Trichomonas vaginalis Legumain-2, TvLEGU-2, Is an Immunogenic Cysteine Peptidase Expressed during Trichomonal Infection.

Trichomonas vaginalis is the causative agent of trichomoniasis, the most prevalent nonviral, neglected sexually transmitted disease worldwide. T. vaginalis has one of the largest degradomes among unicellular parasites. Cysteine peptidases (CPs) are the most abundant peptidases, constituting 50% of the degradome. Some CPs are virulence factors recognized by antibodies in trichomoniasis patient sera, and a few are found in vaginal secretions that show fluctuations in glucose concentrations during infection. The CPs of clan CD in T. vaginalis include 10 genes encoding legumain-like peptidases of the C13 family. TvLEGU-2 is one of them and has been identified in multiple proteomes, including the immunoproteome obtained with Tv (+) patient sera. Thus, our goals were to assess the effect of glucose on TvLEGU-2 expression, localization, and in vitro secretion and determine whether TvLEGU-2 is expressed during trichomonal infection. We performed qRT-PCR assays using parasites grown under different glucose conditions. We also generated a specific anti-TvLEGU-2 antibody against a synthetic peptide of the most divergent region of this CP and used it in Western blot (WB) and immunolocalization assays. Additionally, we cloned and expressed the tvlegu-2 gene (TVAG_385340), purified the recombinant TvLEGU-2 protein, and used it as an antigen for immunogenicity assays to test human sera from patients with vaginitis. Our results show that glucose does not affect tvlegu-2 expression but does affect localization in different parasite organelles, such as the plasma membrane, Golgi complex, hydrogenosomes, lysosomes, and secretion vesicles. TvLEGU-2 is secreted in vitro, is present in vaginal secretions, and is immunogenic in sera from Tv (+) patients, suggesting its relevance during trichomonal infection.

The effect of iron on Trichomonas vaginalis TvCP2: a cysteine proteinase found in vaginal secretions of trichomoniasis patients.

Trichomonas vaginalis (Tv) induces host cell damage through cysteine proteinases (CPs) modulated by iron. An immunoproteomic analysis showed that trichomoniasis patient sera recognize various CPs, also some of them are present in vaginal washes (VWs). Thus, the goal of this work was to determine whether TvCP2 is expressed during infection and to assess the effect of iron on TvCP2 expression, localization and contribution to in vitro cellular damage. Western-blotting (WB) assays using TvCP2r and vaginitis patient serum samples showed that 6/9 Tv (+) but none of the Tv (-) patient sera recognized TvCP2r. WB using an anti-TvCP2r antibody and VWs from the same patients showed that in all of the Tv (+) but none of the Tv (-) VWs, the anti-TvCP2r antibody detected a 27 kDa protein band that corresponded to the mature TvCP2, which was confirmed by mass spectrometry analysis. Iron decreased the amount of TvCP2 mRNA and the protein localized on the parasite surface and cytoplasmic vesicles concomitant with the cytotoxic effect of TvCP2 on HeLa cells. Parasites pretreated with the anti-TvCP2r antibody also showed reduced levels of cytotoxicity and apoptosis induction in HeLa cell monolayers. In conclusion, these results show that TvCP2 is expressed during trichomonal infection and plays an important role in the in vitro HeLa cell cytotoxic damage under iron-restricted conditions.

Síndrome metabólico en menopausia: implicaciones de la terapia hormonal / Menopause syndrome: implications of hormone therapy

Introducción: La incidencia de enfermedad cardiovascular y síndrome metabólico en mujeres postmenopáusicas es de 35%. El objetivo de este trabajo fue determinar la relación entre los diferentes parámetros antropométricos y bioquímicos en pacientes con o sin terapia hormonal de reemplazo con síndrome metabólico. Material y métodos: Se realizó un estudio en una cohorte retrospectiva, con el análisis de casos de la Coordinación de Peri y Postmenopausia del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes en el periodo comprendido entre 1998 y 2009; se incluyeron aquellas pacientes con diagnóstico de síndrome metabólico. Las variables analizadas fueron: a) indicadores antropométricos; b) indicadores bioquímicos y c) niveles de tensión arterial. Se formaron dos grupos: pacientes con terapia de reemplazo hormonal (Grupo I) y el otro con pacientes sin terapia hormonal (Grupo II). El análisis estadístico se realizó dependiendo de la variable, con prueba de chi cuadrada y t de Student y se calculó OR (IC 95%). Resultados: Se incluyeron 310 casos; el Grupo I se conformó por 121 casos y el Grupo II por 189 casos. No existieron diferencias estadísticamente significativas en relación a los índices antropométricos; de los indicadores bioquímicos, se encontraron diferencias en los valores de colesterol (p = 0. 024) y de la tensión arterial, las diferencias se encontraron en la diastólica con (p < 0.001) a favor de las pacientes que recibieron terapia hormonal de reemplazo. Se obtuvo un OR 5.27, IC 95% (2-13.87), para el Grupo II de presentar tensión arterial diastólica > de 90 mmHg. Conclusiones: Las pacientes con síndrome metabólico sin terapia hormonal tienen un mayor riesgo de desarrollar TAD > 90 mmHg y una tendencia a mantener rangos más elevados en el perfil de lípidos y mayor riesgo de desarrollar ECV, aunque la investigación sobre los diferentes factores de riesgo, así como las implicaciones de la terapia hormonal, aún son insuficientes para reconocer la dimensión del problema en el climaterio.

