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Autism spectrum disorder (ASD) is a psychiatric condition characterized by reduced social interaction, anxiety, and stereotypic behaviors related to neuroinflammation and microglia activation. We demonstrated that maternal exposure to Western diet (cafeteria diet or CAF) induced microglia activation, systemic proinflammatory profile, and ASD-like behavior in the offspring. Here, we aimed to identify the effect of alternate day fasting (ADF) as a non-pharmacologic strategy to modulate neuroinflammation and ASD-like behavior in the offspring prenatally exposed to CAF diet. We found that ADF increased plasma beta-hydroxybutyrate (BHB) levels in the offspring exposed to control and CAF diets but not in the cortex (Cx) and hippocampus (Hpp). We observed that ADF increased the CD45 + cells in Cx of both groups; In control individuals, ADF promoted accumulation of CD206 + microglia cells in choroid plexus (CP) and increased in CD45 + macrophages cells and lymphocytes in the Cx. Gestational exposure to CAF diet promoted defective sociability in the offspring; ADF improved social interaction and increased microglia CD206 + in the Hpp and microglia complexity in the dentate gyrus. Additionally, ADF led to attenuation of the ER stress markers (Bip/ATF6/p-JNK) in the Cx and Hpp. Finally, biological modeling showed that fasting promotes higher microglia complexity in Cx, which is related to improvement in social interaction, whereas in dentate gyrus sociability is correlated with less microglia complexity. These data suggest a contribution of intermittent fasting as a physiological stimulus capable of modulating microglia phenotype and complexity in the brain, and social interaction in male mice.

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Prenatal exposure to high-energy diets (HED) increases the susceptibility to behavioral alterations in the male offspring. We addressed whether prenatal HED primes the transgenerational inheritance of structural brain changes impacting anxiety/depression-like behavior in the offspring. For this, we used female Wistar rats exposed to a HED [cafeteria (CAF) diet, n = 6] or chow [control (CON) n = 6] during development. Anxiety and depression-like behavior were evaluated in filial 1 (F1), filial 2 (F2), and filial 3 (F3) male offspring using the open field (OFT), elevated plus maze, novelty suppressed feeding (NSFT), tail suspension (TST), and forced swimming tests. Structural brain changes were identified by deformation-based morphometry (DBM) and diffusion tensor imaging using ex vivo MRI. We found that the F1, F2, and F3 offspring exposed to CAF diet displayed higher anxious scores including longer feeding latency during the NSFT, and in the closed arms, only F1 offspring showed longer stay on edges during the OFT versus control offspring. DBM analysis revealed that CAF offspring exhibited altered volume in the cerebellum, hypothalamus, amygdala, and hippocampus preserved up to the F3 generation of anxious individuals. Also, F3 CAF anxious exhibited greater fractional anisotropy and axial diffusivity (AD) in the amygdala, greater apparent diffusion coefficient in the corpus callosum, and greater AD in the hippocampus with respect to the control. Our results suggest that prenatal and lactation exposure to HED programs the transgenerational inheritance of structural brain changes related to anxiety-like behavior in the male offspring.

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Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that involves functional and structural defects in selective central nervous system (CNS) regions, harming the individual capability to process and respond to external stimuli, including impaired verbal and non-verbal communications. Etiological causes of ASD have not been fully clarified; however, prenatal activation of the innate immune system by external stimuli might infiltrate peripheral immune cells into the fetal CNS and activate cytokine secretion by microglia and astrocytes. For instance, genomic and postmortem histological analysis has identified proinflammatory gene signatures, microglia-related expressed genes, and neuroinflammatory markers in the brain during ASD diagnosis. Active neuroinflammation might also occur during the developmental stage, promoting the establishment of a defective brain connectome and increasing susceptibility to ASD after birth. While still under investigation, we tested the hypothesis whether the monocyte chemoattractant protein-1 (MCP-1) signaling is prenatally programmed to favor peripheral immune cell infiltration and activate microglia into the fetal CNS, setting susceptibility to autism-like behavior. In this review, we will comprehensively provide the current understanding of the prenatal activation of MCP-1 signaling by external stimuli during the developmental stage as a new selective node to promote neuroinflammation, brain structural alterations, and behavioral defects associated to ASD diagnosis.

