[Determination of blood markers and inflammation in subjects with impaired glucose tolerance]. / Determinación de marcadores séricos de trombosis e inflamación en sujetos con intolerancia a la glucosa: evidencia de un estado protrombótico.

OBJECTIVE: This study was designed to explore the presence of a prothrombotic state, fibrinolytic dysfunction and inflammation in impaired glucose tolerance subjects, by evaluating serum markers of thrombosis, fibrinolysis and inflammation. METHODS: In 48 consecutive adults, 25 patients with impaired glucose tolerance (nine men and 16 women, 50.0 ± 9.2 years) were compared with 23 control subjects (six men and 17 women, 48.0 ± 11 years). The markers of thrombotic activation used were D-dimer and fibrinogen. Fibrinolysis dysfunction was evaluated with plasminogen activator inhibitor 1 (PAI-1) and the inflammatory marker studied was hs-C reactive protein (hs-CRP). RESULTS: The markers of thrombotic state were significantly higher in patients with impaired glucose tolerance (IGT) than in controls: D dimer (489.6 ± 277.3 vs. 345.8 ± 158.9 ng/mL) (p< 0.01) and fibrinogen (317.7 ± 32.1 vs. 266.7 ± 25.4 mg/dL) (p < 0.0001). Fibrinolytic marker PAI-1 also differed significantly between the two study groups (66.4 ± 30.7 vs. 35.5 ± 31.0 ng/mL) (p < 0.006). However, hs-CRP, as inflammation marker, (0.45 ± 0.62 mg/dL vs. 0.38 ± 0.47) did not differ significantly between the two study groups (<0.28). CONCLUSION: This result suggests the presence of a prothrombotic state with fibrinolytic dysfunction in subjects with impaired glucose tolerance.

Determinación de marcadores séricos de trombosis e inflamación en sujetos con intolerancia a la glucosa: evidencia de un estado protrombótico / Determination of blood markers and inflammation in subjects with impaired glucose tolerance

Objetivo: Este estudio fue diseñado para explorar la presencia de un estado protrombótico, disfunción fibrinolítica e inflamación en sujetos con intolerancia a la glucosa, mediante la evaluación de los marcadores séricos de trombosis, fibrinólisis e inflamación. Métodos: Se estudiaron 48 individuos consecutivos, 25 intolerantes a la glucosa: (nueve hombres y 16 mujeres, 50.0 ±9.2 años) y 23 sujetos control (seis hombres y 17 mujeres, 48.0 ±11 años). Se compararon entre ambos grupos los niveles de dímero-D y fibrinógeno como marcadores de trombosis, el PAI-1 como marcador de fibrinólisis y la proteína C reactiva ultrasensible (PCR-us) como marcador de inflamación. Resultados: En los sujetos intolerantes a la glucosa respecto al grupo control, se observaron diferencias significativas en los marcadores de trombosis: fibrinógeno 317.7 ± 32.1 vs. 266.7 ± 25.4 mg/dL (p<0.0001), dímero-D 489.6 ± 277.3 vs. 345.8 ± 158.9 ng/mL (p<0.01) y en el marcador de fibrinólisis PAI-1 66.4 ± 30.7 vs. 35.5 ± 31.0 ng/mL (p<0.006). En el marcador de inflamación, PCR-us no se observó diferencia significativa, respecto al grupo control 0.45 ± 0.6 vs. 0.38 ± 0.4 mg/dL (p<0.28). Conclusiones: Estos resultados sugieren la presencia de un estado protrombótico con disfunción del sistema fibrinolítico, en sujetos intolerantes a la glucosa.

