Institute Endocrinologia

Quito, Ecuador

Institute Endocrinologia

Quito, Ecuador

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Galvez Gonzalez A.M.,Escuela Nacional de Salud Publica | Rodriguez Cabrera A.,Escuela Nacional de Salud Publica | Alvarez Vazquez L.,Institute Endocrinologia
Revista Cubana de Salud Publica | Year: 2013

Sexual and reproductive health concerns man in its individual, economic and social dimensions. Pregnancy and child delivery in adolescents generate high costs. The fertility rate of adolescents decreased in Cuba until 2006, but in the last few years, there has been an increase that represents a warning about the health of this group of young people. Cuba is developing projects aimed at improving the health status of adolescents such as the National Program of Integrated Care to the Health of Adolescents. Making economic analysis of the pregnancy at adolescence in Cuba is a pending task. Methodological tools providing timely information on the economic consequences of pregnancy at adolescence are required. The objective of this paper was to submit a methodological proposal in order to identify the economic effects of pregnancy at adolescence in Cuba. A literature and document review was made with Big 6 model as the information management pattern, with a view to identifying the studies on sexual and reproductive health, emphasizing the economic consequences of pregnancy at adolescence. This information was supplemented with interviews to experts in sexual and reproductive health and in economic analysis, who contributed several elements for the design of the final methodological proposal for this type of study from the macroeconomic and the microeconomic perspectives. Both provide the necessary useful economic information to allocate resources and to make decisions.


Guevara-Aguirre J.,San Francisco de Quito University | Rosenbloom A.L.,San Francisco de Quito University | Balasubramanian P.,University of Southern California | Teran E.,San Francisco de Quito University | And 9 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2015

Context: Ecuadorian subjects with GH receptor deficiency (GHRD) have not developed diabetes, despite obesity. Objective: We sought to determine the metabolic associations for this phenomenon. Design: Four studies were carried out: 1) glucose, lipid, adipocytokine concentrations; 2) metabolomics evaluation; 3) metabolic responses to a high-calorie meal; and 4) oral glucose tolerance tests. Setting: Clinical Research Institute in Quito, Ecuador. Subjects: Adults homozygous for the E180 splice mutation of the GH receptor (GHRD) were matched for age, gender, and body mass index with unaffected control relatives (C) as follows: study 1, 27 GHRD and 35 C; study 2, 10 GHRD and 10 C; study 3, seven GHRD and 11 C; and study 4, seven GHRD and seven C. Results:AlthoughGHRDsubjectshadgreatermeanpercentagebodyfatthancontrols,theirfastinginsulin, 2-hour blood glucose, and triglyceride levels were lower. The indicator of insulin sensitivity, homeostasis model of assessment 2%S, was greater (P .0001), and the indicator of insulin resistance, homeostasis model of assessment 2-IR, was lower (P .0025). Metabolomic differences between GHRD and control subjects were consistent with their differing insulin sensitivity, including postprandial decreases of branched-chain amino acids that were more pronounced in controls. High molecular weight and total adiponectin concentrations were greater inGHRD(P .0004 and P .0128, respectively), and leptin levels were lower (P .02). Although approximately 65% the weight of controls, GHRD subjects consumed an identical high-calorie meal; nonetheless, theirmeanglucose concentrationswerelower, withmeaninsulin levels one-third those of controls. Results of the 2-hour oral glucose tolerance test were similar. Main Outcome Measures: Measures of insulin sensitivity, adipocytokines, and energy metabolites. Conclusions:WithoutGHcounter-regulation,GHRDisassociatedwithinsulinefficiencyandobesity.Lower leptin levels, despite higher percentage body fat, suggest that obesity-associated leptin resistance is GH dependent.Elevatedadiponectinlevelsnotcorrelatedwithpercentagebodyfat indicate thatGHsignaling is necessary for their typical suppression with obesity. Copyright © 2015 by the Endocrine Society.