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Resumen Las estatinas son ampliamente utilizadas para el control de los niveles de colesterol en pacientes con hipercolesterolemia, lo cual permite prevenir enfermedades cardiovasculares. Además de controlar la síntesis endógena de colesterol, las estatinas tienen efectos pleiotrópicos diversos, como son las propiedades antiinflamatoria, antioxidante y de inmunomodulación. La enfermedad causada por el virus SARS-CoV-2 (COVID-19) provoca una tormenta de citocinas que contribuye a la generación del síndrome respiratorio agudo, que puede llevar a cuadros graves de esta enfermedad e incluso a la muerte del paciente. Diversos estudios realizados en enfermos con COVID-19 que recibieron estatinas, antes o durante el curso de la enfermedad, registraron cuadros menos graves, estancias hospitalarias más cortas y menor mortalidad. El beneficio de las estatinas en la COVID-19 debe ser explorado más ampliamente, ya que potencialmente pueden contribuir al control de esta pandemia que ha postrado a la humanidad.

Abstract Statins are widely used to control cholesterol levels in patients with hypercholesterolemia, which helps prevent cardiovascular diseases. In addition to controlling endogenous cholesterol synthesis, statins have diverse pleiotropic effects, such as anti-inflammatory, antioxidant, and immunomodulatory properties. The disease caused by the SARS-CoV-2 virus (COVID-19) causes a cytokine storm that contributes to the generation of acute respiratory syndrome, which can lead to severe symptoms of this disease and even the death of the patient. Various studies carried out on patients with COVID-19 who received statins, before or during the disease, registered less severe symptoms, shorter hospital stays and lower mortality. The benefit of statins in COVID-19 should be explored more widely, as they can potentially contribute to the control of this pandemic that has devastated humanity.

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Accumulation of white adipose tissue (WAT) during obesity is associated with the development of chronic low-grade inflammation, a biological process known as lipoinflammation. Systemic and central lipoinflammation accumulates pro-inflammatory cytokines including IL-6, IL-1ß and TNF-α in plasma and also in brain, disrupting neurometabolism and cognitive behavior. Obesity-mediated lipoinflammation has been reported in brain regions of the mesocorticolimbic reward circuit leading to alterations in the perception and consumption of ultra-processed foods. While still under investigation, lipoinflammation targets two major outcomes of the mesocorticolimbic circuit during food reward: perception and motivation ("Wanting") and the pleasurable feeling of feeding ("Liking"). This review will provide experimental and clinical evidence supporting the contribution of obesity- or overnutrition-related lipoinflammation affecting the mesocorticolimbic reward circuit and enhancing food reward responses. We will also address neuroanatomical targets of inflammatory profiles that modulate food reward responses during obesity and describe potential cellular and molecular mechanisms of overnutrition linked to addiction-like behavior favored by brain lipoinflammation.

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Industrial activities provide a modern human lifestyle with advances and comforts in every field. However, such scenario has brought several negative issues. Persistent organic pollutants (POPs) and a growing plastic usage together with the degradation byproducts, namely microplastics (MPs), are current environmental problems present in every ecosystem, disturbing all forms of life. POPs and MPs are also found in human consumption products including animal and vegetal derivatives, human milk substitutes, and in human breast milk. To date, it is currently unknown what are the effects of MPs and POPs when ingested during the first and most important stage for health programming of the offspring, the first 1000 days of life. Here, we add epidemiological and clinical evidence supporting major sources of POPs and MPs in the ecosystem; and we will precisely describe the effect of POP and MP accumulation in animal- or plant-based infant formulas and human breast milk, modulating health outcomes in the newborn. This review provides a rational to incentive the POP and MP identification in human breast milk and human milk substitutes for avoiding susceptibility to negative health outcomes for the newborn.

