Caso autóctono de rickettsiosis por Rickettsia parkeri en la Selva Paranaense, Misiones, Argentina / Autochthonous Rickettsia parkeri rickettsiosis in the Paranaense Forest, Misiones, Argentina

Resumen Se informa un caso autóctono de rickettsiosis por Rickettsia parkeri, ocurrido en junio del 2018 en la zona selvática del Parque Provincial Urugua-í, Misiones, Argentina, región sin registros previos de esta enfermedad en humanos. Se describen los aspectos epidemiológicos, ecológicos, clínicos y de laboratorio necesarios para el diagnóstico oportuno y el tratamiento adecuado. Se resalta el hecho de considerar a las rickettsiosis como diagnóstico diferencial ante un paciente con síndrome febril agudo exantemático; el antecedente epidemiológico de exposición al vector característico de la región, garrapatas del género Amblyomma, es un elemento fundamental.

Abstract We report an autochthonous case of Rickettsia parkeri rickettsiosis occurred in June 2018 in a forested area of the Urugua-í Provincial Park, Misiones, Argentina. No previous records of this disease in humans have been previously reported in this region. The epidemiological, ecological, clinical, and laboratory features required for a proper diagnosis and adequate treatment are described here. The fact of considering rickettsiosis as a differential diagnosis in a patient with exanthematic acute febrile syndrome is highlighted, being the epidemiological history of exposure to the vector (ticks of the genus Amblyomma) an essential element.

[Autochthonous Rickettsia parkeri rickettsiosis in the Paranaense Forest, Misiones, Argentina]. / Caso autóctono de rickettsiosis por Rickettsia parkeri en la Selva Paranaense, Misiones, Argentina.

We report an autochthonous case of Rickettsia parkeri rickettsiosis occurred in June 2018 in a forested area of the Urugua-í Provincial Park, Misiones, Argentina. No previous records of this disease in humans have been previously reported in this region. The epidemiological, ecological, clinical, and laboratory features required for a proper diagnosis and adequate treatment are described here. The fact of considering rickettsiosis as a differential diagnosis in a patient with exanthematic acute febrile syndrome is highlighted, being the epidemiological history of exposure to the vector (ticks of the genus Amblyomma) an essential element.

First molecular epidemiological study of hepatitis B and D in individuals infected with human T-lymphotropic virus 1/2 from Argentina.

Human T-lymphotropic virus 1/2 (HTLV-1/2), hepatitis B virus (HBV), and hepatitis D virus (HDV) share transmission routes. Argentina shows low prevalence of HTLV-1/2, HBV, and HDV infections; however, this situation may vary according to the geographic region and group studied. The aim of this study was to estimate the prevalence of HBV and HDV infections and detect both viral genotypes in HTLV-1/2 individuals from Argentina. A total of 202 HTLV-1/2 confirmed samples (blood donors [BD] and individuals with risk factors for HTLV-1/2 [RF]) were tested for HBsAg and total anti-HBc by enzyme-linked immunosorbent assay. All reactive samples for some HBV markers were analyzed for HBV DNA characterization and HDV serological and molecular analysis. Total prevalence was 1.5% for HBsAg and 6.4% for anti-HBc. Prevalence was 23.1% for anti-HDV in all HBV-reactive samples. No significant difference was observed for HBV and HDV prevalence within HTLV subtypes. The population study showed that prevalence of anti-HBc was higher in the RF than in the BD population, with no significant differences between them. The HBsAg marker and anti-HDV were only found in RF, showing significant differences when compared to BD. Regarding molecular detection, one sample amplified for HBV DNA and none for HDV RNA. HBV sequence was classified as subgenotype F1b. New and updated background on serological markers of HBV and HDV infection in patients with HTLV-1/2 was provided.

Caracterización de factores de riesgo cardiovascular en adultos de una zona suburbana de Posadas-Misiones / Characterization of cardiovascular risk factors in adults of a sub-urban area of the city of Posadas-Misiones / Caracterização de fatores de risco cardiovasculares em adultos de uma zona suburbana de Posadas-Misiones

Las enfermedades cardiovasculares son una importante causa de morbimortalidad. Se propuso determinar la frecuencia de los principales factores de riesgo cardiovascular en individuos adultos que asistieron a un centro de atención primaria de una zona suburbana de la ciudad de Posadas-Misiones. Se evaluaron 300 individuos; 203 mujeres y 97 varones, entre 20 y 75 años. Se registraron datos personales, antropométricos y se extrajo sangre con 12 horas de ayuno para las determinaciones bioquímicas. El diagnóstico de síndrome metabólico se basó en los criterios del ATP III. La frecuencia de factores de riesgo fue: hipertensión 21,3%, prehipertensión 36,7%, síndrome metabólico 35,0%, glucemia alterada en ayunas 28,0%, tabaquismo 23,0%, exceso de peso 68,6%, obesidad abdominal 65,0%, índice de filtración glomerular disminuido 12,0%, antecedentes familiares de enfermedad cardiovascular 33,7% e hipercolesterolemia 22,0%. Según nivel de instrucción, los individuos con bajo nivel educativo presentaron mayor frecuencia de factores de riesgo respecto a los individuos con nivel medio y alto. Los resultados de este estudio alertan sobre la necesidad de la búsqueda activa de factores de riesgo para la enfermedad cardiovascular en toda la población.