Introduction: The incidence of cardiovascular disease and metabolic syndrome during the menopause is around 35%. The objective of this study was to establish the relation between anthropometric and biochemical values in those patients with metabolic syndrome with and without hormone replacement therapy during menopause. Methods: A retrospective cohort study with case analysis of the Coordination of Peri and Postmenopause at the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes during the period between 1998 and 2009; the study included those patients with diagnosis of metabolic syndrome. The variables analyzed were: a) anthropometric, b) biochemical indicators and c) blood pressure levels, divided in two groups: patients with hormone replacement therapy (Group I) and patients without hormonal therapy (Group II). The statistical analysis were performed depending on the variable, with chi-square, Student t test and OR, CI (95%). Results: 310 cases were included: Group I, 121 cases and Group II 189 cases. There were no statistically significant differences on anthropometric and biochemical indicators, but significant differences in cholesterol (p=0.024) and diastolic blood pressure levels, were found (p <0.001) in patients receiving hormone replacement therapy. Group II had an OR 5.27, CI 95% (2-13.87) for diastolic blood pressure> 90 mmHg. Conclusions: Patients with metabolic syndrome without hormone replacement therapy have an increased risk for diastolic blood pressure > 90 mmHg and a tendency to maintain higher cholesterol levels and increasing the risk of developing cardiovascular disease, although research on the different risk factors, and the implications of hormone therapy, are still insufficient to recognize the scale of the problem in the climacteric woman.

[Risk factors for bladder injuries during cesarean section]. / Factores de riesgo asociados a lesiones vesicales en cesárea.

OBJECTIVE: To identify risk factors for bladder injury during cesarean delivery, to let patients and doctors know them and their importance. METHODS: We conducted a case-control study of women undergoing cesarean delivery at the Instituto Nacional de PerinatologíaIsidro Espinosa de los Reyes between January 2001 and December 2007. Cases were women with bladder injuries at the time of cesarean section. Two controls per case were selected randomly. Medical records were reviewed for clinical and demographic data to compare them. RESULTS: Twenty-one bladder injuries were identified among 24, 057 cesarean sections, (incidence 0.087%), only 19 were analized. Prior cesarean section was more prevalent among cases than controls (63% vs 42% p 0.134), with an OR of 2.35 (95% CI 0.759-7.319), when we take only patients with one cesarea in contrast with no cesarea the OR is 3.75 (95% CI 1.002- 14.07). Statistically significant differences (P values < .05) between cases and controls were found in gestacional age (38.16 vs 37.35 weeks), prior cesareans (42% vs 18%), adhesions (79% vs 5%), Odds ratio of 67.5 (95% CI 11.14- 408), VBAC (31.5 vs 3%), median skin incisión (16% vs 68%), Pfannenstiel (84% vs 32%), blood loss (744cc vs 509cc) and length of surgery 135 vs 58 minutes). No differences were found among age, BMI, prior surgery, labor, premature rupture of membranes, station, chorioamnioitis, induction, uterine incision, timing of delivery, uterine rupture. CONCLUSION: Prior cesarean section and adhesions are risk factors for bladder injury at the time of repeat cesarean delivery. Elective cesarean delivery is valid but it is duty of physicians to inform patients the risks of it.