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Prenatal exposure to high-energy diets primes brain alterations that increase the risk of developing behavioral and cognitive failures. Alterations in the structure and connectivity of brain involved in learning and memory performance are found in adult obese murine models and in humans. However, the role of prenatal exposure to high-energy diets in the modulation of the brain's structure and function during cognitive decline remains unknown. We used female C57BL6 mice (n = 10) exposed to a high-energy diets (Cafeteria diet (CAF)) or Chow diet for 9 weeks (before, during and after pregnancy) to characterize their effect on brain structural organization and learning and memory performance in the offspring at two-month-old (n = 17). Memory and learning performance were evaluated using the Y-maze test including forced and spontaneous alternation, novel object recognition (NORT), open field and Barnes maze tests. We found no alterations in the short- or long-time spatial memory performance in male offspring prenatally exposed to CAF diet when compared to the control, but they increased time spent in the edges resembling anxiety-like behavior. By using deformation-based morphometry and diffusion tensor imaging analysis we found that male offspring exposed to CAF diet showed increased volume in primary somatosensory cortex and a reduced volume of fimbria-fornix, which correlate with alterations in its white matter integrity. Biological modeling revealed that prenatal exposure to CAF diet predicts low volume in the fimbria-fornix, which was associated with anxiety in the offspring. The findings suggest that prenatal exposure to high-energy diets prime brain structural alterations related to anxiety in the offspring.

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Psychiatric disorders affect 970 million people worldwide, representing a significant source of disability. Although the underlying neurobiological traits for these disorders are not fully understood, a complex interplay between psychological, environmental, and biological factors contributes to their outcomes. Recent advances in lipidomic analysis and artificial intelligence algorithms have improved the identification of selective lipid species modulating the susceptibility to mental disorders. Sphingolipids (SLs) and ceramides-related SLs are among the most abundant lipids species in the brain that support major key pathways during neurodevelopment and brain plasticity. High levels of ceramides in plasma and brain contribute to psychiatric illness susceptibility in humans and animal models. However, the neuropathological mechanism regarding the involvement of ceramides in these disorders remain inconclusive. The brain is highly susceptible to nutritional insults, which could lead to functional impairment and influence the development and progression of psychiatric disorders. While the brain relies on glucose metabolism to support its physiological needs, a selective nutrient formula appears to have greater effects on brain health than others. For instance, consumption of high-energy diets is associated with brain anatomical, physiological, and metabolic changes, including ceramides metabolism. Herein, we will address the contribution of ceramides metabolism as a modulator of major psychiatric disorders such as depression, anxiety, bipolar disorder, schizophrenia, and attention deficit-hyperactivity disorder. We will also describe molecular and cellular targets of ceramides metabolism assisting the maintenance and progression of psychiatric disorders and their modulation by dietary formulas as non-pharmacologic treatments.

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Depression is a heterogeneous mental disorder characterized by feelings of sadness and loss of interest that render the subject unable to handle basic daily activities such as sleeping, eating, or working. Neurobiological traits leading to depression include genetic background, early life abuse, life stressors, and systemic and central inflammatory profiles. Several clinical and preclinical reports documented that depression shows an increase in pro-inflammatory markers such as interleukin (IL-)1ß, IL-6, IL-12, tumor necrosis factor (TNF), and interferon (IFN)-γ; and a decrease in anti-inflammatory IL-4, IL-10, and transforming growth factor (TGF)-ß species. Inflammatory activation may trigger and maintain depression. Dynamic crosstalk between the peripheral immune system and the central nervous system (CNS) such as activated endothelial cells, monocytes, monocyte-derived dendritic cells, macrophages, T cells, and microglia has been proposed as a leading cause of neuroinflammation. Notably, pro-inflammatory cytokines disrupt the hypothalamic-pituitary-adrenal (HPA) axis and serotonergic, noradrenergic, dopaminergic, and glutamatergic neurotransmission. While still under investigation, peripheral cytokines can engage brain pathways and affect the central synthesis of HPA hormones and neurotransmitters through several mechanisms such as activation of the vagus nerve, increasing the permeability of the blood-brain barrier (BBB), altered cytokines transport systems, and engaging toll-like receptors (TLRs) by pathogen-associated molecular patterns (PAMPs) or damage-associated molecular patterns (DAMPs). However, physiological mechanisms that favor time-dependent central inflammation before or during illness are not totally understood. This review will provide preclinical and clinical evidence of DAMPs and the BBB permeability as contributors to depression and neuroinflammation. We will also discuss pharmacologic approaches that could potentially modulate DAMPs and BBB permeability for future interventions against major depression.