Guevara-Aguirre J.,Institute Endocrinologia | Guevara-Aguirre J.,Florida College | Rosenbloom A.L.,Institute Endocrinologia | Rosenbloom A.L.,Florida College | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2013

Context: The maximum dose of IGF-I recommended for treatment of GH insensitivity is commonly used. Objective: The aim was to test the hypothesis that a lower dose is as effective as a high dose of IGF-I in growth promotion and has fewer deleterious effects. Design and Setting: Subjects were treated for 3 years with regular examinations including bone age and dual energy x-ray absorptiometry and for 1 year with abdominal ultrasound studies at a clinical research institute in Quito, Ecuador. Subjects: The study included 21 subjects ages 3.2-15.9 years with GH insensitivity due to the same splice site mutation on the GH receptor gene. Interventions: Subjects were allocated to receive 120 (n = 14) or 80 (n = 7) μg/kg IGF-I twice daily. Main Outcome Measures: Height velocity, osseous maturation, height SD scores (SDS), body composition, abdominal organ growth, and side effects were assessed. Results: There were no differences in growth velocity or height SDS increment by dosage, and the SDS increasewasgreater than in other reported series. Osseous maturation over 3 years with the high dosewas nearly twice as rapid as with the lower dose (P<.001) and correlated with an increase in percentage body fat (r = .64; P < .001) and with adrenal size increase over 1 year (r = .32; P = .03). The ratio of bone age to height age was lower in the high-dose group after 3 years of treatment (P<.007). Conclusions: The commonly used IGF-I dosage of 120 μg/kg twice a day is excessive in comparison to a dose of 80 μg/kg twice a day, disproportionately accelerating osseous maturation, probably from the combined effects of obesity and inappropriate adrenal growth, thus likely compromising adult height potential. Moreover, the lower dose decreases direct treatment cost by one-third. Copyright © 2013 by The Endocrine Society.


Luis Alvarez M.C.,Hospital Pediatrico William Soler | Alonso Castillo A.,Hospital Pediatrico William Soler | Gonzalez Aleman M.,Hospital Pediatrico William Soler | Arana Rosainz M.,Institute Endocrinologia | Sarmiento Perez L.,Institute Medicina Tropical Pedro Kouri
Revista Cubana de Pediatria | Year: 2014

Introduction: viral meningoencephalitis affecting the child is caused mainly by enteroviruses and have generally self-limited benign course. Objective: to estimate the interleukin-6 and tumor necrosis factor-? present in the serum and the cerebrospinal fluid of children suffering viral meningoencephalitis.Method: cross-sectional descriptive study of 61 patients aged one month to 17 years and diagnosed with viral meningoencephalitis. The diagnosis was based on their clinical picture, the cytochemical study of their cerebrospinal fluid and the detection of enterovirus viral genome through the reverse transcriptase polymerase chain reaction. Forty eight serum samples and 35 cerebrospinal fluid samples served to determine the interleukin-6 and tumor necrosis factor-? concentrations. The statistical analysis included Wilcoxon's test for 2 related samples and the Spearman's test for correlating cytokine concentrations.Results: viral genome was detected in 3 cerebrospinal fluid samples with increased cellularity and predominant polymorphonuclear neutrophils and in other 3 samples with normal cellularity. The quantitation of serum interleukin-6 and of tumor necrosis factor-alpha were 91.6 ± 39.0 pg/mL and 106.5 ± 54.6 pg/mL, respectively. The interleukin-6 and tumor necrosis factor-alpha levels in the cerebrospinal fluid amounted to 109.65 ± 49.6 pg/mL, and 75.28 ± 29.9 pg/mL, respectively.Conclusions: high interleukin-6 and tumor necrosis factor-alpha levels were found in all the studied samples. The factor concentrations were higher in the serum whereas those of interleukin-6 were higher in the cerebrospinal fluid; there was positive correlation between interleukin-6 values in the serum and those of the tumor necrosis factor-alpha. © 2014 Editorial Ciencias Medicas. All rights reserved.


Yanes Quesada M.A.,Hospital Clinicoquirurgico Hermanos Ameijeiras | Ayala Escobar M.,Bogota | Yanes Quesada M.,Institute Endocrinologia | Calderin Bouza R.,Hospital Clinicoquirurgico Hermanos Ameijeiras | And 2 more authors.
Revista Cubana de Medicina | Year: 2015

Introduction: lung cancer is a health problem that significantly affects how mankind. Objective: describe the clinical features and its association with histological subtype in patients with lung cancer. Methods: across-sectional study was conducted in 107 patients with lung cancer hospitalized in the services of internal medicine and pneumology at Hermanos Ameijeiras Hospital from March 2012 to February 2013. Results: 66.4% of the patients were men with a mean age of 65.9 years and 61.7% had smoking habits. Broncho-pneumonia was the most common clinical form of presentation in 20.6% and symptom, cough in 63.6%. In lung adenocarcinoma, 30.4% had the broncho-pneumonic form. Conclusions: atelectasis and pleural clinical form of presentation were associated with squamous cell carcinoma and adeno-carcinoma, respectively. © 2015, Editorial Ciencias Medicas. All rights reserved.


