Early prognostic capacity of serum lactate for severe postpartum hemorrhage.

OBJECTIVE: To evaluate whether the concentration of serum lactate during the diagnosis of postpartum hemorrhage (bleeding ≥500 mL during labor or ≥1000 mL during cesarean delivery) predicts severe hemorrhage (SPPH; blood loss ≥1500 mL at end of labor or in the following 24 h). METHODS: A prospective cohort pilot study was conducted of women with a vaginal or cesarean delivery from February 2018 to March 2019 who presented with bleeding ≥500 mL measured by the gravimetric method in a reference hospital in San Luis Potosi, Mexico. Venous blood samples were taken for analysis of serum lactate. A receiver operating characteristic curve determined the serum lactate threshold value for SPPH and χ2 test assessed the difference in serum lactate elevation between SPPH and non-SPPH groups. Lastly, the prognostic capacity between the thresholds was compared. RESULTS: SPPH developed in 43.33% of the 30 women in the study group. The best prognostic threshold was 2.68 mmol/L of serum lactate (odds ratio [OR] 17.88, 95% confidence interval [CI] 2.7-16.8, P < 0.001); sensitivity was 0.85 (95% CI 0.55-0.98); specificity was 0.76 (95% CI 0.50-0.93). CONCLUSION: Serum lactate may be a useful prognostic marker for SPPH, more studies are needed to validate these findings.

DPP-4 Levels Are Increased in Subjects with Poor Sleep Quality.

Background: Up to 30% of the population has sleep disturbances, generating a negative health impact, a situation that is often not known and no medical attention is sought. It has been observed that after a total deprivation of sleep, the levels of dipeptidyl peptidase 4 (DPP-4) tend to increase. The aim of this study was to compare serum levels of DPP-4 in healthy subjects, with adequate and poor-quality sleep needing medical/pharmacological treatment. Materials and Methods: Cross-sectional study of subjects scheduled for elective surgery with low cardiometabolic risk. Subjects between 18-70 years of age were included, without previous diagnosed pathology (diabetes mellitus type 2; neoplasm; nephropathy; and liver disease) and major amputations, and who signed informed consent. The study protocol was aproved in the Local Committee for Ethics and Research, number 45-16. Anthropometry was performed (% body fat; waist and neck circumferences), and sleep quality assessment (Pittsburgh Sleep Quality Index [PSQI]) to classify them as worthy or not worthy of medical/pharmacological care. Serum DPP-4 was determined by Enzime Linked Immunosorbent Assay (ELISA). The statistical analysis was done in RStudio Software. Results: Fifty seven subjects (2017-2018) were included, with a combined frequency of overweight/obesity of 66.6% and with abdominal circumference values of 93.2 ± 13.6, higher than that proposed by the International Diabetes Federation. The PSQI was 8.3 ± 4.1, and 56.1% were classified as worthy of medical/pharmacological attention. When comparing the levels of DPP-4, these were higher in this group 2385.0 ± 2082.0 versus not worthy 1716.7 ± 1261.7 pg/mL, being statistically significant (P = 0.035). Conclusions: The elevated levels of DPP-4 in person with poor quality sleep worthy of medical/pharmacological treatment could be an early indicator of metabolic disorders, which need to be evaluated in depth.

DPP-4 as a Possible Biomarker of Inflammation Before Abdominal Surgery for Chronic Pathology: Our Experience with Elective Cholecystectomy.

Background and objectives: Dipeptidyl-Peptidase 4 (DPP-4) is a protein expressed in numerous cells and tissues. Recently it has shown its involvement as a catalyst in the inflammatory response in various pulmonary, autoimmune, intestinal and other pathologies. The objective of this study was to compare the preoperative serum levels of DPP-4 in patients with and without surgical finding of perivesicular inflammation. Materials and methods: a cross-sectional analytical study nested in a prospective cohort, including patients scheduled for elective cholecystectomy, without surgical complications, that were 18-70 years of age, with low cardiovascular risk, without a history of peritonitis, pancreatitis, or jaundice and underwent ERCP protocol, type 2 diabetes mellitus, acute inflammatory (Protein C Reactive < 3 mg/L, leucocytes < 10 1000/mm3), neoplastic, nephrologic or liver disease, the use of anti-inflammatory drugs, steroids and/or antibiotics, the use of pacemakers or metallic implants and without major amputations and whom agreed to participate by providing their informed consent. Ethical and Research register: 45-16. Prior to surgery we compiled anthropometric data and a blood sample to determine the serum levels of DPP-4. The presence of perivesicular inflammation was determined in the surgery. The data was analyzed using the statistical program Rstudio. Results: High BMI values were observed (27.8 ± 6.4); waist circumference (94.7 ± 15.1) and percentage of fat mass (34.7 ± 11.7), showing a cumulative frequency of 65.9% for overweight/obesity. In 27.3% of the interventions, intraoperative perivesicular inflammation findings were reported. The serum levels of DPP-4 were lower in the group of patients with perivesicular inflammation (3947.6 ± 1659.5 vs. 3053.2 ± 1469.6, LC95% of the difference: 160.4-1628.3), being statistically significant (P = 0.018). Conclusions: In the subacute or chronic phases of cholecystitis, there appears to be a constant consumption of DPP-4, which would modulate a better immune response that could be related to the reduction of postoperative complications, so the use of Serum levels of DPP-4 as an early biomarker could improve the diagnostic accuracy of this pathology and the surgical approach.

