Soy protein supplement intake for 12 months has no effect on sexual maturation and may improve nutritional status in pre-pubertal children.

AIM: To evaluate the intake of a soy protein-based supplement (SPS) and its effects on the sexual maturation and nutritional status of prepubertal children who consumed it for a year. METHODS: Healthy children (n = 51) were recruited and randomly assigned to consume the lunch fruit juice with (n = 29) or without (n = 22) addition of 45 g of a commercial soy protein-based supplement (SPS) over 12 months. Nutritional assessment including anthropometry (bodyweight, height, triceps skinfold thickness, mid-upper arm circumference), body mass index (BMI), upper arm muscle area, arm muscle circumference, upper arm area, upper arm fat area data were derived from measures using usual procedures; age and gender-specific percentiles were used as reference. Sexual maturation was measured by Tanner stage. Isoflavones were quantified using liquid chromatography and tandem mass spectrometry. RESULTS: Height, BMI/age, weight/age and height/age were significantly different (P < 0.05) at 12 months between girls in the control and intervention groups. Statistically significant differences between groups by gender (P < 0.05) were found in boys in the control group for the triceps skinfold thickness and fat area. Nutritional status was adequate according to the World Health Organization parameters. On average, 0.130 mg/kg body weight/day of isoflavones were consumed by children, which did not show significant differences in their sexual maturation. CONCLUSION: Consumption of SPS for 12 months did not affect sexual maturation or the onset of puberty in prepubertal boys and girls; however, it may have induced an increase in height, BMI/age, height/age and weight/age of the girls, associated with variations in fat-free mass.

Identification of proteins from human permanent erupted enamel.

Proteins from the extracellular matrix of enamel are highly specific and necessary for proper enamel formation. Most proteins are removed from the matrix by enamel proteases before complete mineralization is achieved; however, some residual protein fragments persist in the mineralized matrix of erupted enamel. So far, only amelogenin peptides obtained by traditional bottom-up proteomics have been recovered and identified in human permanent erupted enamel. In this study, we hypothesize that other enamel-specific proteins are also found in human permanent enamel, by analysing human erupted third molars. Pulverized enamel was used to extract proteins, and the protein extract was subjected directly to liquid-chromatography coupled to tandem mass spectrometry (LC-MS/MS) without a previous trypsin-digestion step. Amelogenin and non-amelogenin proteins (ameloblastin and enamelin) were succesfully identified. The sequences of the naturally occurring peptides of these proteins are reported, finding in particular that most of the peptides from the amelogenin X-isoform come from the tyrosine-rich amelogenin peptide (TRAP) and that some were identified in all specimens. In conclusion, our LC-MS/MS method without trypsin digestion increased the coverage of identification of the enamel proteome from a few amelogenin peptides to a higher number of peptides from three enamel-specific proteins.

The insulin-like growth factor-1 binding protein acid-labile subunit alters mesenchymal stromal cell fate.

Age-related osteoporosis is accompanied by an increase in marrow adiposity and a reduction in serum insulin-like growth factor-1 (IGF-1) and the binding proteins that stabilize IGF-1. To determine the relationship between these proteins and bone marrow adiposity, we evaluated the adipogenic potential of marrow-derived mesenchymal stromal cells (MSCs) from mice with decreased serum IGF-1 due to knockdown of IGF-1 production by the liver or knock-out of the binding proteins. We employed 10-16-week-old, liver-specific IGF-1-deficient, IGFBP-3 knock-out (BP3KO) and acid-labile subunit knock-out (ALSKO) mice. We found that expression of the late adipocyte differentiation marker peroxisome proliferator-activated receptor gamma was increased in marrow isolated from ALSKO mice. When induced with adipogenic media, MSC cultures from ALSKO mice revealed a significantly greater number of differentiated adipocytes compared with controls. MSCs from ALSKO mice also exhibited decreased alkaline-phosphatase positive colony size in cultures that were stimulated with osteoblast differentiation media. These osteoblast-like cells from ALSKO mice failed to induce osteoclastogenesis of control cells in co-culture assays, indicating that impairment of IGF-1 complex formation with ALS in bone marrow alters cell fate, leading to increased adipogenesis.

Serum complexes of insulin-like growth factor-1 modulate skeletal integrity and carbohydrate metabolism.

