Does exposure to parasites modify relationships between diurnal cortisol and leukocytes among Honduran women?

BACKGROUND: Altered hypothalamic-pituitary-adrenal (HPA) function and related changes in circulating glucocorticoids have been implicated in the pathogenesis of numerous diseases that involve dysregulated immune function. Glucocorticoid hormones have both direct and indirect modulatory effects on both pro- and anti-inflammatory aspects of the immune system, including granulocytic and lymphocytic leukocyte subsets. However, past findings are complicated by inconsistencies across studies in how glucocorticoids and immune markers interact and relate to disease risk. Some incongruencies are likely due to an overreliance on single-unit (e.g., HPA or one immune marker) measures, and a failure to consider ecological exposures that may shape the base levels or correspondence between these systems. Here, we test single-unit and diurnal measures of HPA axis and immune system interactions in a less-industrial ecological setting with relatively high parasite loads. METHODS: In a sample of 114 Honduran women (mean age = 36 years), morning and evening blood samples were analyzed to quantify granulocytes, lymphocytes, and immunoglobulin-E (IgE). Saliva was collected over 2 days (8 samples per woman) to measure peak cortisol, cumulative cortisol, and slope of decline. These repeated measures of saliva and venous blood were used to investigate associations between single-point and diurnal salivary cortisol and leukocytes, under variable levels of past parasite exposure (proxied by IgE). RESULTS: Individuals with less of a decline in cortisol (i.e., "flatter" decline) show less of an increase in lymphocytes (2.27% increase in cells/µL/hr; 95% CI: 0.91-7.29; p = .01) across the day compared to those with steeper cortisol decline (7.5% increase in lymphocytes; 95% CI: 5.79-9.34; p < .001). IgE levels did not modify this association. Interestingly, IgE did moderate relationships between measures of cortisol and granulocytes: diurnal cortisol was positively associated with granulocytes, only in individuals with high previous exposure to parasites. There were no consistent relationships between single-unit measures of cortisol, lymphocytes or granulocytes, regardless of past parasite exposure. DISCUSSION: Results demonstrate that the relationship between HPA function and immune modulation cannot be fully understood without an understanding of local disease ecology. These results highlight the importance of research that seeks to identify etiologies of disease across environmental contexts.

Complicaciones del tratamiento quirúrgico de la comunicación interventricular en pacientes menores de 17 años en el INSN / Surgical and medical complications in ventricular septal defects surgical treatment in pediatrics patients in INSN

OBJETIVO: Conocer las complicaciones médico quirúrgicas, post tratamiento quirúrgico de la comunicación interventricular (CIV) de pacientes menores de 17 años, tratados en el INSN. MATERIAL Y MÉTODOS: Estudio descriptivo, retrospectivo. Se incluyeron todos los pacientes menores de 17 años atendidos por CIV en el INSN, de Enero del 2007 a Julio del 2011. RESULTADOS: Se revisaron 61 historias clínicas de pacientes con diagnóstico de CIV. 22 eran de sexo femenino (36.1%), y 39 masculino (63.9%). El tipo de CIV más frecuente fue el perimembranoso (78.7%) seguidos por los CIV de entrada de salida y muscular (7.1%). Según la técnica operatoria: 75.4% fueron transatriales y 11.5% transpulmonares. Las complicaciones médicas post quirúrgicas más frecuentes, fueron el bloqueo aurículo ventricular e insuficiencia cardiaca congestiva ambas con el 8.2% de frecuencia. La complicación quirúrgica más frecuente fue el CIV residual (29.5%), seguida de dehiscencia esternal (9.8%) e infección de herida operatoria (8.2%). 47.5% no presentó ninguna complicación quirúrgica. CONCLUSIONES: El tratamiento quirúrgico de la comunicación interventricular es una alternativa segura para la corrección de esta patología.

OBJETIVE: The purpose of this study was to know the surgical and medical complications in ventricular septal defects (VSD) surgical treatment in pediatrics patients in INSN. MATERIALS AND METHODS: A descriptive and retrospective study in pediatrics patients that underwent VSD surgical closure in the cardiac service of ôINSNõ in Lima, Perú, between January 2007 to July 2011. RESULTS: We reviewed 61 medical records, there were 22 (36.1%) females and 39 (63.9%) males. The perimembranous VSDs was the more frequent (78.7%) followed the enter and way muscle VSDs (7.1%). The closure of the ventricular septal defects with the transatrial approach was the predominant surgical treatment (29.5%). The residual shunts were the complication in the surgical management of VSDs with more incidence. The auricular-ventricular block and congestive heart failure were the medical complications with more incidence (both with 8.2%). 47.5% of patients had no surgical complications. CONCLUSIONS: The ventricular septal defects surgical closure is the safe alternative for correction this anomaly in the INSN.

Complicaciones del tratamiento quirúrgico de la comunicación intraventricular en pacientes menores de 17 años en el INSN en el periodo 2007-2011 / Complications of the surgical treatment of the communication intraventricular in 17-year-old minor patients in the INSN in the period 2007-2011

Objetivos: Conocer las complicaciones médico quirúrgicas, post tratamiento quirúrgico de la comunicación interventricular en los pacientes menores de 17 años, tratamos en el INSN en el periodo Enero 2007 a Julio 2011. Método: Estudio descriptivo retrospectivo. Se incluyeron todos los pacientes menores de 17 años atendidos por comunicación ventricular en el INSN en el periodo comprendido entre Enero del 2007 a Julio del 2011. Se excluyó a los mayores de 17 años y/o pacientes con comunicación interventricular sin tratamiento quirúrgico. Resultados: Se revisaron 61 historias clínicas de pacientes con diagnóstico de comunicación interventricular, de las cuales 22 pertenecían al sexo femenino (36.1 por ciento) y 39 al sexo masculino (63.9 por ciento). El tipo de comunicación intraventricular más frecuente fue el CIV perimenbranoso (78.7 por ciento) seguidos por los CIV de entrada de salida muscular (7.1 por ciento). Según la técnica operatoria el 75.4 por ciento fueron transatriales mientras que el 11,5 por ciento fueron transpulmonar. Las complicaciones médicas post quirúrgicas más frecuentes fueron el bloqueo aurículo ventricular e insuficiencia cardiaca congestiva ambas con 8.2 por ciento de frecuencia...

Objetives: The purpose of this study was to know the surgical and medical complications in ventricular septal defects surgical treatment in pediatrics patients in INSN from January 2007 to July 2011. Methods: a descriptive and retrospective study was made in 80 pediatrics patients that underwent ventricular septal defects surgical closure in the cardiac service of INSN in Lima, Perú, between January 2007 to July 2011. Results: We reviewed 61 medical records, there were 22 (36.1 por ciento) females and 39 (63.9 por ciento) males. The perimenbranous VSDs was the more frecuent (78.7 por ciento). The closure of the ventricular spetal defects with the transatrial approach was the predominance surgical treatment (29. 5 por ciento). The residual shunts were the complication in the surgical management of VSDs with more incidence. The auricular-ventricular block and congestive heart failure were the medical complications with more incidence (both with 8.2 por ciento)...