Age-dependent defective TGF-beta1 signaling in patients undergoing coronary artery bypass grafting.

BACKGROUND: Transforming growth factor beta (TGF-ß1) is a pleiotropic cytokine, which is deregulated in atherosclerosis; however the role of age in this process is unknown. We aimed to assess whether TGF-ß1 signaling is affected by age. METHODS: Vascular smooth muscle cells (VSMC) were obtained from patients undergoing abdominal surgery. Levels of TGF-ß1 were measured by ELISA in sera from 169 patients undergoing coronary artery bypass grafting (CABG). The p27 expression was determined by Western blot from internal mammary arteries (IMA) obtained from CABG patients (n=13). In VSMC from these patients undergoing abdominal surgery, secretion of TGF-ß1 was determined by ELISA of cell-conditioned media. RESULTS: In VSMC from aged patients we observed a lower TGF-ß1 secretion, measured as TGF-ß1 concentration in cell conditioned medium (p<0.001). This effect was correlated to an age-dependent decrease of p27 expression in IMA from aged CABG patients. In a similar manner, there was an age-dependent decrease of serum TGF-ß1 levels in CABG patients (p=0.0195). CONCLUSIONS: VSMC from aged patients showed a higher degree of cellular senescence and it was associated to a lower TGF-ß1 secretion and signaling.

The complex regulation of TGF-ß in cardiovascular disease.

Transforming growth factor ß (TGF-ß1) is a pleiotropic cytokine with many and complex effects in cell and tissue physiology. This is made possible by a very complex and interwoven signaling system, whose regulation continues to be the focus of a growing line of research. This complex regulation translates to a key role in cardiovascular physiology, hemostasis, and the blood-vessel interface. In accordance with this, the TGF-ß1 pathway appears to be deregulated in related disorders, such as atherosclerotic vascular disease and myeloproliferative syndromes. It is expected that the growing amount of experimental and clinical research will yield medical advances in the applications of knowledge of the TGF-ß1 pathway to diagnosis and therapeutics.

Cardiomiopatia hipertrofica asimétrica en un paciente con Feocromocitoma / Annual reports 1998 / Asimetric hypertrophic cardiomyopathy in a patient with pheocromocytoma

El feocromocitoma es un tumor secretor de catecolaminas a partir del cual aparecen las clásicas manifestaciones cardiovasculares. Dentro de los efectos ocasionados por este exceso de catecolaminas circulantes, aparte de la hipertensión arterial, se citan miocarditis y cardiopatía hipertrófica, pero la asociación de cardiopatía hipertrófica asimétrica (CMHA) y feocromocitoma es raray poco conocida, de ahí el interés de presentar el siguiente caso

Prevalencia de Tiroiditis Autoinmune en una poblacion Bociosa de Paraguay / Annual Reports 1997 / Prevalence of Autoinmune Thyroiditis in a population with Goiter in Paraguay

Este es un estudio descriptivo de muestreo de corte transverso de selección consecutuiva para determinar la prevalencia de los tirioditis autoinmune con pacientes con bocio de nuestro país que concurren a centros de referencia de estudios tiroideos de Asunción y Areas metrpolitanas. Fueron estudiados 159 pacientes de ambos sexo, en quienes se realizaron los desajes de FT4, TSH, anticuerpo anti-microsomales y ecografía tiroidea. Se obtuvo prevalencia de tiroiditis autoinmune de 10.7 por ciento (17/159). El 25.8 por ciento (41/159) de los pacientes presentaron hipertiroidismo clínico y bioquímico; hipotiroidismo el 13.8 por ciento (22/159) y el resto de la población era funcionalmente normal. Además hemos realizado un estudio comparativo entre dos ensayos serológicos, la hemaglutinación indirecta y el inmunorradiométrico para le detección de los anticuerpos anti-microsomales en una muestra seleccionada en forma aleatoria de 54 pacientes, obteniéndose una correlación del 94 por ciento entre métodos. Nuestros resultados demuestran que existe un elevado porcentaje de tiroiditis autoinmune en la población estudiada y que existe una buena concordancia entre ambas técnicas comparadas