Serum insulin-like growth factor (IGF) -1 is secreted mainly by the liver and circulates bound to IGF-binding proteins (IGFBPs), either as binary complexes or ternary complexes with IGFBP-3 or IGFBP-5 and an acid-labile subunit (ALS). The purpose of this study was to genetically dissect the role of IGF-1 circulatory complexes in somatic growth, skeletal integrity, and metabolism. Phenotypic comparisons of controls and four mouse lines with genetic IGF-1 deficits-liver-specific IGF-1 deficiency (LID), ALS knockout (ALSKO), IGFBP-3 (BP3) knockout, and a triply deficient LID/ALSKO/BP3 line-produced several novel findings. 1) All deficient strains had decreased serum IGF-1 levels, but this neither predicted growth potential or skeletal integrity nor defined growth hormone secretion or metabolic abnormalities. 2) IGF-1 deficiency affected development of both cortical and trabecular bone differently, effects apparently dependent on the presence of different circulating IGF-1 complexes. 3) IGFBP-3 deficiency resulted in increased linear growth. In summary, each IGF-1 complex constituent appears to play a distinct role in determining skeletal phenotype, with different effects on cortical and trabecular bone compartments.

Effect of Daily Exposure to an Isolated Soy Protein Supplement on Body Composition, Energy and Macronutrient Intake, Bone Formation Markers, and Lipid Profile in Children in Colombia.

A soy protein-based supplement may optimize bone health, support physical growth, and stimulate bone formation. This study aimed to assess the effect of a daily soy protein supplement (SPS) on nutritional status, bone formation markers, lipid profile, and daily energy and macronutrient intake in children. One hundred seven participants (62 girls), ages 2 to 9, started the study and were randomly assigned to lunch fruit juice with (n = 57, intervention group) or without (n = 50, control group) addition of 45 g (230 Kcal) of a commercial SPS during 12 months; 84 children (51 girls, 33 boys) completed the study (45 and 39 intervention and control, respectively). Nutritional assessment included anthropometry and nutrient intakes; initial and final blood samples were taken; insulin-like growth factor-I (IGF-I), osteocalcin, bone specific alkaline phosphatase (BAP), insulin-like growth factor binding protein-3 (IGFBP-3), cholesterol, triglycerides, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were analyzed. Statistically significant changes (p < .05) in body mass index and weight for age Z scores were observed between groups while changes in body composition were not. Changes in energy, total protein, and carbohydrate intakes were significantly higher in the intervention group (p < .01). Calorie intake changes were statistically significant between groups (p < .001), and BAP decreased in both groups, with values within normal ranges. Osteocalcin, IGFBP-3, and lipid profile were not different between groups. IGF-I levels and IGF/IGFBP-3 ratio increased significantly in both groups. In conclusion, changes in macronutrient and energy intake and nutritional status in the intervention group compared to control group may ensure harmonious and adequate bone health and development.

[Insulin-like growth factor receptor I signaling in a breast cancer cell line]. / Señalización asociada al receptor del factor de crecimiento similar a la insulina de tipo I en una línea celular colombiana de carcinoma mamario.

INTRODUCTION: In vitro studies strongly suggest that proliferation, migration and cell survival of breast cancer cell lines are significantly affected by activation of the IGF type 1 receptor (IGF-IR). OBJECTIVE: The phosphorylation by IGF-I of IGF-IR and the intracellular signaling molecules Akt (PI-3K pathway) and Erk1/2 (MAPK pathway) was characterized in a human breast cancer cell lines. MATERIALS AND METHODS: The study compared a standard breast adenocarcinoma line (MCF-7) cell line with a line (CSC 1595) derived from an infiltrating ductal breast cancer in a Colombian patient. The CSC 1595 and MCF-7 cell lines were cultured in DMEM supplemented with 10% fetal bovine serum, 2 mM glutamine, 100 U/ml penicillin, and 100 µg/ml streptomycin and grown at 37 °C in 5% CO2 atmosphere and 95% humidity. Cell extracts were prepared, followed by immunoprecipitation and immunoblotting with specific anti-pIGF-IR, anti-pERK1/2 and anti-pAkt antibodies. RESULTS: After 5 minute stimulation with IGF-I, 70% of the IGF-IR was phosphorylated in the cell line CSC 1595 and 25% in MCF-7. In addition, Akt (oncogene protein v-akt) and ERK1/2 (extracellular signal-regulated MAP kinases) were phosphorylated. Basal and stimulated levels of phosphorylated ERK1/2 were substantially higher compared to those in the MCF-7 cell line. CONCLUSIONS: The IGF-IR and MAPK kinase pathway involving proteins ERK1/2 showed more significant phosphorylation in the 1,595 cells compared to the observed in the MCF-7 cell line. Since the IGF-IR is the major activator of this pathway it may play an important role in ductal infiltrating breast cancer tumor growth and metastases.