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Introducción: Existen poblaciones que por razones aún no completamente estudiadas y comprendidas presentan niveles de presión arterial óptimos que determinan la ausencia de morbilidad y mortalidad relacionada con las afecciones cardiovasculares. Objetivo: Determinar los niveles de presión arterial de adultos indígenas Yanomami ubicados en la serranía de Topirapecó en el Estado Amazonas en Venezuela. Métodos: Entre los meses de mayo a julio y diciembre de 2021, se realizó un estudio cuantitativo transversal en 271 adultos indígenas Yanomami de 20 años de edad o más. Se visitó en 2 ocasiones cada shabono con la finalidad de realizarle medición de la presión arterial. Las orientaciones para cumplir con el protocolo de medición de presión arterial fueron impartidas en el idioma original de los Yanomami con el apoyo de un Agente Comunitario Yanomami de Atención Primaria de Salud. El análisis estadístico incluyó promedios, porcentajes e intervalos de confianza para promedios y para porcentajes. Resultados: El 93% de los individuos presentaron valores de presión arterial óptimos (<120 y <80) y 5,5% PA normal (<130 y <85). Solo se presentaron 2 casos (0,7%) con HTA (Grado I). Los niveles promedios de PAS, PAD y PAM fueron 93,10 (±11,70); 60,66 (±9,87) y 71,48 (±9,77) mm Hg, respectivamente. Conclusiones: Los Yanomami que viven en comunidades del área geográfica de la serranía de Tapirapecó presentan niveles óptimos de presión arterial, lo que les previene de comorbilidad asociada a la HTA, lo que indica que no constituye un problema de salud emergente entre los Yanomami (AU)

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Maternal nutritional programming by energy-dense foods leads to the transgenerational heritance of addiction-like behavior. Exposure to energy-dense foods also activates systemic and central inflammation in the offspring. This study aimed to characterize pro- and anti-inflammatory cytokine profiles in blood and their correlation to the transgenerational heritance of the addiction-like behavior in rats. F1 offspring of male Wistar diagnosed with addiction-like behavior were mated with virgin females to generate the F2 and the F3 offspring, respectively. Diagnosis of addiction-like behavior was performed by the operant training schedule (FR1, FR5 and PR) and pro- and anti-inflammatory cytokine profiles in blood were measured by multiplex platform. Multiple linear models between behavior, fetal programming by diet and pro- and anti-inflammatory cytokine profiles were performed. We found that the addiction-like behavior found in the F1 male offspring exposed to energy-dense food (cafeteria, CAF) diet during fetal programing is transgenerational inherited to the F2 and F3 generations. Blood from addiction-like behavior subjects of F2 and F3 generations exposed to CAF diet during maternal programming showed decrease in the anti-inflammatory IL-10 in the plasma. Conversely, decreased levels of the pro-inflammatory MCP-1 was identified in non-addiction-like subjects. No changes were found in plasmatic TNF-α levels in the F2 and F3 offspring of non-addiction-like and addiction-like subjects. Finally, biological modeling between IL-10 or MCP-1 plasma levels and prenatal diet exposure on operant training responses confirmed an association of decreased IL-10 levels on addiction-like behavior in the F2 and F3 generations. Globally, we identified decreased anti-inflammatory IL-10 cytokine in the blood of F2 and F3 offspring subjects diagnosed with addiction-like behavior for food rewards.