Cardiovascular diseases are an important cause of morbidity and mortality. The aim of this study was to determine the frequency of the main cardiovascular risk factors in adult individuals who attend a primary care center in a sub-urban area of the city of Posadas-Misiones. The population was composed of 300 individuals: 203 women and 97 men, age range between 20 and 75 years. Personal, anthropometric data were recorded and blood was extracted with 12 hours of fasting for biochemical determinations. The diagnosis of metabolic syndrome was based on ATP III criteria. The frequency of risk factors was: hypertension 21.3%, pre-hypertension 36.7%, metabolic syndrome 35%, altered fasting glycemia 28%, smoking 23%, over weight 68.6%, abdominal obesity 65%, decreased glomerular filtration rate 12%, family history of cardiovascular disease 33.7% and hypercholesterolemia 22%. According to the level of education, a low educational level had a higher cardiovascular risk factor frequency than medium and high-level. The results of this study warn about the need for an active search for risk factors for cardiovascular disease in the entire population.

As doenças cardiovasculares são uma causa importante não só de morbimortalidade. O objetivo foi determinar a frequência dos principais fatores de risco cardiovascular em indivíduos adultos que frequentaram um centro de atenção primária em uma área suburbana da cidade de Posadas-Misiones. 300 indivíduos foram avaliados; 203 mulheres e 97 homens, entre 20 e 75 anos de idade. Dados pessoais, antropométricos foram registrados e foi extraído sangue com 12 horas de jejum para determinações bioquímicas. O diagnóstico de síndrome metabólica foi baseado nos critérios do ATP III. A frequência dos fatores de risco foi: hipertensão 21,3%, pré-hipertensão 36,7%, síndrome metabólica 35,0%, glicemia alterada em jejum 28,0%, tabagismo 23,0%, excesso de peso 68,6%, obesidade abdominal 65,0%, taxa de filtração glomerular diminuída 12,0%, histórico familiar de doença cardiovascular 33,7% e hipercolesterolemia 22,0%. De acordo com o nível de escolaridade, indivíduos com baixo nível educacional apresentaram maior frequência dos factores de risco quando comparados com indivíduos de nível médio e alto. Os resultados deste estudo alertam para a necessidade de busca ativa de fatores de risco para a doença cardiovascular em toda a população.

Health care importance of Treponema pallidum, Chagas' disease and Human immunodeficiency virus 1 among Amerindians of Argentina: an observational study / Importancia en el sistema de salud de la infección por Treponema pallidum, la enfermedad de Chagas y el virus de la inmunodeficiencia humana 1 en amerindios de Argentina: un estudio observacional

The objective of this study was to estimate the prevalence of Treponema pallidum, Trypanosoma cruzi and Human immunodeficiency virus 1 (HIV-1) in five Amerindian populations of Argentina. A retrospective study was conducted among 857 Amerindian populations (112 Kollas, 298 Mbyá-guaraníes, 79 Sagua Huarpes, 368 Wichis) from 2007 to 2010. Screening and confirmation of T. pallidum, T. cruzi and HIV-1 were performed. T. pallidum and T. cruzi infections were detected in all communities with an overall prevalence rate of 4.2% and 16.8%, respectively. Although HIV was not detected, syphilis and Chagas' disease represent a challenge for the health care system and the reinforcement of public health strategies is necessary considering the socioeconomic isolation of these populations.

El objetivo de este trabajo fue estimar la prevalencia de Treponema pallidum, Trypanosoma cruzi y virus de la inmunodeficiencia humana (HIV-1) en 5 comunidades originarias de Argentina. Para ello, se realizó un estudio retrospectivo en 857 individuos (112 kollas, 298 mbyá-guaraníes, 79 sagua huarpes, 368 wichis) desde el 2007 hasta el 2010. Se realizó el diagnóstico completo para T. pallidum, T. cruzi y HIV-1. En todas las comunidades se confirmaron infecciones por T. pallidum y T. cruzi con una prevalencia total del 4,2 y del 16,8%, respectivamente. Aunque no se detectó HIV-1, sífilis y Chagas, representan un desafío para el sistema de salud, teniendo que reforzarse las estrategias de salud pública teniendo en cuenta el aislamiento socio-económico que sufren estas poblaciones.

