Preeclampsia e Hipoxia

Relación de la expresión del factor inducido por hipoxia-2α (HIF-2α) y sVEGF-R1/sFlt-1: implicación en la fisiopatología de preeclampsia
 

J Ernesto Valdivia-Silva ^a, JC González-Altamirano ^b, K López-Molina ^a, JC Lazo-Velásquez ^a, E García-Zepeda ^c


a Grupo de Investigación en Inmunología. División de Biología Vascular. Departamento de Inmunología y Microbiología. Universidad Nacional San Agustín. Arequipa. Perú.
b Departamento de Cardiología y Cirugía Cardiovascular. Hospital Nacional del Sur CASE. EsSALUD. Arequipa. Perú.
c Laboratorio de Quimiocinas. Departamento de Inmunología. Universidad Nacional Autónoma de México. México D.F. México.

Abstract

Trophoblast invasion is critical for the establishment of uteroplacental circulation. At the early phases of this process, local oxygen pressure in the placenta is lower, which pathologically remains constant in preeclampsia. Consequently, understanding the response of placental cells to these stimuli is important. In the present study, we used primary cultures of trophoblast cells (TCs), fibroblasts from villous cells, and human umbilical endothelial cells isolated from preterm and term placentas (with and without preeclampsia) to explore the effect of oxygen pressure on the expression and synthesis of VEGF, sVEGFR-1/sFlt-1, and HIF-1α and-2α. Our results show that low oxygen pressure led to a significant selective increase in mRNA and the sVEGF-R1 receptor protein in TCs. VEGF expression and synthesis was elevated in three cell types, but free protein (not bound to sVEGF-R1) was decreased in TCs. Expression of HIF-1α or -2α mRNA in cells was similar in all the types of placentas, but the increase in HIF-2α protein was greater in the TCs of preeclamptic placentas. To evaluate the relationship between HIF-2α and the increase in the sVEGFR-1 receptor, we used siRNAHIF2α. In response to inhibition, expression of the sVEGF-R1 receptor diminished dramatically. HIF-2α blockade did not alter VEGF expression. Our data are the first to indicate that the HIF-2α transcription factor protein is one of the molecules involved in the selective expression of the sVEGF-R1 receptor in TCs during hypoxia.

Clínica e Investigación en Ginecología y Obstetricia 02/2008; 35(1). DOI: 10.1016/S0210-573X(08)73033-8

http://www.elsevier.es/ct-revista-clinica-e-investigacion-ginecologia-obstetricia-7-resumen-relationship-between-hypoxiainducible-factor-2-hif-2-13115127

Md. Julio Valdivia Silva PhD. Fundador del GII

Md. Juan Carlos Lazo Velásquez. Fundador del GII

Md. Keisy López Molina. Ex miembro del GII

 

 

 

Alteraciones Vasculares en Chagas

Estudio comparativo de alteraciones electrocardiográficas, frecuencia cardiaca y presión arterial entre seropositivos y seronegativos para Trypanosoma cruzi en el valle de Vítor, Arequipa-Perú 

Sánchez Sánchez Y.1, Velásquez Talavera Ra2, Bocangel Bravo C.3, Vásquez Huerta L.4, Córdova Benzaquen E.5, Delgado Díaz F.6, Ballón Echegaray J.7, Gonzáles Altamirano J.8, Rivas Oviedo L.9.

1. Médico Cirujano. UCSM. Arequipa, Perú.
2. Biólogo. UNSA. Arequipa, Perú.
3. Médico Cardiólogo. Profesor de la Facultad de Medicina,UNSA, Arequipa, Perú.
4. Médico Parasitólogo. Profesor de la Facultad de Medicina, UCSM, Arequipa, Perú.
5. Biólogo. Profesor de la Facultad de Medicina, UNSA, Arequipa, Perú.
6. Médico Patólogo Clínico. Director de Laboratorio de Referencia Regional. Dirección Regional de Salud de Arequipa, Perú.
7. Médico Cirujano. Docente de la Facultad de Medicina, UNSA, Arequipa, Perú
8. Médico Cardiólogo. Hospital Nacional Carlos Alberto Seguin Escobedo, EsSSALUD Arequipa, Perú.
9. Médico Cirujano. Centro de Salud de Vítor, Arequipa, Perú. 

