A Critical Analysis of the Automated Hematology Assessment in Pregnant Women at Low and at High Altitude: Association between Red Blood Cells, Platelet Parameters, and Iron Status.

The objectives of the study were to determine differences in the parameters of red blood cells (RBC), white blood cells (WBC), and platelets at low altitude (LA) and at high altitude (HA) and with the gestation being advanced, and to determine correlations between parameters of RBC and platelets. We also studied the association of RBC and platelets with markers of iron status. In addition, markers of iron status and inflammation were measured and compared at each trimester of gestation in pregnant women at LA and HA. A cross-sectional comparative study was conducted at Lima (150 m above sea level) and Cusco at 3400 m above sea level from May to December 2019. Hematological parameters in pregnant women (233 at LA and 211 at HA) were analyzed using an automated hematology analyzer. Serum ferritin levels, soluble transferrin receptor (sTfR), hepcidin, erythropoietin, testosterone, estradiol, and interleukin-6 (IL6) levels were measured by ELISA. One-way ANOVA supplemented with post hoc test, chi-square test, and Pearson correlation test statistical analyses were performed. p < 0.05 was considered significant. Pregnant woman at HA compared to LA had significantly lower WBC (p < 0.01), associated with higher parameters of the RBC, except for the mean corpuscular volume (MCV) that was no different (p > 0.05). Platelets and mean platelet volume (MPV) were higher (p < 0.01), and platelet distribution width (PDW) was lower at HA than at LA (p < 0.01). A higher value of serum ferritin (p < 0.01), testosterone (p < 0.05), and hepcidin (p < 0.01) was observed at HA, while the concentration of sTfR was lower at HA than at LA (p < 0.01). At LA, neutrophils increased in the third trimester (p < 0.05). RBC parameters decreased with the progress of the gestation, except RDW-CV, which increased. The platelet count decreased and the MPV and PDW were significantly higher in the third trimester. Serum ferritin, hepcidin, and serum testosterone decreased, while sTfR and serum estradiol increased during gestation. At HA, the WBC and red blood cell distribution width- coefficient of variation (RDW-CV), PCT, and serum IL-6 did not change with gestational trimesters. RBC, hemoglobin (Hb), hematocrit (Hct), mean corpuscular hemoglobin concentration (MCHC), and platelet count were lower as gestation advanced. MCV, MPV, and PDW increased in the third trimester. Serum ferritin, testosterone, and hepcidin were lower in the third trimester. Serum estradiol, erythropoietin, and sTfR increased as gestation progressed. Direct or inverse correlations were observed between RBC and platelet parameters and LA and HA. A better number of significant correlations were observed at HA. Hb, Hct, and RDW-CV showed a significant correlation with serum ferritin at LA and HA. Of these parameters, RDW-CV and PDW showed an inversely significant association with ferritin (p < 0.05). In conclusion, a different pattern was observed in hematological markers as well as in iron status markers between pregnant women at LA and HA. In pregnant women a significant correlation between several RBC parameters with platelet marker parameters was also observed. Data suggest that pregnant women at HA have adequate iron status during pregnancy as reflected by higher serum ferritin levels, lower sTfR levels, and higher hepcidin values than pregnant women at LA.

Índice cintura-estatura como prueba diagnóstica del Síndrome metabólico en adultos de Trujillo / Waist-height index as a diagnostic tool for metabolic syndrome in adults in Trujillo

Objetivos: Determinar el Índice cintura-estatura como prueba diagnóstica del síndrome metabólico en adultos de Trujillo. Material y métodos: Estudio de prueba diagnóstica, prospectivo, transversal realizado en una población en Trujillo. Se incluyeron 610 adultos, 299 varones y 311 mujeres, con edades entre 20 y 79 años. El síndrome metabólico fue determinado según los criterios de ATP III y JIS, y para el Índice cintura-estatura se determinaron los valores de acuerdo al sexo. Resultados: El punto de corte para el Índice cintura-estatura según ATP III fue 0,56 para ambos sexos y según JIS 0,54, siendo para mujeres 0,53 y para varones, 0,55; con un área bajo la curva de 0,83 y 0,79, respectivamente. El riesgo de presentar SM, aumentó directamente con la edad. Conclusiones: El Índice cintura-estatura puede ser usado como prueba diagnóstica para el Síndrome metabólico, tanto para ATP III y JIS, ya que tiene un alto valor significativo. (AU)