Health care importance of Treponema pallidum, Chagas' disease and Human immunodeficiency virus 1 among Amerindians of Argentina: an observational study.

The objective of this study was to estimate the prevalence of Treponema pallidum, Trypanosoma cruzi and Human immunodeficiency virus 1 (HIV-1) in five Amerindian populations of Argentina. A retrospective study was conducted among 857 Amerindian populations (112 Kollas, 298 Mbyá-guaraníes, 79 Sagua Huarpes, 368 Wichis) from 2007 to 2010. Screening and confirmation of T. pallidum, T. cruzi and HIV-1 were performed. T. pallidum and T. cruzi infections were detected in all communities with an overall prevalence rate of 4.2% and 16.8%, respectively. Although HIV was not detected, syphilis and Chagas' disease represent a challenge for the health care system and the reinforcement of public health strategies is necessary considering the socioeconomic isolation of these populations.

Adiponectin and waist circumference as predictors of insulin-resistance in women.

BACKGROUND AND AIMS: The initial disturbance of insulin resistance seems to focus on adipose tissue is a dynamic organ involved in many physiological and metabolic processes. Expresses and secretes a variety of active peptides, adipocytokines. To evaluate the prevalence of insulin-resistance in an healthy urban middle age population and to explore the role of adiponectin, inflammatory biomarkers (hs-CRP) and traditional cardiovascular risk factors as predictors of the insulin-resistance state. MATERIALS AND METHODS: We studied of 176 participants (117 women and 59 men, 25-74 years), individuals with diabetes, hypothyroidism or hyperthyroidism, infectious disease, renal, or hepatic neoplasms and pregnant women were excluded. We evaluated glucose, insulin, adiponectin and hs-CRP. RESULTS: We found that 17.2% of individuals presented insulin-resistance. Correlation was found between waist circumference, body mass index, blood pressure and HOMA index (p<0.01). Adiponectin was associated with the insulin-resistance (p<0.001) but not hs-CRP. Adiponectin (ß=0.385, p=0.004) and waist circumference (ß=0.116, p=0.02) were predictors of IR only in women, meanwhile none of the analyzed biomarkers predicted insulin-resistance in men. Besides, postmenopausal women presented higher adiponectin levels than premenopausal 7.63 (4.46-9.58) vs 5.50 (3.83-7.40) µg/ml, p=0.01. CONCLUSIONS: Adiponectin and waist circumference are important predictors of insulin-resistance even in healthy non-diabetic women, they may open a new opportunity to improve current risk estimation.

Hepatitis B virus and hepatitis D virus in blood donors from Argentina: circulation of HBsAg and reverse transcriptase mutants.

In Argentina, current procedures to ensure the safety of the blood supply for transfusion include the serologic detection of specific blood-borne infections. The aim of this study was to evaluate the prevalence and the genetic diversity of hepatitis B virus (HBV) and hepatitis D virus (HDV) in blood donor populations from two distantly located Argentine regions. Data from 56,983 blood donations from the Favaloro Foundation, in the city of Buenos Aires (Central Region), and the Central Blood Bank of Misiones Province (Northeast Region) were analyzed. Samples that were reactive for HBsAg were analyzed for HBV-DNA characterization and HDV serological and molecular analysis. The HBV prevalence was 0.12 % for HBsAg and 1.68 % for anti-HBc antibodies in Buenos Aires, and 0.73 % and 8.55 %, respectively, in Misiones. Seventy-seven HBsAg-reactive samples were analyzed by polymerase chain reaction for HBV-DNA. Subgenotypes A2, B2, C2, F1b and F4 (Buenos Aires) and F1b and D3 (Misiones) were detected. Several mutations within the major hydrophilic region of HBsAg, the reverse transcriptase, the basal core promoter, and the precore/core were detected. HDV genotype 1 was identified in Buenos Aires. This study confirms the circulation of several HBV subgenotypes, as well as known and newly identified variants, and the presence of HDV1 in this population. A thorough investigation has to be carried out to evaluate the clinical importance of some of the documented mutations as well as those detected in the HDV1 case.