Abstract

Introduction: the cardiac syndrome is the main cause of morbidty and mortality in Chagas disease, and its pathogenesis appears to be related to abnormalities of the autonomous nervous system which affect cardiovascular physiology.
Objectives: to compare the values of heart rate ,blood pressure and electrocardiographic (EKG) abnormalities of the infected population with those of the control population.
Materials and Methods: this is an analytic, observational, cross sectional study made in the valley of Vítor, Arequipa, from 2004 to 2005. Volunteers over 15 yearse of age ere studied: 25 T. cruzi seropositive an 50 T. cruzi seronegative persons. Examinations including heart rate, blood pressure and standard 12-lead EDGs were performed, comparing the results between the groups.
Results: heart rate and blood pressure values were similar between seropositive subjects and their controls; the same was true of sinus bradycardia, hypotension and hypertension. EKG abnormalities were found in 40% of seropositives and 26% of the controls; the difference didn’t reach statistical significance. The EKG abnormalities detected most often in the 2 groups were nonspecific repolarization changes, sinus bradycardia, left anterior bundle block, and supraventricular estrasystoles. Complete right bundle block and partial left anterior bundle block were seen in seropositive persons under 40.
Conclusions: the prevalence of cardiovascular abnormalities was similar between subjects infected with T. cruzi and their controls. The EKG abnormalities seen most frequently are different from those typically described in Chagas disease patients. Keywords: Chagas disease, EKG abnormalities.

Acta médi. peruana v.24 n.2 Lima mayo/agos. 2007

http://www.scielo.org.pe/scielo.php?pid=S1728-59172007000200002&script=sci_arttext 

Md. Jorge Ballón Echegaray MSc. Tutor del GII

 

 

Seroprevalencia-Chagas

Seroprevalencia de la infección por Trypanosoma cruzi y factores asociados en población adulta en una zona de alta endemicidad de Arequipa, Perú

 

Yván Sánchez Sánchez¹, Renato Velásquez Talavera², Luis Vásquez Huerta³, Eleazar Córdova Benzaquen⁴, Freddy Delgado Díaz⁵, Jorge Ballón Echegaray⁶, César Bocangel Bravo⁶, Jenny Ancca Juarez⁷, Luis Rivas Oviedo⁸, Juan Zevallos García¹
 
1. Médico Cirujano. Universidad Católica de Santa María. Arequipa 
2. Biólogo. Universidad Nacional de San Agustín. Arequipa. 
3. Médico Parasitólogo. Docente de la Facultad de Medicina Humana. Universidad Católica de Santa María. Arequipa. 
4. Biólogo. Docente de la Facultad de Medicina. Universidad Nacional de San Agustín. Arequipa. 
5. Médico Patólogo Clínico. Laboratorios de Referencia Regional. Dirección Regi onal de Salud de Arequipa. 
6. Médico Cirujano. Docente de la Facultad de Medicina. Universidad Nacional de San Agustín. Arequipa 
7. Bióloga. Laboratorios de Referencia Regional. Dirección Regional de Salud de Arequipa. 
8. Médico Cirujano. Centro de Salud de Vítor. Arequipa.