Objective: This study was designed to explore the presence of a prothrombotic state, fibrinolytic dysfunction and infammation in impaired glucose tolerance subjects, by evaluating serum markers of thrombosis, fibrinolysis and infammation. Methods: In 48 consecutive adults, 25 patients with impaired glucose tolerance (nine men and 16 women, 50.0 ±9.2 years) were compared with 23 control subjects (six men and 17 women, 48.0 ±11 years). The markers of thrombotic activation used were D-dimer and fibrinogen. Fibrinolysis dysfuntion was evaluated with plasminogen activator inhibitor 1 (PAI-1) and the infammatory marker studied was hs-C reactive protein (hs-CRP). Results: The markers of thrombotic state were significantly higher in patients with impaired glucose tolerance (IGT) than in controls: D dimer (489.6 ± 277.3 vs. 345.8 ± 158.9 ng/mL) (p < 0.01) and fibrinogen (317.7 ±32.1 vs. 266.7 ±25.4 mg/dL) (p < 0.0001). Fibrinolytic marker PAI-1 also differed significantly between the two study groups (66.4 ± 30.7 vs. 35.5 ± 31.0 ng/ mL) (p < 0.006). However, hs-CRP, as infammation marker, (0.45 ± 0.62 mg/dL vs. 0.38 ± 0.47) did not differ significantly between the two study groups (<0.28). Conclusion: This result suggests the presence of a prothrombotic state with fibrinolytic dysfunction in subjects with impaired glucose tolerance.

Intoxicación con plomo: evaluación clínica y estudios complementarios en niños / Lead intoxication: clinic and diagnostic evaluation in children / Intoxicação por chumbo: avaliação clínica e estudos complementarios em crianças

La pobreza, la mala nutrición, la injusticia social y ambiental predominan en América Latina como factores que condicionan la acción de sustancias contaminantes sobre los niños. La intoxicación con plomo y la contaminación ambiental constituyen problemas de salud pública en todo el mundo, afectando múltiples sistemas del organismo, en especial los sistemas nervioso central (SNC), hematopoyético, renal, endocrino y óseo, entre otros, en las primeras etapas de la vida. Objetivo: evaluar los efectos clínicos, bioquímicos y vasculares en niños expuestos a fuente conocida de plomo. Materiales y métodos: se estudiaron siete niños con fuente definida de exposición a plomo y se realizó laboratorio general y específico para plomo. Se valoraron función endotelial y parámetros electrocardiográficos. Estadística descriptiva. Resultados: media de edad: 6,2 años (DE± 1,6), hematocrito promedio 31% (DE±0,02); hemoglobina promedio 10,2 gr/dl (DE± 0,78). La totalidad de las muestras, 100%, presentó anemia, hipocromía, microcitosis y anisocitosis marcadas. Plombemia promedio: 37,9 ug/dl (DE± 6,22), ALA-D promedio: 8,9 U/L (DE±4,5). No se encontraron modificaciones en el perfil lipídico ni en función renal. Todos presentaron microalbuminuria y disfunción endotelial. Conclusión: estos resultados evidencian los efectos que la exposición ambiental al plomo puede producir en niños no expuestos laboralmente.

Poverty, poor nutrition, environmental and social injustice prevailing in Latin America are factors that determine the action of pollutants on children. Lead poisoning and pollution constitute a public health problem throughout the world. Lead affects multiple organs: nervous system particularly, hematopoietic, renal, endocrine, bone and others. Objective: to assess clinical, biochemical and vascular effects in children exposed to known source of lead. Materials and methods: Seven children with defined source lead exposure were studied, general and specific lead laboratory were made. Endothelial function and electrocardiographic parameters were assessed. Statistic: descriptive. Results: Age average was 6,2 years (DE± 1, 6), average haematocrit 31% (DE±0,02); hemoglobin average 10,2 g/dl (DE± 0,78). 100% presented hypochromia, microcitosis, anemia and marked anisocytosis. Lead average: 37,9 ug/dl (DE±6,22), ALA-D average: 8,9 U/L (DE±4,5). No changes were found in lipid profile and kidney function. All presented microalbuminuria and endothelial dysfunction. Conclusion: These results show the effects of environmental lead exposure that can result in children not occupationally exposed.

A pobreza, a má nutrição, a injustiça social e ambiental predominam na América Latina como fatores que condicionam a ação de sustâncias contaminantes sobre as crianças. A intoxicação por chumbo e a contaminação ambiental constituem problemas de saúde pública no mundo todo, afetando múltiplos sistemas do organismo, em especial o sistema nervoso central (SNC), hematopoiético, renal, endócrino e ósseo, entre outros, nas primeiras etapas da vida. O objetivo deste trabalho foi avaliar os efeitos clínicos, bioquímicos e vasculares nas crianças expostas a fontes conhecidas de chumbo. Material e método: estudaram-se sete crianças com fonte definida de exposição ao chumbo e se realizou laboratório geral e específico para chumbo. Avaliaram-se a função endotelial e parâmetros electrocardiográficos. Estadística descritiva. Resultados: Média de idade: 6,2 anos (DE± 1,6), média de hematócrito 31% (DE±0,02); média de hemoglobina 10,2 gr/ dl (DE± 0,78). Da totalidade das amostras, 100%, apresentaram anemia, hipocromia, microcitose e anisocitose marcadas. Média de plumbemia: 37,9 ug/dl (DE± 6,22), média de ALA-D: 8,9 U/L (DE±4,5). Não se encontraram modificações no perfil lipídico nem em função renal. Todos apresentaram microalbuminúria e disfunção endotelial.

