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Abstract Background With nearly 15 million annual preterm births globally, preterm birth is the most common cause of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality. As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study. Methods This is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on management of preterm infants including required investigations to reach final diagnoses. The study will document the clinical and management protocols followed in these settings. The approach consists of clinical examinations and monitoring, laboratory investigations, and determination of primary and contributory causes of mortality through both clinical means and by post-mortem examinations. An independent panel of experts will validate the primary and contributory causes of mortality. To obtain the estimated sample size of 5000 preterm births, the study will be undertaken in five hospitals in three regions of Ethiopia, which are geographically distributed across the country. All preterm infants who are either born or transferred to these hospitals will be eligible for the study. Three methods (last menstrual period, physical examination using the New Ballard Score, and ultrasound) will be used to determine gestational age. All clinical procedures will be conducted per hospital protocol and informed consent will be taken from parents or caretakers prior to their participation in the study as well as for autopsy if the infant dies. Discussion This study will determine the major causes of death and illness among hospitalized preterm infants in a low-resource setting. The result will inform policy makers and implementers of areas that can be prioritized in order to contribute to a significant reduction in neonatal mortality.

Summary: Background: Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality. We aimed to establish the major causes of preterm mortality in preterm infants in the first 28 days of life in Ethiopia. Methods: We did a prospective, cross-sectional, observational study in five hospitals in Ethiopia. Study participants were preterm infants born in the study hospitals at younger than 37 gestational weeks. Infants whose gestational age could not be reliably estimated and those born as a result of induced abortion were excluded from the study. Data were collected on maternal and obstetric history, clinical maternal and neonatal conditions, and laboratory investigations. For neonates who died of those enrolled, consent was requested from parents for post-mortem examinations (both complete diagnostic autopsy and minimally invasive tissue sampling). An independent panel of experts established the primary and contributory causes of preterm mortality with available data. Findings: Between July 1, 2016, to May 31, 2018, 4919 preterm infants were enrolled in the study and 3852 were admitted to neonatal intensive care units. By 28 days of post-natal age, 1109 (29%) of those admitted to the neonatal intensive care unit died. Complete diagnostic autopsy was done in 441 (40%) and minimally invasive tissue sampling in 126 (11%) of the neonatal intensive care unit deaths. The main primary causes of death in the 1109 infants were established as respiratory distress syndrome (502 [45%]); sepsis, pneumonia and meningitis (combined as neonatal infections; 331 [30%]), and asphyxia (151 [14%]). Hypothermia was the most common contributory cause of preterm mortality (770 [69%]). The highest mortality occurred in infants younger than 28 weeks of gestation (89 [86%] of 104), followed by infants aged 28–31 weeks (512 [54%] of 952), 32–34 weeks (349 [18%] of 1975), and 35–36 weeks (159 [8%] of 1888). Interpretation: Three conditions accounted for 89% of all deaths among preterm infants in Ethiopia. Scale-up interventions are needed to prevent or treat these conditions. Further research is required to develop effective and affordable interventions to prevent and treat the major causes of preterm death. Funding: Bill & Melinda Gates Foundation.

Los tumores sólidos primitivos son generalmente de origen mesenquimático, y dentro de estos predominan los derivados del músculo liso, constituyendo un capítulo de gran interés por su carácter excepcional y por su dificultad diagnóstica. Se presenta el caso de una paciente de 50 años de edad, con molestias en flanco derecho, donde se notaba un aumento de volumen, desde hacía algunos meses, que ya causaba dolor. Al examen físico se constató una tumoración abdominal gigante que ocupaba todo el flanco derecho y se proyectaba a mesogastrio. Se realizaron estudios imagenológicos, que incluyeron tomografía axial computarizada contrastada de abdomen, y se sometió a laparotomía exploradora con diagnóstico preoperatorio de tumor abdominal. Se realizó exéresis tumoral y estudio histológico, concluyendo un leiomiosarcoma de mesenterio. Se puso tratamiento con quimioterapia y la evolución clínica fue favorable. El objetivo de esta presentación es comunicar a la comunidad médica este caso por el insuficiente reporte encontrado en la literatura.