Insulin-like growth factor-I regulates the liver microenvironment in obese mice and promotes liver metastasis.

Among the mechanisms implicated in the tumor-promoting effects of obesity, signaling by insulin-like growth factor-I (IGF-I) and insulin has received considerable attention. However, the emerging realization that obesity is associated with chronic inflammation has prompted other consideration of how the IGF-I axis may participate in cancer progression. In the present study, we used two mouse models of chronic (LID) and inducible (iLID) igf-1 gene deficiency in the liver to investigate the role of IGF-I in regulating the host microenvironment and colorectal carcinoma growth and metastasis in obese mice. Obese mice had a heightened inflammatory response in the liver, which was abolished in mice with chronic IGF-I deficiency (LID). In control animals changes to the hepatic microenvironment associated with obesity sustained the presence of tumor cells in the liver and increased the incidence of hepatic metastases after intrasplenic/portal inoculation of colon carcinoma cells. These changes did not occur in LID mice with chronic IGF-1 deficiency. In contrast, these changes occurred in iLID mice with acute IGF-1 deficiency, in the same manner as the control animals, revealing a fundamental difference in the nature of the requirement for IGF-1 on tumor growth and metastasis. In the setting of obesity, our findings imply that IGF-1 is critical to activate and sustain an inflammatory response in the liver that is needed for hepatic metastasis, not only through direct, paracrine effect on tumor cell growth, but also through indirect effects involving the tumor microenvironment.

Growth hormone protects against ovariectomy-induced bone loss in states of low circulating insulin-like growth factor (IGF-1).

Early after estrogen loss in postmenopausal women and ovariectomy (OVX) of animals, accelerated endosteal bone resorption leads to marrow expansion of long bone shafts that reduce mechanical integrity. Both growth hormone (GH) and insulin-like growth factor (IGF-1) are potent regulators of bone remodeling processes. To investigate the role of the GH/IGF-1 axis with estrogen deficiency, we used the liver IGF-1-deficient (LID) mouse. Contrary to deficits in controls, OVX of LID mice resulted in maintenance of cortical bone mechanical integrity primarily owing to an enhanced periosteal expansion affect on cross-sectional structure (total area and cortical width). The serum balance in LID that favors GH over IGF-1 diminished the effects of ablated ovarian function on numbers of osteoclast precursors in the marrow and viability of osteocytes within the cortical matrix and led to less endosteal resorption in addition to greater periosteal bone formation. Interactions between estrogen and the GH/IGF-1 system as related to bone remodeling provide a pathway to minimize degeneration of bone tissue structure and osteoporotic fracture.

Insulin-mediated acceleration of breast cancer development and progression in a nonobese model of type 2 diabetes.

Epidemiologic studies suggest that type 2 diabetes (T2D) increases breast cancer risk and mortality, but there is limited experimental evidence supporting this association. Moreover, there has not been any definition of a pathophysiological pathway that diabetes may use to promote tumorigenesis. In the present study, we used the MKR mouse model of T2D to investigate molecular mechanisms that link T2D to breast cancer development and progression. MKR mice harbor a transgene encoding a dominant-negative, kinase-dead human insulin-like growth factor-I receptor (IGF-IR) that is expressed exclusively in skeletal muscle, where it acts to inactivate endogenous insulin receptor (IR) and IGF-IR. Although lean female MKR mice are insulin resistant and glucose intolerant, displaying accelerated mammary gland development and enhanced phosphorylation of IR/IGF-IR and Akt in mammary tissue, in the context of three different mouse models of breast cancer, these metabolic abnormalities were found to accelerate the development of hyperplastic precancerous lesions. Normal or malignant mammary tissue isolated from these mice exhibited increased phosphorylation of IR/IGF-IR and Akt, whereas extracellular signal-regulated kinase 1/2 phosphorylation was largely unaffected. Tumor-promoting effects of T2D in the models were reversed by pharmacological blockade of IR/IGF-IR signaling by the small-molecule tyrosine kinase inhibitor BMS-536924. Our findings offer compelling experimental evidence that T2D accelerates mammary gland development and carcinogenesis,and that the IR and/or the IGF-IR are major mediators of these effects.