Estudio piloto para tamizaje de hipotiroidismo congenito / A pilot study for screening of congenital hypothyroidism / Annual reports 1996

El hipotiroidismo congènito es una de las causas mas frecuentes de retardo mental prevenible. La ùnica forma de lograr una casi totalidad de recuperaciòn es el tratamiento precoz, lo cual es solo posible con el diagnòstico temprano con cuantificaciòn de los niveles hormonales de T4 y TSH en los primeros dìas de vida.Este fue un estudio descriptivo de corte transversal de selecciòn consecutiva en recièn nacidos de la sala de neonatologìa del Instituto de previsiòn Social. Un total de 4297 recièn nacidos vivos fueron estudiados entre setiembre de 1994 a febrero de 1996, a travès del dosaje de TSH por el mètodoIRMA (NETRIA-Inglaterra), en sangre de cordòn umbilical recogido en papel de filtro (SS903). Como valor de corte fue considerado 30 uUI/m1 y a aquellos que presentaron valores de TSH mayor o igual a 30 uUI/m1, una segunda muestra confirmatoria en sangre perifèrica fue tomada. Once recien nacidos presentaron niveles de TSH mayores al punto de corte a 10 de ellos se le pudo tomar una segunda muestra confirmatoria. Solo en uno de los 10 testados se confirmò la patologìa, siendo la incidencia de hipotiroidismo congènito en este estudio de 1:4297. Esta incidencia es similar a la de las regiones vecinas, lo que demuestra que el problema sì existe en Paraguay y un programa a nivel nacional deberìa implementarse. Otros problemas fueron tambièn detectados en este estudio como ser la baja cobertura del tamizaje, pues de 8162 niños nacidos vivos en ese perìodo, solo 4297 fueron testados, ademàs la escasa consignaciòn de datos del paciente, que dificulta su posterior localizaciòn.

Estudio piloto para tamizaje de hipotiroidismo congenito / A pilot study for screening of congenital hypothyroidism / Annual reports 1996

El hipotiroidismo congènito es una de las causas mas frecuentes de retardo mental prevenible. La ùnica forma de lograr una casi totalidad de recuperaciòn es el tratamiento precoz, lo cual es solo posible con el diagnòstico temprano con cuantificaciòn de los niveles hormonales de T4 y TSH en los primeros dìas de vida.Este fue un estudio descriptivo de corte transversal de selecciòn consecutiva en recièn nacidos de la sala de neonatologìa del Instituto de previsiòn Social. Un total de 4297 recièn nacidos vivos fueron estudiados entre setiembre de 1994 a febrero de 1996, a travès del dosaje de TSH por el mètodoIRMA (NETRIA-Inglaterra), en sangre de cordòn umbilical recogido en papel de filtro (SS903). Como valor de corte fue considerado 30 uUI/m1 y a aquellos que presentaron valores de TSH mayor o igual a 30 uUI/m1, una segunda muestra confirmatoria en sangre perifèrica fue tomada. Once recien nacidos presentaron niveles de TSH mayores al punto de corte a 10 de ellos se le pudo tomar una segunda muestra confirmatoria. Solo en uno de los 10 testados se confirmò la patologìa, siendo la incidencia de hipotiroidismo congènito en este estudio de 1:4297. Esta incidencia es similar a la de las regiones vecinas, lo que demuestra que el problema sì existe en Paraguay y un programa a nivel nacional deberìa implementarse. Otros problemas fueron tambièn detectados en este estudio como ser la baja cobertura del tamizaje, pues de 8162 niños nacidos vivos en ese perìodo, solo 4297 fueron testados, ademàs la escasa consignaciòn de datos del paciente, que dificulta su posterior localizaciòn

Determinaciòn de TSH para el diagnòstico precoz de hipotiroidismo neonatal: estudios previos a la implementaciòn de un programa de Tsh / Annual reports 1993 / Determination of TSH for early diagnosis of neonatal hipothyroidism: neonatal preliminary studies for the implementation of a neonatal Tsh program