Análisis de las características clínicas y anatomopatológicas asociadas al HER-2/neu en cáncer de mama primariamente operable con técnica de inmunohistoquímica en una población hospitalaria / Analysis of the association between clinical and pathological features of breast cancer and HER-2/neu operable primarily, evaluated by inmunohitochemistry in a hospital population

Objetivo: describir la asociación entre las características clínicas y anatomopatológicas del cáncer de mama primariamente operable y el HER-2/neu evaluado por inmunohistoquímica. Materiales y métodos: estudio descriptivo. Se evaluó la edad, tamaño tumoral, grado histológico, ganglios axilares, RE, RP y el estado del HER-2/neu en pacientes con diagnóstico de carcinoma invasivo primariamente operables del Servicio de Ginecología del Hospital Ramón Madariaga de Posadas, Misiones, comprendido entre enero de 2007 y 30 de agosto del 2012. Con un total de 95 pacientes, se comparó características clínicas y anatomopatológicas de los tumores con relación al estado del HER-2. Resultados: los receptores hormonales negativos fueron más frecuentemente HER-2/neu positivos, tanto para los RE (75,00% vs. 23,25%) como para RP (73,07% vs. 25,58%). En el análisis multivariado, el RE se asoció como predicción en forma independiente del HER-2/neu. Conclusiones: en el análisis multivariado el estado del receptor de estrógeno resultó predicción independiente de la sobreexpresión del HER-2/neu, no así el receptor de progesterona, el tamaño tumoral, los ganglios linfáticos y la edad. En el aná- lisis univariado RE y RP se asociaron negativamente a la sobreexpresión del HER-2/neu.(AU)

Análisis de las características clínicas y anatomopatológicas asociadas al HER-2/neu en cáncer de mama primariamente operable con técnica de inmunohistoquímica en una población hospitalaria / Analysis of the association between clinical and pathological features of breast cancer and HER-2/neu operable primarily, evaluated by inmunohitochemistry in a hospital population

Objetivo: describir la asociación entre las características clínicas y anatomopatológicas del cáncer de mama primariamente operable y el HER-2/neu evaluado por inmunohistoquímica. Materiales y métodos: estudio descriptivo. Se evaluó la edad, tamaño tumoral, grado histológico, ganglios axilares, RE, RP y el estado del HER-2/neu en pacientes con diagnóstico de carcinoma invasivo primariamente operables del Servicio de Ginecología del Hospital Ramón Madariaga de Posadas, Misiones, comprendido entre enero de 2007 y 30 de agosto del 2012. Con un total de 95 pacientes, se comparó características clínicas y anatomopatológicas de los tumores con relación al estado del HER-2. Resultados: los receptores hormonales negativos fueron más frecuentemente HER-2/neu positivos, tanto para los RE (75,00% vs. 23,25%) como para RP (73,07% vs. 25,58%). En el análisis multivariado, el RE se asoció como predicción en forma independiente del HER-2/neu. Conclusiones: en el análisis multivariado el estado del receptor de estrógeno resultó predicción independiente de la sobreexpresión del HER-2/neu, no así el receptor de progesterona, el tamaño tumoral, los ganglios linfáticos y la edad. En el aná- lisis univariado RE y RP se asociaron negativamente a la sobreexpresión del HER-2/neu.

HDAg-L variants in covert hepatitis D and HBV occult infection among Amerindians of Argentina: new insights.

BACKGROUND: Guidelines suggest that all HBsAg-positive patients should be tested for anti-HDV IgG antibodies and to confirm active hepatitis D virus (HDV) infection by detection of HDV RNA by reverse transcriptase (RT) polymerase chain reaction (PCR). OBJECTIVES: The aim of this study was to determine the serological prevalence and molecular features of HDV within an Amerindian community from Argentina exhibiting positivity for HBsAg and/or anti-HBc total Ig. STUDY DESIGN: Forty-six plasma samples were tested for the detection of total anti-HDV antibodies by ELISA. Concomitantly, a partial RNA region coding for the delta antigen (HDAg) was amplified by RT-nested PCR (RT-nPCR). In silica translation of DNA sequences into the amino acid (aa) sequence of HDAg-S (aa110-195) and HDAg-L (aa110-214) was performed. RESULTS: Out of 46 HDV non-reactive samples by ELISA, 3 were HDV RNA positive by RT-nPCR. These samples were anti-HBc-only positive, 2 of them identified as cases of occult hepatitis B infection (OBI). The 3 cases were HBeAg-negative and showed normal ALT/AST levels. All sequences were ascribed to HDV genotype 1, but exhibited nucleotide differences in HDAg-L coding region, among which, mutations at codons 197 and 201 - reportedly known to promote in vitro an unsuitable interaction with HBsAg - were observed. CONCLUSIONS: These results provide evidence of covert HDV infection even among OBI, highlighting the need to reevaluate the currently applied guidelines for HDV diagnostic algorithms, as well as to explore if the observed mutations promote any effect on HDV pathogenesis.

New natural variants of hepatitis B virus among Amerindians from Argentina with mainly occult infections.