Los tumores del estroma gastrointestinal fueron catalogados originalmente como otros tumores (leiomioma, leiomioblastoma o leiomiosarcoma), debido a su apariencia histológica similar; sin embargo, los avances en la biología molecular y la inmunohistoquímica, han permitido diferenciarlos de otras neoplasias digestivas, y definirlos como una entidad clínica e histopatológica propia. Se presenta un paciente, de sexo femenino, de la raza negra, de 79 años de edad, con dolor abdominal de 3 días de evolución, que se había iniciado en fosa ilíaca derecha y luego se mantuvo en bajo vientre, acompañado de vómitos, fatiga y decaimiento. Se decide intervenir quirúrgicamente y se lleva al salón de operaciones con el diagnóstico de una apendicitis aguda, del muñón, tipo oclusiva en el anciano, sin descartar una oclusión por bridas. Al realizar laparotomía se encuentra sangre libre en cavidad que no coagula, y se observó tumor hemorrágico, pediculado, muy móvil, hacia íleon terminal. Se realiza exéresis de este, se resecan aproximadamente 5 cm de intestino delgado y se realiza sutura termino-terminal posteriormente. Se realizó amplia toillette de la cavidad peritoneal y el cierre habitual, con evolución satisfactoria, y con alta a los 7 días. Se mantiene asintomática al año y medio de operada, y la biopsia arrojó tumor de intestino delgado, de bajo grado de malignidad, de 5 cm de diámetro.The tumors of the gastrointestinal stroma were originally classified as other type of tumors (leiomyoma, leiomyobastoma or leiomyosarcoma) due to it similar histological appearance; however, the advances in the molecular biology and the immunohistochemistry have allowed its differentiation of other digestive neoplasms and to define them as an own clinical and histopathological entity. This is the case of a black female patient aged 79 presenting with abdominal pain during 3 days of evolution started in the right iliac fossa and then it remains in the low belly accompanied by vomiting, fatigue and weakness. She was operated on and is diagnosed with a stump acute appendicitis and of occlusive type en elderly without to rule out an adhesion occlusion. Carrying out the laparotomy it was found that this not-coagulating cavity was blood-free and also a stalked hemorrhagic tumor with movements towards the terminal ileum. Authors carried out its exeresis resecting approximately 5 cm of small intestine with a termino-terminal suture later. A significant cleaning of peritoneal cavity was carried out with the habitual closure achieving a satisfactory evolution with her discharge at 7 days. Patient remains asymptomatic at one a half year postoperative and biopsy yielded a 5 cm-small intestine tumor with a low grade of malignancy.

Primary carcinoma in the fallopian tube is a rare gynecological tumor. Its preoperative diagnosis is difficult because of its insidious and silent course. It is usually performed in the postoperative stage. This carcinoma is most frequently presented in post menopausal women. Its clinical and histological behavior is often similar to that of an ovarian cancer. In literature there are reports on the association between ovarian and endometrial cancer. Nevertheless, there are but few references to their association with fallopian tubes cancer. Two cases of primary cancer in the fallopian tubes, diagnosed in a 6 months period through post-surgical histology, that were treated in the Gynecology Service of the ¨Enrique Cabrera¨ General Teaching Hospital are presented. Their preoperative diagnoses were endometrial adenocarcinoma and ovarian cancer. It is relevant that one patient, with 44 years old, was diagnosed through endometrial biopsy performed to remove an intra uterine device. The result of that study was an endometrial adenocarcinoma that required surgery.

La tuberculosis, infección bacteriana crónica causada por el Mycobacterium tuberculosis, declarada por la OMS (1993) como emergencia epidemiológica, afecta mayoritariamente los pulmones, pero puede afectar a otros órganos (Tb. Extrapulmonar), entre estos a la laringe, constituyendo la más frecuente enfermedad granulomatosa a este nivel y considerada una localización rara (menos de 1%); por ello nuestro interés de presentar un caso de Tuberculosis en faringe y laringe, con el objetivo de resaltar lo infrecuente de esta ubicación, los problemas diagnósticos y la importancia del estudio histopatológico. Paciente de 49 años, femenina, consulta por Odinofagia, se encuentra tumor en faringe, se realiza biopsia y el diagnóstico fue: Sarcoidosis faríngea, no regresó a consulta. Meses después asiste por disfonía, se visualiza tumor en laringe, se realiza biopsia y el informe fue carcinoma de laringe; se negó a tratarse. Cuatro meses más tarde, ingresa en el Hospital Neumológico, por disnea, tos y disfonía, el diagnóstico fue tuberculosis pulmonar (Cod 9). Interconsultan con Otorrinolaringología el tratamiento del cáncer laríngeo. Decidimos nueva revisión de las biopsias, y se arribó a las conclusiones siguientes: "Tuberculosis miliar acorde con su cuadro clínico y hallazgos anatomo-patológicos: (faringitis y laringitis granulomatosa); no se corresponde ni con Sarcoidosis ni con carcinoma Epidermoide previamente reportado."Tuberculosis is a chronic bacterial disease caused by Mycobacterium tuberculosis, declared by WHO in 1993 as epidemilogical emergency warning, affecting mostly the lungs but it can also damage others organs (Extra lung Tb) such as the larynxbeing the most frequent granulomatous disease as this level and it considered as a rare location (less than 1%), that is why we are so interested in presenting this case report of larynx and pharynx disease, with the aspiration to highlight how few are the cases with this location, the diagnostic problems and the importance of a histopathologic analysis. 49 years, female patient came to the consultation because of odenaphagia. A pharyngeal tumour was diagnosed and a biopsy was undergone which revealed pharyngeal Sarcoidosis. The patient did not come back to the consultation until several months later due to diphonia. A tumour in the larynx is visualized and a biopsy is undergone again which shoved to the positive for laryngeal cancer; the patient refuses to be treated. Four months later the patient is admitted to the hospital in the Neumology hospital with a clinical picture of dyspnea, cough and dysphonic. The diagnosis was pulmonary tuberculosis. A consult is carried out which the otorrhynolaringologyst and a new consideration came out, concluding by pathological anatomy as tuberculosis. Taking into account the clinical picture and the anatomopathological firdings that do not corresponded inther with Sarcoidosis or Epidermoide carcinoma previously reported. The characteristics of this case led to this presentation.