Presencia de síndrome metabólico en ratas inducido por distintas concentraciones de plomo / Presence of metabolic syndrome induced by different concentrations of lead in rats / Presença de síndrome metabólica em ratos induzidos por diferentes concentrações de chumbo

Introducción. El plomo (Pb) y otros agentes ambientales son capaces, por mecanismos bioquímicos, de producir alteraciones del perfil glucídico y lipídico, y generar hipertensión arterial, la cual se produce por lesión directa sobre el endotelio y/o indirecta, renal. Objetivos. Determinar la presencia de componentes bioquímicos, antropométricos y de presión arterial como elementos constitutivos del síndrome metabólico, en ratas tratadas con distintas concentraciones de plomo. Material y método. Se trabajó con ratas Wistar, tratadas con 25, 100, 250, 500 y 1000 ppm de acetato de plomo en el agua de bebida, en distintos tiempos según la concentración de Pb y controles libres del metal (n=6 cada grupo). Laboratorio toxicológico: ALA-D (ácido delta amino levulínico deshidratasa) y plomo en sangre. Se determinaron en plasma niveles de triglicéridos, colesterol, colesterol HDL, hemoglobina (Hb) glicosilada y glucosa. Se midieron presión arterial sistólica y peso. Resultados. Todas las ratas tratadas con las distintas concentraciones de Pb presentaron un aumento del peso. La glucemia, el colesterol total y los triglicéridos plasmáticos se elevaron en los grupos tratados con 25, 500 y 1000 ppm, no así en los controles, lo mismo ocurrió con la Hb glicosilada (p<0,03). Se observó un descenso del colesterol HDL. La presión arterial se elevó en todos los grupos con respecto al grupo control (p<0,03). A mayor concentración de plomo, todos los elementos constitutivos estudiados del síndrome metabólico sufren modificaciones de manera creciente. Conclusiones. El plomo, en distintas dosis, modifica el normal funcionamiento del metabolismo de los lípidos y sus respectivas concentraciones séricas; siendo uno de los factores no convencionales de enfermedad cardiovascular aterosclerótica, al inducir síndrome metabólico.

Background. Lead and other environmental agents can produce, by biochemical mechanisms, alterations in carbohydrate and lipid profile and generate high blood pressure, which is produced by direct injury in endothelium and/or indirect kidney damage. Objectives. To determine the presence of biochemical, anthropometric components and elevation of blood pressure as constituent elements of metabolic syndrome in rats treated with different concentrations of lead. Material and method. We worked with Wistar rats, treated with 25, 100, 250, 500, 1000 ppm of lead acetate in drinking water at different times depending on the concentration of lead and other group of metal-free water (control) (n=6 each group). Toxicological laboratory: ALA-D (Delta-aminolevulinic acid dehydratase) and lead in blood. Plasmatic determinations of triglycerides, total cholesterol, HDL cholesterol, glycosylated hemoglobin (Hb) and glucose were done. Systolic blood pressure and weight were measured. Results. All rats treated with different concentrations of lead presented an increase in weight. Glucose, total cholesterol, triglycerides were elevated in treated groups with 25, 500 and 1000 ppm, not so in controls, the same thing happened with glycosylated Hb (p<0.03). A decrease in HDL cholesterol was observed. Blood pressure was raised in all lead treatments groups and not in control group (p<0.03). In lead highest concentration, all the constituent elements of the studied metabolic syndrome suffer increasingly modifications. Conclusions. Lead in different doses modifies the normal functioning of lipids metabolism and their respective concentrations of serum; inducing metabolic syndrome, it would be one of unconventional, atherosclerotic cardiovascular disease risk factors.