ABSTRACT

Objective: determine the seroprevalence of infection by T. cruzi in the population above age 15 in the valley of Vítor, describing general characteristics and the presence of associated factors. 
Materials and Methods: 499 people above age 15 were randomly selected; epidemiological information was obtained through a survey. The diagnosis of the disease was made by ELISA and IIF. Results: the seroprevalence for Chagas reactivity was 10,2%, 10,35% in women and 10,0% in men. The median of age of the “typical” Chagas disease patient was 42±17,9, his/her time of residence in Vítor was 34±15,9 years; 51,0% had been born in the valley of Vítor. Agricultural workers made up 41,2%, of the general population, and 51,0% have a high school education. Rustic housing materials were associated with the infection. 
Conclusions: the valley of Vítor is an endemic area for Chagas disease. The infection equally affects men and women. The “typical” infected patient is native to the valley of Vítor, works in agriculture and has secondary level education. Rustic building materials is associated to the infection by T.cruzi because it favors the presence of the vector.

Key words: Chagas, seroprevalence, adults

Acta méd. peruana v.24 n.1 Lima ene./abr. 2007

http://www.scielo.org.pe/scielo.php?pid=S1728-59172007000100006&script=sci_arttext

Md. Jorge Ballón Echegaray MSc. Tutor del GII

Asma Bronquial

Evaluation of severity of bronchial asthma through an exercise bronchial challenge.

Lazo-Velásquez JC1, Lozada AR, Cruz HM.

¹Primary Care Service, Ministry of Health, Arequipa, Peru. jucar105@hotmail.com

Abstract

Optimum treatment of bronchial asthma requires accurate diagnosis and severity classification. We studied the use of an exercise bronchial challenge in the asthmatic patient as a diagnostic tool. An exercise bronchial challenge test was carried out in 431 asthmatic children and 114 children without a history of asthma in a moderate-altitude environment (2,230 m above sea level/7,314 feet above sea level). Values of peak expiratory flow (baseline and maximum fall) were analyzed through time in each asthma severity group (intermittent, mild persistent, moderate persistent, severe persistent, and nonasthmatic controls). There was a significant difference among responses of asthma severity groups for almost all variables. No difference was found between nonasthmatic and intermittent groups who had similar behavior, except in bronchodilator response. An exercise bronchial challenge helps classify a patient according to asthma severity; it is easy to reproduce and does not require expensive equipment. It allows diagnosing and classifying asthma severity easily and supplementing the clinical evaluation. Based on our results, we propose a fall of PEF >or= 11% as new cutoff point for making a diagnosis of persistent bronchial asthma. A fall of 11-25% indicates mild persistent asthma; from 25-50%, moderate persistent asthma; and a bigger fall, severe persistent asthma.

Pediatr Pulmonol. 2005 Nov;40(5):457-63.

http://onlinelibrary.wiley.com/doi/10.1002/ppul.20275/abstract

Md. Juan Carlos Lazo Velásquez. Fundador del GII

Staphylococcus MRSA

Susceptibilidad antimicrobiana de Staphylococcus aureus sensible, con sensibilidad "BORDERLINE" y resistentes a la meticilina

Mendoza Ticona, Carlos Alberto *; Velasquez Talavera, Renato **; Mercado Diaz, Ludwig **; Ballon Echegaray, Jorge **;  Maguiña Vargas, Ciro ***.

* Médico Residente de Enfermedades Infecciosas y Tropicales de la Universidad Peruana Cayetano Heredia.
** Laboratorio de Análisis Clínicos de la Facultad de Medicina de la Universidad Nacional de San Agustín de Arequipa.
***Instituto de Medicina Tropical Alexander Von Humboltd. Profesor Principal, Dpto. de Medicina. Facultad de Medicina. Universidad Peruana Cayetano Heredia