Serum IGF-1 determines skeletal strength by regulating subperiosteal expansion and trait interactions.

Strong correlations between serum IGF-1 levels and fracture risk indicate that IGF-1 plays a critical role in regulating bone strength. However, the mechanism by which serum IGF-1 regulates bone structure and fracture resistance remains obscure and cannot be determined using conventional approaches. Previous analysis of adult liver-specific IGF-1-deficient (LID) mice, which exhibit 75% reductions in serum IGF-1 levels, showed reductions in periosteal circumference, femoral cross-sectional area, cortical thickness, and total volumetric BMD. Understanding the developmental sequences and the resultant anatomical changes that led to this adult phenotype is the key for understanding the complex relationship between serum IGF-1 levels and fracture risk. Here, we identified a unique developmental pattern of morphological and compositional traits that contribute to bone strength. We show that reduced bone strength associated with low levels of IGF-1 in serum (LID mice) result in impaired subperiosteal expansion combined with impaired endosteal apposition and lack of compensatory changes in mineralization throughout growth and aging. We show that serum IGF-1 affects cellular activity differently depending on the cortical surface. Last, we show that chronic reductions in serum IGF-1 indirectly affect bone strength through its effect on the marrow myeloid progenitor cell population. We conclude that serum IGF-1 not only regulates bone size, shape, and composition during ontogeny, but it plays a more fundamental role-that of regulating an individual's ability to adapt its bone structure to mechanical loads during growth and development.

Estandarizacion de un protocolo de extraccion y caracterizacion del material proteico del esmalte dental erupcionado / Standardization of a protocol of extraction and characterization of erupted dental enamel proteins

Introduccion: El 95% del peso del esmalte dental erupcionado sano corresponde a material inorganico, 4% agua y 1% a materia organica (con un 0,03 a 0,1% de trazas de proteinas estructurales). En el caso del esmalte con defectos del desarrollo - como la fluorosis dental - existe evidencia de la retencion de material proteico, despertando la necesidad del estudio del proteoma del esmalte en estas condiciones. Limitaciones inherentes a los tejidos duros, como su bajo contenido proteico encerrado en una matriz mineral, dificultan los procesos de extraccion y caracterizacion de proteinas. El presente estudio, busca hacer una adaptacion metodologica de los procedimientos de extraccion de proteinas en esmalte dental erupcionado humano, para su posible aplicacion al estudio del proteoma del esmalte con defectos del desarrollo. Objetivo: Estandarizar una tecnica de extraccion y caracterizacion del material proteico del esmalte de dientes erupcionados. Materiales y metodos: Se recolectaron dientes sanos con extraccion indicada y se realizaron: -cortes de secciones longitudinales de 550 ¦Ìm, - separacion mecanica de esmalte/dentina y - pulverizacion de esmalte dental. El pulverizado se sometio a desmineralizacion/precipitacion de proteinas con TCA 12%. El extracto fue separado por electroforesis SDS-PAGE y caracterizado por LC-MS/ MS. Resultados: el procedimiento fue estandarizado. No se evidenciaron bandas de proteina despu¨¦s de la electroforesis SDS-PAGE, pero se identificaron y caracterizaron 138 peptidos, correspondientes a 13 proteinas, 3 de ellas especificas del esmalte (Amelogenina X, Amelogenina Y, Ameloblastina). Conclusiones: por primera vez en Colombia, se estandarizan y se adaptan metodos de extraccion y caracterizacion de proteinas del esmalte dental, abriendo las puertas al estudio del proteoma de este tejido.

Introduction: 95% of erupted enamel corresponds to inorganic material, 1% organic and 4% water content (by weight) and it only has traces of structural proteins (0,03¨C0,1%), making extraction and characterization a difficult process. Enamel developmental defects as dental fluorosis, have been related to protein retention, indicating a clear need for the study of the enamel proteome. Standardization of methods for extraction and characterization of enamel proteins will allow the characterization of the human enamel proteome under these particular conditions. Methods: ethical approval from Universidad El Bosque ethics committee was granted and informed consent was given. Human permanent erupted teeth were collected from Universidad El Bosque Dental Clinics. The teeth crowns were cut in 550 ¦Ìm sections, and dental tissues were separated. The enamel sections were grinded with liquid nitrogen to get enamel powder. Powdered enamel was demineralized and the proteins precipitated with TCA 12%. The proteins were separated by SDS-PAGE Electrophoresis and characterized by LC-MS/MS. Results: enamel powdering and protein extraction techniques were standardized at Universidad El Bosque laboratories. No protein bands were detected after SDS- PAGE Electrophoresis, however, by LC-MS/MS, 138 peptides from 13 proteins were identified, 3 of them enamel-specific (Amelogenin X, Amelogenin Y). Conclusions: for the first time in Colombia, methods for extraction and characterization of proteins are standardized and applied on dental enamel, opening the doors for the study of the proteome from sound and defective dental enamel.