Objectives: To evaluate the waist-height index as a diagnostic tool for metabolic syndrome (MS) in adults in Trujillo. Methods: prospective, cross sectional diagnostic study carried-out in an adult population in Trujillo. A total of 610 adults were included, 299 were males and 311 were females, ages ranged from 20 and 79 years. The presence of MS was evaluated following AP II and JIS definitions and values for age were used to determine the waist-height index. Results: The threshold for the waist-height index following ATP was 0.56 for both sexes and it was 0.54 following JIS; being 0.53 for females and 0.55 for males; the area under the curve was 0.83 and 0.79 respectively. The risk to have MS increased directly with age. Conclusions: the waist-height index may be used as a diagnostic tool for MS, both for ATP II and JIS. (AU)

Nitric Oxide And Hypoxia Response In Pluripotent Stem Cells.

The expansion of pluripotent cells (ESCs and iPSCs) under conditions that maintain their pluripotency is necessary to implement a cell therapy program. Previously, we have described that low nitric oxide (NO) donor diethylenetriamine/nitric oxide adduct (DETA-NO) added to the culture medium, promote the expansion of these cell types. The molecular mechanisms are not yet known. We present evidences that ESC and iPSCs in normoxia in presence of low NO triggers a similar response to hypoxia, thus maintaining the pluripotency. We have studied the stability of HIF-1α (Hypoxia Inducible Factor) in presence of low NO. Because of the close relationship between hypoxia, metabolism, mitochondrial function and pluripotency we have analyzed by q RT-PCR the expression of genes involved in the glucose metabolism such as: HK2, LDHA and PDK1; besides other HIF-1α target gene. We further analyzed the expression of genes involved in mitochondrial biogenesis such as PGC1α, TFAM and NRF1 and we have observed that low NO maintains the same pattern of expression that in hypoxia. The study of the mitochondrial membrane potential using Mito-Tracker dye showed that NO decrease the mitochondrial function. We will analyze other metabolic parameters, to determinate if low NO regulates mitochondrial function and mimics Hypoxia Response. The knowledge of the role of NO in the Hypoxia Response and the mechanism that helps to maintain self-renewal in pluripotent cells in normoxia, can help to the design of culture media where NO could be optimal for stem cell expansion in the performance of future cell therapies.

Efecto de la Plukenetia volubilis Linneo (sacha inchi) en la trigliceridemia posprandial / Effect of Plukenetia volubilis Linneo (sacha inchi) on postprandial triglycerides

Introducción: La lipemia posprandial es un factor de riesgo coronario. Existe evidencia que los ácidos omega 3 disminuyen los lípidos plasmáticos. La Plukenetia volubilis Linneo, 'sacha inchi', es rica en omega 3. Objetivo: Determinar el efecto de la ingesta de sacha inchi sobre la trigliceridemia posprandial, en adultos jóvenes. Diseño: Estudio cuasi-experimental. Lugar: Facultad de Medicina, Universidad Nacional de Trujillo. Participantes: Estudiantes de medicina. Intervenciones: A doce estudiantes de medicina seleccionados al azar se les aplicó la prueba de tolerancia a triglicéridos, en dos fases: en la primera, después de la ingesta de 82 gramos de aceite de oliva y, en la segunda, adicionando 50 gramos de sacha inchi. Principales medidas de resultados: Efecto reductor de los lípidos plasmáticos. Resultados: En la primera fase, los triglicéridos basales fueron 99,67 mg/dL en promedio y luego se incrementaron en promedio 32 a la 1½ h, 74 a las 3 h, 89 a las 4½ h y 54 a las 6 h. En la segunda fase, el promedio basal fue 100,92 mg/dL, incrementándose 15 a la 1½ h, 52 a las 3 h, 40 a las 4½ h y 43 a las 6 h, en promedio, siendo significativa la reducción a la 1½ h (p=0,0232) y a las 4½ h (p=0,0496). Al graficar la prueba de tolerancia a triglicéridos, se evidenció significancia estadística al comparar el área bajo la curva de ambas fases (p=0,0080). Conclusiones: El consumo de la Plukenetia volubilis Linneo disminuye la trigliceridemia posprandial en adultos jóvenes.