BACKGROUND: Hepatitis B virus infection is frequent among Amerindians. In Argentina HBV genotypes A, B, C, D, E, F and H were described in different populations, while some cases of occult hepatitis B infection (OBI) were reported in human immunodeficiency virus (HIV) coinfected patients. OBJECTIVE: To determine the prevalence, genetic diversity of HBV and to analyze the deduced amino acid sequence of both S and viral polymerase (P) genes among Amerindians of Argentina. STUDY DESIGN: A cross-sectional study including 561 individuals belonging to distinct ethnic groups, the Mbyá-guaraní (MG), the Kolla (K), the Sagua-Huarpe (SH) and the Wichi (W) was performed. RESULTS: The prevalence of HBsAg was 1.7% and 1.4% for the MG and SH, respectively, while anti-HBc was detected in all communities. HBV DNA of S/P and preCore-Core genomic regions were amplified by nested polymerase chain reaction in 59 reactive samples for anti-HBc total Ig and/or HBsAg. Of them, thirteen exhibited detectable HBV DNA, eleven of which were identified as OBI. Genotype F was predominant in the MG community with co-circulation of subgenotypes F4, F1b, A2 and D3, while subgenotype C2 prevailed within the SH community. All cases exhibited the polymorphism rtL217R within the RT domain associated to resistance to adefovir. Mutations rtD206E and rtV207I associated with lamivudine resistance were found in two MG and three SH respectively. Other new substitutions were described within the P sequence. CONCLUSIONS: This study shows for the first time the predominance of OBI, HBV subgenotypes and natural variants in Amerindians from Argentina.

Perfil lipídico y ácido úrico en embarazadas hipertensas del Hospital Madariaga, Posadas, Misiones / Lipid profile and uric acid in hypertensive pregnant women in Madariaga Hospital, Posadas, Misiones

Se evaluaron el perfil lipídico y el ácido úrico en embarazadas hipertensas que cursaban el tercer trimestre de gestación y que fueron atendidas de forma secuencial en el Servicio de Obstetricia del Hospital Madariaga (Posadas, Misiones), entre febrero y junio de 2009. Se estudiaron 31 embarazadas hipertensas y 58 embarazadas normotensas, ambos grupos con edades comprendidas entre 20-35 años e Índice de Masa Corporal entre 18,5 - 29,9 kg/m² antes de la gestación. Se registraron datos personales, ginecobstétricos y familiares. Se extrajo sangre venosa con 12 horas de ayuno para las determinaciones bioquímicas, las cuales fueron realizadas por métodos enzimáticos colorimétricos, con controles de calidad interno y externo. Las embarazadas hipertensas versus normotensas presentaron: triglicéridos (261±238 vs 196,8±90,6 mg/dL, p=0,01), col-VLDL (49,07±23,75 vs 39,52±16,19 mg/dL, p=0,04), triglicéridos/col-HDL (5,45±4,1 vs 3,57±1,77, p=0,031), ácido úrico (40,57±10,49 vs 55,64±20,26 mg/L, p<0,001), no encontrándose diferencias significativas para colesterol total, col- HDL, col no HDL, col-LDL y col Total/Col-HDL. Por análisis multivariado, el ácido úrico, el col-VLDL y los antecedentes familiares de hipertensión (AFHTA), explican el 40% de la variación de la presión arterial sistólica. Se considera conveniente sugerir la inclusión del perfil lipídico y ácido úrico en la evaluación bioquímica de las gestantes hipertensas, determinaciones accesibles a laboratorios de baja complejidad y que contribuirían a la evaluación del daño endotelial transitorio producido por la hipertensión arterial.

The lipid profile and uric acid were evaluated in pregnant women who suffer high blood pressure in the first three-month period of pregnancy, treated sequentially in the Obstetric Service of Madariaga Hospital form February to June, 2009. Thirty-one hypertense pregnant women and fifty-eight pregnant women with normal blood pressure were studied. Both groups were between 20 and 35 years old and their body mass index was between 18.5-29.9 kg/m² before pregnancy. Personal, gynecological-obstetric and family data were recorded. Venous blood was extrated after 12 hours of fasting for biochemical determinations, which were analyzed through enzymatic colorimetric methods with internal and external quality controls. Hypertensive pregnant women versus pregnant women with normal blood pressure presented triglycerides (261±238 vs 196.8±90.6, p=0.01), VLDL-Chol (49.07± 23.75 vs 39.52± 16.19, p=0.04), triglycerides/HDL-Chol (5.45±4.1 vs 3.57±1.77, p=0.031), uric acid (40.57±10.49 vs 55.64±20.26, p<0.001) no important differences were found for total cholesterol, HDL-Chol, no-HDL-Chol, LDL-Chol and Chol/HDL-Chol. The systolic blood pressure correlated in a significant way with most of the lipid parameters and uric acid. On multivariate analysis, uric acid, VLDL-chol and FAHTA account for 40% of the variation in systolic blood pressure. The inclusion of the lipid profile and uric acid in hypertensive pregnant women's biochemical evaluation is suggested because they are accessible in low complexity laboratories and they would contribute to the evaluation of endothelium damage caused by transient high blood pressure.