The article aims to describe the clinical and laboratory features of a female patient suffering from pheochromocytoma. The case is a 52-year-old female patient who presents to our healthcare center with high blood pressure, cold limbs, sweating, jitteriness, and episodes of oppressive chest pain that appear several times per day. She also reports fatigue and a 13-kilogram weight loss. The sonogram revealed a nodular image in the right adrenal gland that had low echogenicity and regular margins measuring 5 mm. The image was confirmed with a contrast-enhanced adrenal CAT scan. Urine vanillylmandelic acid levels were high and an adrenal biopsy confirmed a pheochromocytoma measuring 4.5 x 3.5 x 3 cm.

Introduction. Tuberculous lymphadenitis, which currently is most often caused by Mycobacterium tuberculosis, was once mainly caused by Mycobacterium bovis. Objective. To describe an unusual case of tuberculous adenitis from Mycobacterium bovis. Case report. A woman with a history of consuming raw milk and unsupervised dairy home-made products presents with cervical adenitis of 5 month course unassociated to other symptoms. A diagnosis of Mycobacterium bovis tuberculous adenitis was made by biopsy, ELISA, PCR and culture. Discussion. Approximately 11 to 25% of all TB cases are extrapulmonary exclusively. Cervical lymphadenitis is the most common presentation of peripheral disease. Treatment usually is based on four drugs. Surgery is indicated for diagnostic procedures and complications. Conclusion. Mycobacterium bovis infection is uncommon in our environment, but must be considered in the diagnostic evaluation of all patients with cervical adenitis and epidemiological correlations.

Se presenta el caso de una paciente de 52 años de edad que acudió a la consulta de Ginecología por un aumento de volumen en el abdomen. Se le indicó ingreso, se estudió y se diagnosticó un tumor gigante de víscera ginecológica. Se decide tratamiento quirúrgico mediante laparatomía. Durante el acto quirúrgico se demuestra que la tumoración corresponde a la vejiga, por lo que se solicita la presencia de un urólogo. Continuamos la intervención y encontramos una tumoración grande, de base ancha, que ocupa la parte posterior y lateral izquierda de la vejiga, con áreas de necrosis de color blanquecino y consistencia algo blanda. Se cateteriza el meato ureteral derecho, el izquierdo no es visible y se realiza la exéresis del tumor. Se deja una sonda Foley No. 20 por cistostomía y uretral, se cierra la vejiga en dos planos y se revisa la cavidad abdominal. Se encontraron útero y ovarios normales; colón, intestino e hígado normales. En el estudio histológico se demostró que la tumoración es un rabdomiosarcoma pleomórfico. Se siguió su evolución y se realizaron interconsultas con el servicio de oncología para el tratamiento posteriorThe case of a 52-year-old female patient that was seen at the Gynecology office due to an increase of volume in the abdomen, is reported. She was admitted, studied and diagnosed a giant tumor of gynecological viscus. It was decided to perform laparotomy. During surgery, it was observed that the tumor corresponded to the urinary bladder, so an urologist was requested. The operation continued and a big tumor of wide base was found that occupied the posterior and lateral left part of the urinary bladder, with necrosis areas of whitish color and a little soft consistency. The right ureteral meatus was catheterized, the left was not visible, and exeresis of the tumor was performed. A Foley catheter no. 20 was left by cystotomy. The urinary bladder was closed in 2 planes, and the abdominal cavity was checked. Normal uterus, ovaries, colon, intestine and liver were found. In the histological study, it was proved that the tumor was a pleomorphic rhabdomyosarcoma. Its evolution was followed and interconsultations were made with the oncology service for further treatment