SUMMARY

Objective: To determine the susceptibility to different antibacterials of three categories of S. aureus according to its susceptibility to methicillin. Methods: 76 S. aureus strains that colonized patients and health workers were isolated from three Departments at Hospital Honorio Delgado in Arequipa, 36 of which were susceptible to methicillin (MSSA), 15 had borderline susceptibility (BORSA) and 25 where resistant to methicillin (MRSA). They underwent antibiogram for 14 antibacterials. Results: The only antibiotic to which all isolates were susceptible was vancomycin. MRSA were resistant to all betalactamics except imipenem that obtained 64% susceptibility. BORSA keep an 80% susceptibility to cephalotin and 100% to imipenem. The antibiotics cephalotin, imipenem, ciprofloxacine, cotrimoxazole, rifampicine, erithromycin, tetracycline, cloramphenicol, lincomycin and gentamycin had variable susceptibilities (p<0.01) among the three categories, a bigger proportion of MSSA were susceptible to these antibiotics, less for BORSA and lesser for MSSA. The multiresistant strains were more frequent in MRSA that in the other groups (p < 0.01). Conclusions: There are S. aureus strains in our environment with borderline susceptibility to methicillin. There are differences in the susceptibility to any antibacterials among the three groups of S. aureus; this differences can lead to a more rational antibacterial therapy. We should apply international recommendations for methicillin resistance detection in every strain isolation. (Rev. Med. Hered. 2003; 14: 181-185).

KEY WORDS : Staphylococcus aureus, methicillin resistance, borderline susceptibility, antibacterial susceptibility.

Rev Med Hered v.14 n.4 Lima oct. 2003

http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1018-130X2003000400006&lang=pt

Md. Jorge Ballón Echegaray MSc. Tutor del GII

Staphylococcus MRSA

Staphylococcus aureus (MRSA): Colonización y susceptibilidad en pacientes y personal de salud de un hospital de referencia
 

Dres. Carlos Mendoza Ticona (*), Jorge Ballón Echegaray (**),
Juan José De Los Ríos Alvarez (***) y Blgo. Renato Velásquez Talavera (*)

(*) Laboratorio de Análisis Clínicos. Universidad Nacional de San Agustín de Arequipa. Perú.
(**) Cátedra de Microbiología e Inmunología Universidad Nacional de San Agustín de Arequipa. Perú
(***) Infectólogo-Pediatra. Hospital Regional Honorio Delgado de Arequipa. Cátedra de Pediatría Universidad Católica de Santa María. Perú

Abstract

From 66 patients and 45 members of the health staff (HS) of the services of burnt, neonatology and pediatrics of the Hospital Regional Honorio Delgado of Arequipa, 56 strains of S. aureus were isolated, 30 of patients and 26 of the HS. The methicillin resistance was determined and its susceptibility was compared to 7 B-lactam and 9 not B-lactam antibiotics. 66,7% of isolated S. aureus of patient and 34,6% of the HS was MRSA (p<0,05). 100% of burnt patients' isolated S. aureus was methicillin resistant, 60% from neonates and 40% from pediatric patients. In the HS the frequency of MRSA was similar for the three services. 100% of MRSA was resistant to penicillin, ampicillin, oxacillin and methicillin and 100% was sensitive to vancomycin. In the other rehearsed antimicrobial agents the MRSA of the patients was less susceptible than those of the HS (amoxycillin-clavulanic acid 25% and 78%, cephalothin 20% and 78%, imipenem 70% and 100% , ciprofloxacin 35% and 78%, rifampin 45% and 78%, trimethoprim-sulfamethoxazole 50% and 67%, erythromycin 40% and 89%, tetracycline 35% and 89%, chloramphenycol 35% and 89%, lincomycin 5% and 67% and gentamicin 0% and 33%). We conclud that the MRSA colonizes the patients preferably and these have smaller susceptibility than the isolated MRSA of the HS. The vancomycin conserves its sensibility. Alternative antimicrobial agents don't possess high sensibilities in MRSA of patients.

Key words: Staphylococcus aureus, methicillin-resistance, MRSA, intrahospital infection, oxacillin, vancomycin.

Diagnóstico. Mayo 2001; 40(3). 

http://www.fihu-diagnostico.org.pe/revista/numeros/2001/mayjun01/149-156.html 

Md. Jorge Ballón Echegaray MSc. Tutor del GII