[Reference values and prevalence of lipidic profile alterations in adolescents]. / Valores de referencia y prevalencia de las alteraciones del perfil lipídico en adolescentes.

INTRODUCTION: Altered lipid metabolism along with other cardiovascular risk factors promotes atherosclerosis at early age, leading to cardiovascular disease development. We aimed to estimate the prevalence of abnormal lipid profle in school adolescents from the city of Posadas, Misiones, Argentina, and describe the distribution of values in an apparently healthy subgroup. POPULATION AND METHODS: Descriptive cross-sectional study in a sample of students from 12 to 18 years of age. We obtained personal data, anthropometric measurements and a blood sample with 12 hours fasting for lipid determinations. Lipid profle percentiles were determined in a subgroup of apparently healthy adolescents. RESULTS: We studied 523 adolescents. We found cholesterolemia > or = 200 mg/dL in 7.8%, total cholesterol between 170 and 199 mg/dL in 18.7%; triglyceridemia >110 mg/dl in 20.1% and HDL cholesterol < 40 mg/dl in 17.0%. In the stratifcation by sex and age, males aged 15-18 years showed a higher prevalence of HDL cholesterol decreased (27.3%; p= 0.02). We found a more atherogenic lipid profle in overweight or obese adolescents than in those with normal weight or underweight. In the subgroup of 354 apparently healthy adolescents, the 75th percentile values were: total cholesterol 171 mg/dL, triglycerides 96 mg/dL, LDL cholesterol 102 mg dL, HDL cholesterol 117 mg/dL, total cholesterol/HDL cholesterol 3.48 and triglyceride/HDL cholesterol of 2.01. The 5th percentile for HDL cholesterol was 35 mg/dL. CONCLUSION: There was a high prevalence of lipid abnormalities. Lipid profle values were similar to those described in other populations of adolescents aged 12-18 yr, except triglyceride.

Valores de referencia y prevalencia de las alteraciones del perfil lipídico en adolescentes / Reference values and prevalence of lipidic profile alterations in adolescents

Introducción. El metabolismo lipídico alterado junto a otros factores de riesgo cardiovascular promueven la aterosclerosis a edades tempranasy el desarrollo de enfermedades cardiovasculares.Nos propusimos estimar la prevalencia de alteraciones del perfil lipídico en adolescentes escolarizados de la ciudad de Posadas, Misiones, Argentina y describir la distribución de losvalores en un subgrupo aparentemente sano.Población y métodos. Estudio descriptivo transversal en alumnos de 12-18 años. Se obtuvieron datos personales y medidas antropométricas, yse efectuaron las determinaciones lipídicas. En un subgrupo de adolescentes aparentemente sanosse determinaron los percentilos del perfil lipídico.Resultados. Se estudiaron 523 adolescentes. Se encontró colesterol total ≥ 200 mg/dl en 7,8 por ciento,entre 170 y 199 mg/dl en 18,7 por ciento, trigliceridemia >110 mg/dl en 20,1 por ciento y colesterol HDL <40 mg/dl en 17,0 por ciento. Los varones de 15-18 años presentaron una mayor prevalencia de colesterol HDL disminuido(27,3 por ciento, p= 0,02). Se halló un perfil lipídico más aterogénico en adolescentes con sobrepeso uobesos que en aquellos con peso normal o bajo.En un subgrupo de 354 adolescentes aparentemente sanos, los valores del percentilo 75 fueron:colesterol total 171 mg/dl, triglicéridos 96 mg/dl, colesterol de LDL 102 mg/dl, colesterol no HDL 117 mg/dl, colesterol total/colesterol HDL 3,48 y triglicéridos/colesterol HDL 2,01. Elpercentilo 5 para colesterol HDL fue 35 mg/dl.Conclusión. Se observó una elevada prevalencia de alteraciones lipídicas. Los valores del perfil lipídico fueron similares a los recomendadospara adolescentes de 12-18 años, con excepción de los triglicéridos.(AU)

Valores de referencia y prevalencia de las alteraciones del perfil lipídico en adolescentes / Reference values and prevalence of lipidic profile alterations in adolescents