En este trabajo estandarizò la toma de muestra en sangre de cordòn de recièn nacidos por goteo en papel de filtro y se adecuo la tècnica de dosaje de TSH neonatal por el mètodo IRMA, en base a la producciòn local de estandaresw y trazadores, complementados con reactivos NETRIA. Se analizaron 2500 muestras del Centro de Salud N§ 5 y de la Maternidad del Hospital de Clìnicas. El rango de TSH neonatal (Confianza del 95 por ciento), es de 13.6 +/-15.7 microUI/ml, siendo el punto de corte de 30 microUI/ml

Evaluaciòn de la recurrencia de bocio post tiroidectomia utilizando la clinica, medicina nuclear y ecografìa: caracteristicas y factores de riesgo / Annual reports 1993 / Evaluation of the recurency of goiter post- thyordectomy using the clinic, nuclear medicine and ultrasound: characteristics and risks factors

Siendo el Paraguay un paìs con elevada prevalencia de bocio y la cirugìa de tiroides uno de los tratamientos realizados comùnmente en esta enfermedad, se estudiaron 24 pacientes operados de la glàndulas tiroides por la clìnica, centellografìa y ecografìa de tiroides. Se observò recurrencia de bocio en el 100 por ciento de los pacientes siendo 67 por ciento nodular y 33 por ciento difuso. El 79 por ciento de los operados no fueron medicados con hormonoterapia de reemplazo, razòn por la cual esta ausencia de homonoterapia se puede considerar como causa principal de la elevada recurrencia post- tiroidectomìa

Factores de riesgo de la enfermedad cardiovascular en Asunción y area metropolitana / Annual reports 1994 / Risk factors for the cardiovascular diseases in Asunción and metropolitan area

Estudios epidemiológicos internacionales están de acuerdo en que los factores de riesgo más importantes a tener en cuenta para el desarrollo de las enfermedades cardiovasculares son, hipertensión arterial, diabetes mellitus, dislipidemias, obesidad, sedentarismo, tabaquismo y alcoholismo, entre otros, y el peso o significado que ellos tienen varía notablemente entre los países y los grupos humanos. El siguiente estudio de corte transversal realizado por un grupo de profesionales del área de la salud, tuvo como propósito cuantificar la presencia de factores de riesgo de enfermedad cardiovascular y la magnitud de la asociación de esos factores entre sí, en una población de nivel socioeconómico medio de la República del Paraguay, teniendo presente que la primera causa de mortalidad registrada en varios países del mundo, incluyendo al nuestro, son las enfermedades del aparato circulatorio. Las mediaciones del estudio fueron a través de encuestas, exámen físico y análisis laboratorial de la población en estudio. Las conclusiones de esta investigación fueron llamativas; en una muestra de un total de 1606 personas estudiadas representativas del Gran Asunción, se encontró que el 53,8 por ciento de esa población era obesa, el 40 por ciento era de vida sedentaria, el 26,5 por ciento tenía hábitos tabáquicos, 11,5 por ciento presentaba hipertensión arterial y el 6 por ciento era diabética

Prevalencia de los factores de riesgo de enfermedades cardiovasculares en Asunción, Paraguay. Informe preliminar / Annual Reports 1992 / Prevalence of risk factors for cardiovascular diseaes in Asunción, Paraguay. Preliminary Report

This is the first research effort investigating cardiovascular risk in Paraguay. We report results of our ongoing cross-sectional prevalence study of riskfactors for coronary heart disease in the first 497 of 2,000 adult volunteers recruited from a population-based sample of households selected by a random process from the catchment area of 10 public outpatient health care facilities in grater Asunción. Consenting adults were interviewed, received a physical examination and grave blood specimens after a 12-huor fast at the corresponding facility to measure glycemia, cholesterol, triglycerides, insulinemia and 2-huor glucose tolerance. Specimens were processed at the IICS according to international standards. Although there is a preponderance of female subjects in this first group studied, results are similar to those obtained in population elsewhere, particulary with respect to high blood pressure (about 24 percent), diabetes mellitus (8 percent) and glucose intolerance (11 percent), diagnosed according to WHO criteria.Almost one half of diabetic and about one fifth of hypertensives had not known of their diagnosis. In accordance to body mass index, over 27 percent of women and about 32 percent of men were found obese, but 28 percent of obese women hes extreme obesity in comparison to only 17 percent of men. Hypercholesterolemia compatible with a moderate risk for CVD ranged from 7.5 to 9.8 percent, but the cholesterol level associated with a high risk for CVD was almost double (13 percent) in individuals over 40 years of age. About 13 percent of the population had a triglyceride level superior o igual a 200 mg/dl.About 2 percent of subjects studied were smokers