Introduction: Postprandial lipemia is a coronary risk factor and is affected byomega-3 fatty acids. There is evidence that omega-3 acids decrease plasmalipids. Plukenetia volubilis Linne (sacha inchi) is rich in omega-3. Objectives: To determine the effect of sacha inchi ingestion on postprandial triglycerides inyoung adults. Design: Quasi-experimental study. Setting: Faculty of Medicine, Universidad Nacional de Trujillo. Participants: Medical students. Interventions: To 12 randomly selected Universidad Nacional de Trujillo medical students we performed oral glucose tolerance test in two phases: in the first following the ingestion of 82 grams of olive oil and in the second adding 50 grams of sacha inchi. Main outcome measures: Plasma lipids reduction. Results: In the first phase we obtained an average of 99,67 mg/dL basal triglycerides that following the ingestion of the olive oil increased in 32 at 1½ h, 74 at 3 h, 89 at 4½ h and 54 at 6 h average; in the second phase, average basal value was 100,92 mg/dL and after the olive oil and sacha inchi it increased in 15 at 1½ h, 52 at 3 h, 41 at 4½ h, and 43 at 6 h, these values were significantly lower at 1½ h (p=0,02) and 4½ h (p=0,0035). Following the consumption of sacha inchi the triglyceride tolerance test graphic showed statistical significance in the area under the curve in both phases (38,17%; p=0,0080). Conclusions: Plukenetia volubilis Linneo consumption decrease postprandial triglycerides in young adults.

Conocimientos y actitudes de médicos gíneco-obstetras de Lima y Callao, sobre los mecanismos de acción y prescripción de la anticoncepción oral de emergencia / Knowledge and attitudes of gynaecologists-obstetricians of Lima and Callao, towards action mechanismsand prescription of the emergency contraception pill

Objetivos: el presente estudio busca determinar el nivel de conocimientos y actitudes que tienen los médicos gíneco-obstetras que laboran en hospitales de Ministerio de Salud en Lima y Callao sobre la anticoncepción oral de emergencia (AOE). Material y Métodos: Se realizó un estudió transversal descriptivo de corte prospectivo en nueve hospitales del Ministerio de Salud de Lima y Callao en una muestra aleatoria representativa de 94 médicos gineco-obstetras. Se aplicó una encuesta estructurada basada en anteriores experiencias, previas validación de "expertos". Resultados: se observó que 100 por cientos de los médicos entrevistados había escuchado acerca de la AOE. El 18 por ciento conocía los tres mecanismos de acción descritos en la literatura, 82 por ciento refirió estar dispuesto a recetarla, mientras que 66 por ciento ya lo había recetado en alguna oportunidad y 83 por ciento la menciona, con diferente frecuencia, como parte de su consejería habitual sobre anticoncepción. El 13 por ciento considera que la píldora anticonceptiva de emergencia posee algún mecanismo abortivo y 20 por ciento no estaría dispuesto a utilizarla en su pareja ni en su persona. Conclusiones: Se observó que un porcentaje alto de los médicos gíneco-obstetras está sensibilizado con el tema, conocen su modo de uso, los principales efectos adversos y contraindicaciones pero es bajo su conocimiento sobre el mecanismo de acción. Nuevos estudios necesitan ser realizados en población general e intervenciones educativas para mejorar la calidad de los profesionales de salud.