Introducción. El metabolismo lipídico alterado junto a otros factores de riesgo cardiovascular promueven la aterosclerosis a edades tempranasy el desarrollo de enfermedades cardiovasculares.Nos propusimos estimar la prevalencia de alteraciones del perfil lipídico en adolescentes escolarizados de la ciudad de Posadas, Misiones, Argentina y describir la distribución de losvalores en un subgrupo aparentemente sano.Población y métodos. Estudio descriptivo transversal en alumnos de 12-18 años. Se obtuvieron datos personales y medidas antropométricas, yse efectuaron las determinaciones lipídicas. En un subgrupo de adolescentes aparentemente sanosse determinaron los percentilos del perfil lipídico.Resultados. Se estudiaron 523 adolescentes. Se encontró colesterol total ≥ 200 mg/dl en 7,8 por ciento,entre 170 y 199 mg/dl en 18,7 por ciento, trigliceridemia >110 mg/dl en 20,1 por ciento y colesterol HDL <40 mg/dl en 17,0 por ciento. Los varones de 15-18 años presentaron una mayor prevalencia de colesterol HDL disminuido(27,3 por ciento, p= 0,02). Se halló un perfil lipídico más aterogénico en adolescentes con sobrepeso uobesos que en aquellos con peso normal o bajo.En un subgrupo de 354 adolescentes aparentemente sanos, los valores del percentilo 75 fueron:colesterol total 171 mg/dl, triglicéridos 96 mg/dl, colesterol de LDL 102 mg/dl, colesterol no HDL 117 mg/dl, colesterol total/colesterol HDL 3,48 y triglicéridos/colesterol HDL 2,01. Elpercentilo 5 para colesterol HDL fue 35 mg/dl.Conclusión. Se observó una elevada prevalencia de alteraciones lipídicas. Los valores del perfil lipídico fueron similares a los recomendadospara adolescentes de 12-18 años, con excepción de los triglicéridos.

[Seroprevalence of HTLV-1/2 in blood donors from Misiones Province]. / Seroprevalencia de HTLV-1/2 en donantes de sangre de la Provincia de Misiones.

Human T-cell Lymphotropic viruses type 1 (HTLV-1), the first human oncoretrovirus to be discovered, is the etiologic agent of Adult T-cell Leukemia (ATL) and HTLV-1 Associated Mielopathy or Tropical Spastic Paraparesis (HAM/TSP). It is endemic worldwide, including the North of Argentina where both associated diseases have also been detected. No etiologic role has been described for HTLV-2, although it has been associated with HAM/TSP-like neurologic syndromes. Both retroviruses are endemic in native populations of The Americas, Africa and at-risk populations. They are transmitted through sex contact, parenterally and from mother to child. The aim of this study was to estimate the seroprevalence of HTLV-1/2 in a blood donor population from Misiones province. A total of 6912 accepted blood donations in 2008 were analyzed. HTLV-1/2 screening was performed with ELISA and particle agglutination, and reactive samples were confirmed by Western Blot. From the total, 5 samples resulted seropositive with a final prevalence of 0.00072. Out of the 5 positive samples, one was an HTLV, three HTLV-1 and one HTLV-2. These blood donors were residents of Posadas, Eldorado and Oberá, with no risk antecedents. This study demonstrates the presence of HTLV-1/2 in a population of Misiones with a prevalence rate similar to those reported among blood donors from non-endemic areas.

Seroprevalencia de HTLV-1/2 en donantes de sangre de la Provincia de Misiones / Seroprevalence of HTLV-1/2 in blood donors from Misiones Province

El Virus Linfotrópico T Humano tipo 1 (HTLV-1), primer oncorretrovirus humano descubierto, es el causante etiológico de la leucemia de células T del adulto (ATL) y de la mielopatía asociada al HTLV-1 o paraparesia espástica tropical (HAM/TSP). Es endémico en distintas partes del mundo, inclusive en el noroeste argentino, donde ambas enfermedades fueron detectadas. El HTLV-2, no tiene un rol etiológico definido, si bien ha sido asociado con síndromes neurológicos similares a la HAM/TSP. Ambos virus son endémicos en comunidades originarias del continente americano, tribus de Africa y poblaciones en riesgo. Ambos retrovirus se transmiten por vía sexual, parenteral y de madre a hijo. El objetivo de este trabajo fue determinar la seroprevalencia de HTLV-1/2 en una población de donantes de sangre de la provincia de Misiones. Se analizaron 6912 donaciones de sangre recibidas en el Banco de Sangre Central de la Provincia de Misiones durante 2008. La detección de anticuerpos se realizó por ELISA y aglutinación de partículas, y las muestras reactivas fueron confirmadas por Western Blot. Del total de muestras, 5 resultaron seropositivas con una prevalencia final de 0.00072. De ellas, una era HTLV, tres HTLV-1 y una HTLV-2 positiva. Los donantes positivos provenían de Posadas, Eldorado y Oberá, sin antecedentes de riesgo. Este estudio demuestra la presencia de HTLV-1/2 en donantes de sangre de Misiones, con cifras similares a las notificadas en donantes de sangre de zonas no endémicas.