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During pregnancy the human fetus receives timed cues from the circadian rhythms of temperature, metabolites, and hormones from the mother. This influence is interrupted after parturition, the infant does not secrete melatonin and their circadian rhythms are still immature. However, evolution provided the solution to this problem. The newborn can continue receiving the mother's timed cues through breastmilk. Colostrum, transitional, and mature human milk are extraordinary complex biofluids that besides nutrients, contain an array of other non-nutritive components. Upon birth the first milk, colostrum, is rich in bioactive, immunological factors, and in complex oligosaccharides which help the proper establishment of the microbiome in the gut, which is crucial for the infants' health. Hormones, such as glucocorticoids and melatonin, transfer from the mother's plasma to milk, and then the infant is exposed to circadian cues from their mother. Also, milk components of fat, proteins, amino acids, and endogenous cannabinoids, among others, have a markedly different concentration between day and night. In the present review, we give an overview of nutritive and non-nutritive components and their daily rhythms in human milk and explore their physiological importance for the infant. Finally, we highlight some interventions with a circadian approach that emphasize the importance of circadian rhythms in the newborn for their survival, proper growth, and development. It is estimated that ~600,000 deaths/year are due to suboptimal breastfeeding. It is advisable to increase the rate of exclusive breastfeeding, during the day and night, as was established by the evolution of our species.

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Interleukin-6 (IL-6) is a major cytokine that promotes anti- and pro-inflammatory outcomes by activating the membrane IL-6 receptor (IL-6R) or the soluble IL-6 receptor (sIL-6R). IL-6R and sIL-6R signaling engage the JAK1/2/3 targets and the downstream transcription of STAT1 and STAT3 family. In the brain, physiological IL-6 signaling preserves neurogenesis, neuronal differentiation, and neuroprotection against tissue injury, but IL-6 has been proposed as a biomarker for poor prognosis in several mental pathologies such as depressive disorders, schizophrenia, bipolar disorder, and autism. Physiological or pathological outcomes of IL-6 are related to its pleiotropic effects in the brain by microglia, astrocytes, neurons, and endothelial cells, and also by peripheral infiltrating macrophages or T lymphocytes. Notably, definition of anti- or pro-inflammatory profiles by IL-6 signaling in the brain are sensitive to the levels, cellular source, and targets of the IL-6 itself, as well as IL-6 receptor signaling, and its activation/inhibition ratio. We propose that a mutual IL-6 crosstalk between microglia, astrocytes, neurons, and endothelial cells defines the anti- and pro-inflammatory outcomes in the brain, modulating brain function. This review will describe the cellular, molecular and context-dependent signaling pathways that define anti- or pro-inflammatory profiles setting by IL-6 during physiological or pathological outcomes in the brain.

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Autism spectrum disorder (ASD) is a disease characterized by reduced social interaction and stereotypic behaviors and related to macroscopic volumetric changes in cerebellar and somatosensory cortices (SPP). Epidemiological and preclinical models have confirmed that a proinflammatory profile during fetal development increases ASD susceptibility after birth. Here, we aimed to globally identify the effect of maternal exposure to high-energy dense diets, which we refer to as cafeteria diet (CAF) on peripheral and central proinflammatory profiles, microglia reactivity, and volumetric brain changes related to assisting defective social interaction in the mice offspring. We found a sex-dependent effect of maternal exposure to CAF diet or inoculation of the dsARN mimetic Poly (I:C) on peripheral proinflammatory and social interaction in the offspring. Notably, maternal exposure to CAF diet impairs social interaction and favors an increase in anxiety in male but not female offspring. Also, CAF diet exposure or Poly (I:C) inoculation during fetal programming promote peripheral proinflammatory profile in the ASD-diagnosed male but not in females. Selectively, we found a robust accumulation of the monocyte chemoattractant protein-1 (MCP-1) in plasma of ASD-diagnosed males exposed to CAF during fetal development. Biological assessment of MCP-1 signaling in brain confirms that systemic injection of MCP-1-neutralizing antibody reestablished social interaction and blocked anxiety, accompanied by a reduction in cerebellar lobule X (CbX) volume and an increase volume of the primary somatosensory (SSP) cortex in male offspring. These data highlight the contribution of diet-dependent MCP-1 signaling on volumetric brain changes and microglia morphology promoting ASD-like behavior in male mice.

