posteriormente recibió 6 ciclos de quimioterapia con cisplatino y fosfamida. La paciente tuvo una rápida progresión, falleciendo un año luego del diagnóstico.Los tumores mixtos Müllerianos con áreas rabdomioblásticas se caracterizan por un comportamiento agresivo, resistencia al tratamiento y una evolución rápidamente fatal.Su diagnóstico histopatológico es muy importante por su implicancia diagnóstica

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Presentamos un caso de un paciente de 57 años de edad que presenta un tumor mixto m³lleriano heterólogo 7 años post-radioterapia pelviana. Se efectuó anexohisterectomía total y posteriormente recibió 6 ciclos de quimioterapia con cisplatino y fosfamida. La paciente tuvo una rápida progresión, falleciendo un año luego del diagnóstico.Los tumores mixtos M³llerianos con áreas rabdomioblásticas se caracterizan por un comportamiento agresivo, resistencia al tratamiento y una evolución rápidamente fatal.Su diagnóstico histopatológico es muy importante por su implicancia diagnóstica

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