Señalización asociada al receptor del factor de crecimiento similar a la insulina de tipo I en una línea celular colombiana de carcinoma mamario / Insulin-like growth factor receptor I signaling in a breast cancer cell line

Introducción. Varios estudios in vitro sugieren que la proliferación, migración y supervivencia en líneas celulares de cáncer de seno se ven significativamente afectadas por la activación del receptor IGF de tipo I (Insulin-like Growth Factor-I Receptor, IGF-IR).Objetivo. Caracterizar la fosforilación del IGF-IR y las moléculas de señalización intracelular Akt y Erk1/2 (vías de señalización PI-3K y MAPK, respectivamente), causada por el factor IGF-I en una línea celular colombiana de cáncer de mama ductal infiltrante (CSC 1595). Materiales y métodos. Las líneas celulares CSC 1595 y MCF-7 se cultivaron en medio DMEM con suplemento de suero fetal bovino 10%, glutamina 2 mM, penicilina 100 U/ml, estreptomicina 100 µg/ml a 37 0C, atmósfera de CO2 al 5% y humedad de 95%. Los extractos celulares se sometieron a inmunoprecipitación e inmunodetección con anticuerpos específicos anti-pIGF-IR, anti-pERK1/2 y anti-pAkt. Resultados. Cinco minutos después del estímulo con 10 nM de IGF-I, 70% y 25% del IGF-IR fueron fosforilados en las células CSC 1595 y MCF-7, respectivamente; también se observó activación de las proteínas Akt y ERK1/2. Los niveles basales y estimulados de las proteínas ERK1/2 fueron significativamente más altos en las células CSC 1595, comparados a los observados en MCF-7. Conclusiones. El IGF-IR y la vía MAPK cinasa que involucra las proteínas ERK1/2 muestran una fosforilación mayor en las células 1595 a la observada en las MCF-7. El IGF-IR, principal activador de esta vía, podría jugar un papel importante en los procesos de proliferación y metástasis de tumores de cáncer de mama ductal infiltrante.

Introduction. In vitro studies strongly suggest that proliferation, migration and cell survival of breast cancer cell lines are significantly affected by activation of the IGF type 1 receptor (IGF-IR).Objective. The phosphorylation by IGF-I of IGF-IR and the intracellular signaling molecules Akt (PI-3K pathway) and Erk1/2 (MAPK pathway) was characterized in a human breast cancer cell lines. Materials and methods. The study compared a standard breast adenocarcinoma line (MCF-7) cell line with a line (CSC 1595) derived from an infiltrating ductal breast cancer in a Colombian patient. The CSC 1595 and MCF-7 cell lines were cultured in DMEM supplemented with 10% fetal bovine serum, 2 mM glutamine, 100 U/ml penicillin, and 100 µg/ml streptomycin and grown at 37°C in 5% CO2 atmosphere and 95% humidity. Cell extracts were prepared, followed by immunoprecipitation and immunoblotting with specific anti-pIGF-IR, anti-pERK1/2 and anti-pAkt antibodies. Results. After 5 minute stimulation with IGF-I, 70% of the IGF-IR was phosphorylated in the cell line CSC 1595 and 25% in MCF-7. In addition, Akt (oncogene protein v-akt) and ERK1/2 (extracellular signal-regulated MAP kinases) were phosphorylated. Basal and stimulated levels of phosphorylated ERK1/2 were substantially higher compared to those in the MCF-7 cell line. Conclusions. The IGF-IR and MAPK kinase pathway involving proteins ERK1/2 showed more significant phosphorylation in the 1,595 cells compared to the observed in the MCF-7 cell line. Since the IGF-IR is the major activator of this pathway it may play an important role in ductal infiltrating breast cancer tumor growth and metastases.