Human T-cell Lymphotropic viruses type 1 (HTLV-1), the first human oncoretrovirus to be discovered, is the etiologic agent of Adult T-cell Leukemia (ATL) and HTLV-1 Associated Mielopathy or Tropical Spastic Paraparesis (HAM/TSP). It is endemic worldwide, including the North of Argentina where both associated diseases have also been detected. No etiologic role has been described for HTLV-2, although it has been associated with HAM/TSP-like neurologic syndromes. Both retroviruses are endemic in native populations of The Americas, Africa and at-risk populations. They are transmitted through sex contact, parenterally and from mother to child. The aim of this study was to estimate the seroprevalence of HTLV-1/2 in a blood donor population from Misiones province. A total of 6912 accepted blood donations in 2008 were analyzed. HTLV-1/2 screening was performed with ELISA and particle agglutination, and reactive samples were confirmed by Western Blot. From the total, 5 samples resulted seropositive with a final prevalence of 0.00072. Out of the 5 positive samples, one was an HTLV, three HTLV-1 and one HTLV-2. These blood donors were residents of Posadas, Eldorado and Oberá, with no risk antecedents. This study demonstrates the presence of HTLV-1/2 in a population of Misiones with a prevalence rate similar to those reported among blood donors from non-endemic areas.

Perfil lipídico por trimestre de gestación en una población de mujeres adultas / Lipid profile of adult women during the first, second and third trimester of gestation

Antecedentes: En el embarazo se producen variaciones hormonales muy marcadas y estas se asocian con grandes modificaciones del perfil lipídico. Objetivos: Evaluar el perfil lipídico de mujeres adultas por trimestre de gestación y comparar el perfil lipídico de un grupo control de mujeres no embarazadas con gestantes del primer trimestre, que consultan al servicio de Maternidad del Hospital Público Provincial "Dr. Ramón Madariaga". Método: Se estudiaron 248 embarazadas, 69 en primer trimestre, 78 segundo y 101 tercero. Además un grupo control de 43 no gestantes con distribución etérea, índice de masa corporal y criterios de exclusión similares al grupo de gestantes. Se extrajo sangre con 12 horas de ayuno para las determinaciones bioquímicas, las cuales fueron realizadas por métodos enzimáticos colorimétricos, con controles de calidad interno y externo. Resultados: Se encontró que colesterol total, triglicéridos, col-VLDL, col-LDL, los índices colesterol total/col-HDL y triglicéridos/col-HDL, fueron aumentando significativamente en cada trimestre, mientras que el c-HDL no presentó diferencias. Los valores de percentilo 95 del tercer trimestre para CT de 321 mg/dl y TG 371 mg/dl, podrían ser utilizados como valores de corte en nuestra población. Cuando se comparó mujeres no gestantes versus embarazadas del primer trimestre no se encontraron cambios significativos. Conclusiones: El seguimiento del perfil lipídico de las gestantes podría convertirse en una herramienta diagnóstica que permita monitorear aumentos que superen lo considerado como fisiológico, llevando a un adecuado control prenatal.

Background: In pregnancy hormonal changes occur very marked and these are associated with major changes in the lipid profile. Aims: To evalúate the lipid profile of adult women during normal pregnancy in the first, second and third trimester and to compare the lipid profile of woman who are not pregnant with the lipid profile of woman who are in the first trimester of gestation and who are attended at the Maternity Public and Provincial Hospital "Dr. Ramón Madariaga". Methods: 248 pregnant women were evaluated of which: 69 women were in the first trimester; 78 women were in the second trimester and 101 women were in the third trimester. In addition a control group of 43 non-pregnant women with age distribution, body mass Índex and exclusión criteria similar to the group of pregnant women. Blood was extracted after twelve hours fasting to get the biochemical determinations which results were gotten by enzymatic colorimetric methods, with infernal and external quality control. Results: It was found that total cholesterol; triglycerides, very low density and low density lipoprotein, the total cholesterol index/ high density lipoprotein y triglycerides/ high density lipoprotein were significantly increasing in each period of three trimesters while c-HDL did not show any variation. The values of 95th percentil obtained in the third trimester for CT de 321 mg/dl y TG 371 mg/ di, could be used as cut values for our population. When the group of not pregnant women were compared to the group of first trimester no significantly differences were found. Conclusions: The frequent evaluation of the lipid profile of women in gestation time could become a good way of diagnosis that gives the opportunity to follow the increasing results that are considered superior to what is physiologically acceptable, carrying out a good performance in prenatal control.