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Introducción: Es reiterativo observar publicaciones sobre el comportamiento de la COVID-19 que entremezclan aspectos sanitarios con una crisis política y social en Venezuela; lo cual descontextualiza la realidad e impiden al lector la adquisición de información veraz sobre el complejo proceso salud-enfermedad en ese país. Objetivo: Analizar las publicaciones científicas que asocian al contexto político al comportamiento de la COVID-19 en Venezuela. Métodos: Se realizó una búsqueda en PubMed sobre información publicada que relacionara las condiciones sanitarias con la situación política y económica actual de Venezuela, entre los años 2019 a 2021. Se realizó una clasificación según tipo de artículo, autores, institución y país de afiliación, revistas, fuentes de financiamiento y número de citas o descargas. Resultados: Se hallaron un total de 20 artículos, de los cuales siete eran artículos de investigación, cinco revisiones, cuatro correspondencias y cuatro artículos de información. El autor con mayor número de publicaciones fue Paniz et al., seguido por Ramírez et al. El país de afiliación del 45 % (9) de los autores principales es EE.UU.; cuatro autores trabajan en instituciones venezolanas y tres en Colombia. The Lancet es la revista donde se publicaron la mayoría de los artículos (6), seguida de revistas del grupo Public Library of Science (PLoS) (3) y Emerging Infectious Diseases (2). Conclusiones: El descontextualizar la crisis política en Venezuela no contribuye a aportar soluciones a los problemas de salud pública que enfrentan los venezolanos en la actualidad.

Introduction: It is repetitive to observe publications on the behavior of COVID 19 in Venezuela that mix health aspects with a political and social crisis in Venezuela; which takes reality out of context and prevents the reader from acquiring truthful information about the complex health-disease process in Venezuela. Objective: To analyze the scientific publications that associate the political context with the behavior of COVID 19 in Venezuela. Methods: A PubMed search was carried out on published information that related health conditions with the current political and economic situation in Venezuela, between the years 2019 and 2021. A classification was made according to type of article, authors, institution and country of affiliation, journals, funding sources, and number of citations or downloads. Results: A total of 20 articles were found, of which 7 were research articles, 5 reviews, 4 correspondence and 4 information articles. The author with the highest number of publications was Paniz et al., followed by Ramírez et al. The country of affiliation of 45% (9) of the main authors is the USA; 4 authors work in Venezuelan institutions and 3 in Colombia. The Lancet is the journal where most articles were published (6), followed by journals from the Public Library of Science (PLoS) group (3) and Emerging Infectious Diseases (2). Conclusions: Decontextualizing the political crisis in Venezuela does not contribute to providing solutions to the public health problems that Venezuelans face today.