Dermatosis en 500 expedientes revisados, en la población asegurada: Hospital IDSS "Arzobispo Meriño" - Sabana Grande de Boyá / Dermatosis in 500 records reviewd, in a social security population: Hospital IDSS Arzobispo Meriño - Sabana Grande de Boyá

Se realizó un estudio retrospectivo en el hospital del IDSS "Arzobispo Meriño" de Sabana Grande de Boyá, donde fueron revisados 500 expedientes en los archivos del Hospital ya citado correspondiente al año 1984. Los resultados obtenidos en dicho estudio fueron: Escabiasis 22 casos (29.3%), tiña inguinal 14 casos (18.7%), tiña corporis 8 (10.7%), pitiriasis versicolor 8 (10.7%), tiña pedis 5 (6.7%), tiña ungueal 4 (5.2%), tiña copetis 3 (4%). Entre otras, menos frecuentes encontramos: Dematitis por contacto 2 (2.7%), tiña de mano 1 (1.3%)

Evolución del embarazo en pacientes con cerclaje ístmico-cervical: Hospital Juan Pablo Pina, San Cristóbal, 1990-1992 / Progression of the pregnancy in patients with cerclaje isthmus-cervix : Hospital Juan Pablo Pina, San Cristobal, 1990-1992

Se trata de una investigación retrospectiva y descriptiva realizada en el Hospital Juan Pablo Pina, de San Cristóbal, República Dominicana, durante el período enero del 1990-enero de 1992, donde se estudió a 12 pacientes con insuficiencia ístmicocervical (IIC) a las cuales les fue realizado cerclaje. Los resultados de esta investigación coinciden en su gran mayoria con los reportados por los autores internacionales. Fueron practicados doce (12) procedimientos con la técnica de McDonald, y se obtuvo 8 embarazos en curso normal (66.66 por ciento ) y un parto prematuro. La mayoria no tuvo complicaciones después de la intervención. El estado del cuello ístmico en las pacientes sometidas a la práctica del cerclaje fue 83.33 por ciento normal y 16.66 por ciento con desgarros cervicales

Comportamiento sexual en una población de embarazadas que acuden a consulta prenatal / Sexual behavior in a population of gravid women that attend a prenatal consult

Se realizó un estudio de tipo descriptivo para obsevar el comportamiento sexual de 300 mujeres embarazadas que acudieron a la consulta prenatal del Hospital Juan Pablo Pina de la ciudad de San Cristóbal durante el período mayo-julio del 1994. Se determinó que el embarazo modifica la conducta sexual de estas mujeres, altera la líbido y hace más difícil la obtención del orgasmo en la medida en que avanza el estado gestacional y que el temor al aborto o daño fetal pudiera explicar los cambios observados en el presente trabajo

Comportamiento epidemiológico de la mortalidad materna en el Hospital Maternidad Nuestra Señora de la Altagracia, 1992-1996 / Epidemiological behaviour of maternal mortality at \"Nuestra Señora de la Altagracia\" Maternity Hospital, 1992-1996

Con la finalidad de conocer la posible causa de muerte directa o asociada al embarazo, realizamos un estudio descriptivo transversal con la recolección retrospectiva de la información en el Hospital Maternidad Nuestra Señora de la Altagracia, durante el período 1992-1996. Del total de 121.197 pacientes admitidas 169 fueron defunciones, lo que representa una tasa de mortalidad materna de 156.5/100,000 NV., y se realizaron 95.007 partos y 12,492 cesáreas de las cuales se representaron (0.07//) defunciones vía parto vaginal y 0.41// mediante operación cesárea (9.75//) correspondieron a pacientes que fallecieron embarazadas y 10.97// por aborto, (1.21//) a las que se les practicó laparotomía; (32.92//) eran primigesta, (42//) las multíparas, (11.9//) adolescentes, (73.8// entre 20 y 30 años; (14.3//) eran mayores de 30 años, (16.45//) eran gran multíparas. La causa de muerte fue (43.29//) por hemorragias, donde el DPPNT ocupó el primer lugar (10.5//), (ver cuadro 12); (27.4//) debido a trastornos hipertensivos; (5.24//) muertes por sepsis, (2.4//) por accidente anestésico, (4.3//) por causa desconocida. Consideramos que las principales causas de mortalidad materna son hemorragias, trastornos hipertensivos y sepsis