Introdução. Chumbo e outros agentes ambientais são capazes de mecanismos bioquímicos de alterar seu perfil de glicose e lipídios, além de gerar pressão arterial elevada, que é causada por lesão direta ao endotélio e/ou danos indiretos, renal. Objetivos. Determinar a presença de componentes bioquímicos, antropométricas e de pressão arterial como elementos constituintes da síndrome metabólica em ratos tratados com diferentes concentrações de chumbo. Material e métodos. Nós trabalhamos com ratos Wistar tratados com 25, 100, 250, 500 e 1000 ppm de acetato de chumbo na água de beber em momentos diferentes, dependendo da concentração de chumbo e controles livre do metal (n=6 cada grupo). Laboratório de toxicologia: ALA-D (ácido delta amino levulínico deshidratasa) e chumbo no sangue.É determino a plasma níveis de triglicérides, colesterol, HDL-colesterol, hemoglobina glicosilada e glicose. Nós medimos a pressão arterial sistólica e peso. Resultados. Todos os ratos tratados com diferentes concentrações de chumbo mostraram um aumento no peso, plasmáticas de glicose, colesterol total e triglicérides foram elevadas nos grupos tratados com 25, 500 e 1000 ppm, mas não nos controles, assim como hemoglobina glicosilada (P<0,03). Houve um declínio nos níveis de colesterol HDL. A pressão arterial subiu em todos os grupos com o grupo controle (P<0,03). A maior concentração de chumbo, todos os elementos constituintes estudados da síndrome metabólica são mais elevados. Conclusões. Chumbo, em diferentes doses, altera o funcionamento normal do metabolismo de lipídios e suas concentrações séricas, sendo um da doença aterosclerótica não convencional cardiovascular, para induzir a síndrome metabólica.

Microalbuminuria en ratas tratadas con plomo en bajas concentraciones / Microalbuminuria in rats with low lead concentrations treatment

La función endotelial puede ser modificada por tóxicos ambientales como el plomo; la microalbuminuria es un marcador de disfunción endotelial y refleja alteración temprana y generalizada de la misma. La microalbuminuria, es un marcador de riesgo renal y un potente indicador de riesgo de morbimortalidad cardiovascular. Objetivo: Evaluar si el tratamiento con bajas concentraciones de plomo (0,5 ppm) produce microalbuminuria y si ésta sufre modificaciones con el tiempo de exposición al metal. Se trabajó con ratas blancas de la cepa Wistar, tratadas con 0,5 ppm de acetato de plomo en el agua de bebida. Los animales se separaron en tres grupos según el tiempo de tratamiento con el tóxico: 6, 9 y 12 meses; el cuarto grupo constituyó el control no tratado, con agua ad libitum. Laboratorio: Plombemia por absorción atómica, determinación de microalbuminuria por el método turbidimétrico (látex) de Biosystems. Resultados: Ratas controles promedio de microalbuminuria: 2,41± 0,79 mg/dl. Ratas tratadas durante 6 meses, 9 meses y 12 meses fue de 3,25 ± 1,05 mg/dl, 6,17 ± 1,24 mg/dl y 27,4 ± 15,78 mg/dl, respectivamente. Al comparar el grupo control con cada uno de los grupos tratados se observaron en todos los casos diferencias significativas, p<0,03 (Mann Whitney). Al comparar con el control, una diferencia mayor fue encontrada en el tratado durante 12 meses con p<0,01 (ANOVA). Dosis bajas de plomo producen microalbuminuria, la cual progresa en relación al tiempo de exposición al metal. Este trabajo fortalece la hipótesis del rol del plomo en la génesis de enfermedades cardiovasculares.

The endothelial function can be modified by environmental toxics as lead; microalbuminuria is a marker of endothelial disfunction and reflects early and generalized alteration of it. Microalbuminuria, is a marker of renal risk, and a powerful indicator of cardiovascular risk mortality. Objective: Evaluate if low level lead treatment (0.5 ppm) produces microalbuminuria and if it undergoes modifications with time of exposition. Wistar rats, with 0.5 ppm lead acetate in the drink water were included. The animals were separated in three groups according to the time of treatment in: 6, 9 and 12 months; the fourth group constituted of control with water ad libitum. Laboratory: Plombemia by atomic absorption, determination of microalbuminuria by turbidimetric method (latex) of Biosystems. Results: Rats controls average of microalbuminuria: 2.41± 0.79 mg/dl. Rats treated during 6 months, 9 months and 12 months:3.25 ± 1.05 mg/dl, 6.17± 1.24 mg/dl and 27.4 ± 15.78 mg/dl respectively. When comparing the group control with each one of the treated groups significant differences were observed in all the cases, p<0.03 (Mann Whitney), comparing with the control, a greater difference was found in the treated group during 12 months with p<0.01 (ANOVA). A low dose of lead exposition produces microalbuminuria, which progresses in relation to the time of metal exposition. This work fortified the hypothesis of lead role in cardiovascular diseases origin.