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The first 1,000 days in the life of a human being are a vulnerable stage where early stimuli may program adverse health outcomes in future life. Proper maternal nutrition before and during pregnancy modulates the development of the fetus, a physiological process known as fetal programming. Defective programming promotes non-communicable chronic diseases in the newborn which might be prevented by postnatal interventions such as breastfeeding. Breast milk provides distinct bioactive molecules that contribute to immune maturation, organ development, and healthy microbial gut colonization, and also secures a proper immunological response that protects against infection and inflammation in the newborn. The gut microbiome provides the most critical immune microbial stimulation in the newborn in early life, allowing a well-trained immune system and efficient metabolic settings in healthy subjects. Conversely, negative fetal programming by exposing mothers to diets rich in fat and sugar has profound effects on breast milk composition and alters the immune profiles in the newborn. At this new stage, newborns become vulnerable to immune compromise, favoring susceptibility to defective microbial gut colonization and immune response. This review will focus on the importance of breastfeeding and its immunological biocomponents that allow physiological immune programming in the newborn. We will highlight the importance of immunological settings by breastfeeding, allowing proper microbial gut colonization in the newborn as a window of opportunity to secure effective immunological response.

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Joint cartilage damage affects 10-12% of the world's population. Medical treatments improve the short-term quality of life of affected individuals but lack a long-term effect due to injury progression into fibrocartilage. The use of mesenchymal stem cells (MSCs) is one of the most promising strategies for tissue regeneration due to their ability to be isolated, expanded and differentiated into metabolically active chondrocytes to achieve long-term restoration. For this purpose, human adipose-derived MSCs (Ad-MSCs) were isolated from lipectomy and grown in xeno-free conditions. To establish the best differentiation potential towards a stable chondrocyte phenotype, isolated Ad-MSCs were sequentially exposed to five differentiation schemes of growth factors in previously designed three-dimensional biphasic scaffolds with incorporation of a decellularized cartilage matrix as a bioactive ingredient, silk fibroin and bone matrix, to generate a system capable of being loaded with pre-differentiated Ad-MSCs, to be used as a clinical implant in cartilage lesions for tissue regeneration. Chondrogenic and osteogenic markers were analyzed by reverse transcription-quantitative PCR and cartilage matrix generation by histology techniques at different time points over 40 days. All groups had an increased expression of chondrogenic markers; however, the use of fibroblast growth factor 2 (10 ng/ml) followed by a combination of insulin-like growth factor 1 (100 ng/ml)/TGFß1 (10 ng/ml) and a final step of exposure to TGFß1 alone (10 ng/ml) resulted in the most optimal chondrogenic signature towards chondrocyte differentiation and the lowest levels of osteogenic expression, while maintaining stable collagen matrix deposition until day 33. This encourages their possible use in osteochondral lesions, with appropriate properties for use in clinical patients.

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RESUMEN Fundamento: la autopsia permitirá dilucidar la patogenia y la correlación clínico-patológica de la infección por SARS-Cov-2, si bien su realización presenta riesgos de contagio, estos pueden ser minimizados al aplicar medidas de bioseguridad recomendadas por instituciones con gran experiencia en el manejo de enfermedades infecciosas. Objetivo: contribuir a la organización de la evidencia sobre la realización de autopsias de casos COVID-19 bajo niveles óptimos de bioseguridad. Métodos: se realizó una búsqueda en MEDLINE/PUBMED, se utilizaron las palabras: COVID-19, SARS-Cov-2, autopsia y bioseguridad. Se incluyeron guías y resoluciones de instituciones, series y presentaciones de casos con descripción de los procederes de autopsia. Los criterios de elegibilidad fueron: el país, número de autopsias realizadas, tipo de autopsia (completa o mínimamente invasiva), descripción de las medidas personales de bioseguridad y características del espacio físico de la morgue. Resultados: se obtuvieron 27 artículos que describen los procedimientos, equipos empleados y condiciones de infraestructura para garantizar la bioseguridad. De ellos, 13 describen la realización de la autopsia en una sala con presión negativa, y en 11 se describe la técnica y las medidas de bioseguridad a utilizar, con el uso de los equipos de protección personal. Se hallaron un total de cuatro documentos normativos o recomendaciones oficiales sobre los procedimientos a seguir para la realización de la autopsia con el mínimo de riesgos. Además de dos artículos que resumen dichas normativas. Conclusiones: los exámenes post mortem de casos COVID-19 se pueden realizar de manera segura con la aplicación de los equipos de protección personal adecuados.