Factores de riesgo asociados a lesiones vesicales en cesárea / Risk factors for bladder injuries during cesarean section

Objetivo: Identificar los factores de riesgo para lesión vesical durante la operación cesárea. Material y métodos: Se realizó un estudio de casos y controles de mujeres sometidas a cesárea en el periodo comprendido entre el 1 de enero de 2001 y el 31 de diciembre de 2007 en el INPerIER. Los casos fueron mujeres que habían sufrido lesión vesical en el procedimiento, como controles se seleccionaron al azar 2 mujeres por caso a las que se les realizó cesárea sin lesión vesical en el mismo periodo de tiempo. Se revisaron los expedientes analizando las características demográficas y clínicas las cuales se compararon entre sí. Resultados: Se encontraron 21 lesiones vesicales entre 24,057 cesáreas (incidencia 0,087%), de las cuales sólo se analizaron 19. La cesárea previa fue más frecuente en los casos que en los controles (63% vs 42% p 0,134), con un Odds Ratio (OR) de 2,35 (IC 95%0,759- 7,319), al comparar el antecedente de una cesárea contra ninguna el OR resultó de 3,75 (IC 95% 1,002- 14,07). Se encontraron diferencias estadísticamente significativas (p<,05) en: edad gestacional (38,16 vs 37,35 semanas), una cesárea previa (42% vs18%), adherencias (79% vs 5%), VBAC (31,5% vs 3%), incisión media (16% vs 68%), incisión Pfannenstiel (84% vs 32%), hemorragia (744cc vs 509cc) y tiempo quirúrgico (135 vs 58 minutos), con lesión vesical y sin ella respectivamente. No se encontraron diferencias significativas en la edad materna, el IMC, cirugías previas, TDP, RPM, altura del feto, corioamnioitis, preinducción, incisión uterina, urgencia del procedimiento o ruptura uterina. La presencia de adherencias tuvo un OR de 67,5 (IC 95% 11,14- 408). Conclusiones: El antecedente de cesárea y de adherencias son factores de riesgo para lesión vesical durante la cesárea (AU)

Objective: To identify risk factors for bladder injury during cesarean delivery, to let patients and doctors know them and their importance. Methods: We conducted a case-control study of women undergoing cesarean delivery at the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes between january 2001 and december 2007. Cases were women with bladder injuries at the time of cesarean section. Two controls per case were selected randomly. Medical records were reviewed for clinical and demographic data to compare them. Results: Twenty-one bladder injuries were identified among 24, 057 cesarean sections, (incidence 0.087%), only 19 were analized. Prior cesarean section was more prevalent among cases than controls (63% vs 42% p 0.134), with an OR of 2.35 (95% CI 0.759-7.319), when we take only patients with one cesarea in contrast with no cesarea the OR is 3.75 (95% CI 1.002- 14.07). Statistically significant differences (P values < .05) between cases and controls were found in gestacional age (38.16 vs 37.35 weeks), prior cesareans (42% vs 18%), adhesions (79% vs 5%), Odds ratio of 67.5 (95% CI 11.14- 408), VBAC (31.5 vs 3%), median skin incisión (16%vs 68%), Pfannenstiel (84% vs 32%), blood loss (744cc vs 509cc) and length of surgery 135 vs 58 minutes). No differences were found among age, BMI, prior surgery, labor, premature rupture of membranes, station, chorioamnioitis, induction, uterine incision, timing of delivery, uterine rupture. Conclusion: Prior cesarean section and adhesions are risk factors for bladder injury at the time of repeat cesarean delivery. Elective cesarean delivery is valid but it is duty of physicians to inform patients the risks of it (AU)

Relactancia al seno materno. Experiencia en el Hospital Amigo del Niño y la Madre de Cd. Nezahualcóyotl La Perla / Maternal relactation. Experience in a child-mother friendly hospital. Cd. Nezahualcoyotl La Perla

Objetivo. Evaluar la eficiencia de un programa de relactación materna en un hospital amigo del niño y de la madre. Material y métodos. Se realizó un estudio prospectivo, longitudinal y descriptivo con 310 pacientes menores de cuatro meses de edad con abandono de la alimentación al seno materno. Se preguntó la causa del abandono de la lactancia materna y se inicó relactancia, citándose cada tercer día permitiéndose a la madre una comunicación continua para resolver las dudas y problemas que la paciente tuviese para la relactación. Resultados. La poca producción de leche y la mala técnica para amamantar fueron los principales causas de suspensión de la lactancia materna. En la mayor parte de los casos, se logró reestablecer la lactancia. Se mencionan los problemas que ocasionaron el fracaso en la relactancia como es el pezón invertido. La madre trabajadora sin apoyo, etc. y también se hace referencia a los métodos usados para llevar a cabo la reelactancia, como sería la técnica adecuada para succionar, el uso del suplementador, etc