[Nocardia endocarditis in aortic and tricuspid native valves]. / Endocarditis infecciosa por nocardia en valvulas nativas aortica y tricuspide.

Nocardia endocarditis in native valve is an uncommon infection that usually arises in immunodepressed patients. We report a 51-year-old man diagnosed as having Nocardia endocarditis in aortic and tricuspid native valves, which received antimicrobial therapy and required aortic valve replacement. In 6 month follow up the patient remained asymptomatic with good clinical evolution.

Endocarditis infecciosa por nocardia en valvulas nativas aortica y tricuspide / Nocardia endocarditis in aortic and tricuspid native valves

La endocarditis infecciosa por Nocardia en válvula nativa es una infección excepcional, que afecta a pacientes inmunodeprimidos. Presentamos el caso de un varón de 51 años con diagnóstico de endocarditis infecciosa por Nocardia en válvulas nativas aórtica y tricúspide, que recibió terapia antimicrobiana específica y que requirió reemplazo valvular aórtico, con buena evolución clínica en el seguimiento a 6 meses.(AU)

Nocardia endocarditis in native valve is an uncommon infection that usually arises in immunodepressed patients. We report a 51-yearold man diagnosed as having Nocardia endocarditis in aortic and tricuspid native valves, which received antimicrobial therapy and required aortic valve replacement. In 6 month follow up the patient remained asymptomatic with good clinical evolution.(AU)

Endocarditis infecciosa por nocardia en valvulas nativas aortica y tricuspide / Nocardia endocarditis in aortic and tricuspid native valves

La endocarditis infecciosa por Nocardia en válvula nativa es una infección excepcional, que afecta a pacientes inmunodeprimidos. Presentamos el caso de un varón de 51 años con diagnóstico de endocarditis infecciosa por Nocardia en válvulas nativas aórtica y tricúspide, que recibió terapia antimicrobiana específica y que requirió reemplazo valvular aórtico, con buena evolución clínica en el seguimiento a 6 meses.

Nocardia endocarditis in native valve is an uncommon infection that usually arises in immunodepressed patients. We report a 51-yearold man diagnosed as having Nocardia endocarditis in aortic and tricuspid native valves, which received antimicrobial therapy and required aortic valve replacement. In 6 month follow up the patient remained asymptomatic with good clinical evolution.

Diagnostic role of new Doppler index in assessment of renal artery stenosis.

BACKGROUND: Renal artery stenosis (RAS) is one of the main causes of secondary systemic arterial hypertension. Several non-invasive diagnostic methods for RAS have been used in hypertensive patients, such as color Doppler ultrasound (US). The aim of this study was to assess the sensitivity and specificity of a new renal Doppler US direct-method parameter: the renal-renal ratio (RRR), and compare with the sensitivity and specificity of direct-method conventional parameters: renal peak systolic velocity (RPSV) and renal aortic ratio (RAR), for the diagnosis of severe RAS. METHODS: Our study group included 34 patients with severe arterial hypertension (21 males and 13 females), mean age 54 (+/- 8.92) years old consecutively evaluated by renal color Doppler ultrasound (US) for significant RAS diagnosis. All of them underwent digital subtraction arteriography (DSA). RAS was significant if a diameter reduction > 50% was found. The parameters measured were: RPSV, RAR and RRR. The RRR was defined as the ratio between RPSV at the proximal or mid segment of the renal artery and RPSV measured at the distal segment of the renal artery. The sensitivity and specificity cutoff for the new RRR was calculated and compared with the sensitivity and specificity of RPSV and RAR. RESULTS: The accuracy of the direct method parameters for significant RAS were: RPSV >200 cm/s with 97% sensitivity, 72% specificity, 81% positive predictive value and 95% negative predictive value; RAR >3 with 77% sensitivity, 90% specificity, 90% positive predictive value and 76% negative predictive value. The optimal sensitivity and specificity cutoff for the new RRR was >2.7 with 97% sensitivity (p < 0.004) and 96% specificity (p < 0.02), with 97% positive predictive value and 97% negative predictive value. CONCLUSION: The new RRR has improved specificity compared with the direct method conventional parameters (RPSV >200cm/s and RAR >3). Both RRR and RPSV show better sensitivity than RAR for the RAS diagnosis.