ABSTRACT Background: the autopsy will allow elucidating the pathogenesis and the clinical-pathological correlation of the infection by SARS-Cov-2, although its performance presents risks of contagion, these can be minimized by applying bio-safety measures recommended by institutions with great experience in the management infectious diseases. Objective: to contribute to the organization of the evidence on the performance of autopsies of COVID-19 cases under optimal levels of bio-safety. Methods: a MEDLINE / PUBMED search was performed, using the words: COVID-19, SARS-Cov-2, autopsy and bio-safety. Guidelines and resolutions from institutions, series and case presentations were included with a description of the autopsy procedures. The eligibility criteria were: country, number of autopsies performed, type of autopsy (complete or minimally invasive), description of personal bio-safety measures, and characteristics of the physical space of the morgue. Results: 27 articles were obtained that describe the procedures, equipment used and infrastructure conditions to guarantee bio-security. Of these, 13 describe the autopsy in a room with negative pressure, and 11 describe the technique and bio-safety measures to be used, using personal protective equipment. A total of four normative documents or official recommendations were found on the procedures to follow to carry out the autopsy with the minimum of risks. In addition to 2 articles that summarize these regulations. Conclusions: post-mortem examinations of COVID-19 cases can be performed safely with the application of appropriate personal protective equipment.

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Introducción: los tumores del apéndice cecal constituyen un grupo heterogéneo de neoplasias con evolución y pronóstico variables; representan una pequeña parte de todas las neoplasias gastrointestinales y de las apendicetomías. Objetivo: realizar la comunicación de la presentación de tumores infrecuentes del apéndice cecal y revisar la literatura con énfasis la importancia del diagnóstico histopa-tológico. Presentación de caso: durante la necropsia del paciente HC: 199584 se realizó el diagnóstico histopatológico de un tumor neuroendocrino y mucocele apendicular y en la pieza quirúrgica del paciente HC: 223360 correspondiente a una apendicectomía se realizó el diagnóstico de adenoma tubulo-velloso, dadas que estas lesiones son poco frecuente se decide su comunicación y la revisión del tema en la literatura en idioma inglés y español a través de las bases de datos MEDLINE/PubMed, Elsevier, SciELO, EBSCO, Hinari y búsqueda avanzada en Google Scholar, encontrándose un total de 29 publicaciones entre 1990 a 2019. Conclusiones: el diagnóstico de tumores del apéndice cecal se realiza en forma incidental en el estudio anatomopatológico después de una apendicectomía por apendicitis aguda, es por ello que siempre se debe realizar el estudio histológico de la pieza quirúrgica, no solo para confirmar o negar el diagnostico que motivo la apendicetomía, sino para descartar la presencia de lesiones neoplásicas benignas o malignas.

Introduction: Tumors of the cecal appendix constitute a heterogeneous group of neoplasms with variable evolution and prognosis; they represent a small part of all gastrointestinal neoplasms and appendectomies. Objective: To communicate the presentation of infrequent tumours of the cecal appendix and to review the literature with emphasis on the importance of histopathological diagnosis. Case presentation: During the necropsy of patient HC: 199584, a histopathological diagnosis of carcinoid tumours and appendicular mucocele was made, and in the surgical specimen of patient HC: 223360 correspondings to an appendectomy, the diagnosis of tubu-lovillous adenoma were made, given that These lesions are rare, it is decided to communicate and review the subject in the literature in English and Spanish through the MEDLINE / PubMed, Elsevier, SciELO, EBSCO, Hinari and Advanced Search in Google Scholar data-bases, finding a total of 29 publications between 1990 to 2019. Conclusions: The diagnosis of tumours of the cecal appendix is made incidentally in the pathological study after an appendectomy for acute appendicitis, which is why the histological study of the surgical piece should always be carried out, not only to confirm or deny the diagnosis. What reason for the appendectomy but to rule out the presence of benign or malignant neoplastic lesions.