[The prothrombotic state in early stages of chronic chagas' disease]. / Estado protrombótico en estadios tempranos de la enfermedad de Chagas crónica.

OBJECTIVE: This study was designed to explore the presence of a prothrombotic state in the early stages of chronic Chagas' disease by evaluating serum markers of thrombosis and fibrinolysis. PATIENTS AND METHOD: Forty-two patients with chronic Chagas' disease (12 men and 30 women, 32.5 6.7 years) were compared with 21 healthy volunteers (10 men and 11 women, 24.2 5.6 years). The markers of thrombotic activation used were fragment 1 + 2, ATM complex, PDF/pdf, D-dimer, and beta-thromboglobulin. Fibrinolysis was evaluated before and after venous occlusion, together with euglobulin lysis time, t-PA, and PAI-1 titers. RESULTS: The markers of thrombotic state were significantly higher in patients with chronic Chagas' disease than in controls: F1 + 2 (p < 0.0001), ATM (p < 0.0001), PDF/pdf (p < 0.05), and D dimer (p < 0.05). There was no significant difference in beta-thromboglobulin (p = 0.06). Euglobulin lysis time, a global fibrinolytic marker, differed significantly (p < 0.0001) between patients with Chagas' disease and healthy volunteers. However, the more specific fibrinolytic markers t-PA and PAI-1 did not differ significantly between the two study groups. CONCLUSIONS: Although there were no significant differences in fibrinolytic markers between patients with chronic Chagas' disease and healthy volunteers, the significant increase in thrombosis markers (F1 + 2, ATM complex, PDF/pdf, and D dimer) suggests the presence of a prothrombotic state in the early stages of chronic Chagas' disease.

Estado protrombótico en estadios tempranos de la enfermedad de Chagas crónica / The prothrombotic state in early stages of chronic Chagas' disease

Introducción. Las complicaciones tromboembólicas son frecuentes en estadios avanzados del período crónico de la enfermedad de Chagas. Objetivo. Estudiar, con marcadores de trombosis (trombóticos y fibrinolíticos), si existe un estado protrombótico en los estadios tempranos de la enfermedad de Chagas crónica. Pacientes y método. Se estudió a 42 pacientes con enfermedad de Chagas crónica (12 varones y 30 mujeres) con una edad promedio de 32,5 ñ 6,7 años, comparándolos con 21 voluntarios sanos (10 varones y 11 mujeres) con una edad promedio de 24,2 ñ 5,6 años. Los marcadores de trombosis utilizados fueron: fragmento 1 + 2, complejo ATM, PDF/pdf, dímero D yBeta-tromboglobulina. Se evaluó la fibrinólisis pre y poscompresión con el tiempo de lisis de las euglobulinas, así como la dosificación de t-PA y PAI-1.Resultados. En los marcadores de trombosis se observaron diferencias estadísticamente significativas entre pacientes con enfermedad de Chagas crónica y controles en las variables F1 + 2 (p < 0,0001), ATM (p < 0,0001), PDF/pdf (p < 0,05) y dímero D (p < 0,05). La -tromboglobulina no alcanzó significación estadística (p = 0,06). En cuanto a las variables fibrinolíticas, la diferencia fue estadísticamente significativa en el tiempo de lisis de las euglobulinas (p < 0,0001), tanto en condiciones basales como después de provocar estrés con oclusión venosa. En cambio, los valores de t-PA y PAI-1 en condiciones similares no pusieron de manifiesto diferencias estadísticamente significativas entre los grupos estudiados. Conclusiones. En los resultados obtenidos se observa que no existe alteración de la fibrinólisis, pero el incremento significativo de los marcadores de trombosis (F1 + 2, complejo ATM, PDF/pdf y dímero D) sugeriría la existencia de un estado protrombótico en estadios tempranos de la enfermedad de Chagas crónica (AU)