Onativia A.,Institute Endocrinologia | Rodriguez Campoamor N.,Institute Endocrinologia
Revista Argentina de Endocrinologia y Metabolismo | Year: 2015

A consideration was done in the results of the treatment of the endemic goiter, with iodine, desiccated thyroid powder, and triiodothyronine, in a group of 300 patients during a three month period of time as a minimun and from six month to one year as maximun. It was observed cure of the goiter with the complete disappearance of it in 31 patients (10.33 %); improvement with diminution of the volume in 161 (53.66 %) and with no changes in 108 (36 %). The highest rate of cure are those corresponding to difuse goiter, and the lowerst to the nodular. The results of the treatment are modified by the time history of the disease in its direct relationship with the histologic changes that are produced rapidly in the endemic goiter. In the difuse goiter and in the nodular of recent formation, no matter what the age of the patient is the medical treatment should be tried specially with active compounds of thyroid hormon. The large difuse goiter and the nodular of long standing should be amendable of the surgical treatment. The results that we have obteined, the difficulty in the medical treatment regarding to the cooperation of the patient to mantein the treatment for a correct time, to be followed with the profilactic in order to prevent the recurrences, will lesser more its value. This facts speaks more in favor of the profilaxis with iodine salts. Copyright © 2015 por la Sociedad Argentina de Endocrinología y Metabolismo.


Milan A.M.F.,Policlinico Plaza de la Revolucion | Despaigne D.A.N.,Institute Endocrinologia
Revista Cubana de Obstetricia y Ginecologia | Year: 2010

OBJECTIVE: To determine the relationship between the total adiposity and its abdominal distribution with the arterial pressure levels in middle-age women. METHODS: A cross-sectional and descriptive study was conducted in four consulting rooms of the 19 de Abril University Polyclinic from the Plaza de la Revolución municipality. A total of 229 women aged between 45 and 59 were studied to determine the body mass index (BMI), waist circumference (WC) was measured registering the arterial pressure figures. RESULTS: The 72% of study women had excess weight; the 38% had a waist circumference ≥88 cm, the 37% was hypertensive. There was a highly significant association between the BMI and the high blood pressure and between the WC and the high blood pressure. There was also an incidence of 65 pre-hypertensive patients and 11 hypertensive patients. CONCLUSION: The hypertensive percentage increases according to an increase in BMI, the high blood pressure is more frequent in women with WC = 88 cm, the high blood pressure percentage is greater in postmenopausal women.


Guevara-Aguirre J.,San Francisco de Quito University | Guevara-Aguirre J.,Institute Endocrinologia | Procel P.,Institute Endocrinologia | Guevara C.,Institute Endocrinologia | And 3 more authors.
Growth Hormone and IGF Research | Year: 2015

In the present pandemics of obesity and insulin resistant diabetes mellitus (DM), the specific contribution of etiological factors such as shifts in nutritional and exercise patterns, genetic and hormonal, is subject of ongoing research. Among the hormonal factors implicated, we selected obesity-driven insulin resistance for further evaluation. It is known that growth hormone (GH) has profound effects on carbohydrate metabolism. In consequence, we compared the effects of the lack of the counter-regulatory effects of GH, in a group of subjects with GH receptor deficiency (GHRD) due to a mutated GH receptor vs. that of their normal relatives. It was found that, despite their obesity, subjects with GHRD, have diminished incidence of diabetes, lower glucose and insulin concentrations, and lower values of indexes indicative of insulin resistance such as HOMA-IR. The GHRD subjects were also capable of appropriately handling glucose or mixed meal loads despite diminished insulin secretion. These observations allow us to suggest that the association of obesity with increased risk for diabetes appears to be dependent on intact growth hormone signaling. © 2015 Elsevier Ltd.


PubMed | Institute Endocrinologia
Type: Journal Article | Journal: The Journal of clinical endocrinology and metabolism | Year: 2013

The maximum dose of IGF-I recommended for treatment of GH insensitivity is commonly used.The aim was to test the hypothesis that a lower dose is as effective as a high dose of IGF-I in growth promotion and has fewer deleterious effects.Subjects were treated for 3 years with regular examinations including bone age and dual energy x-ray absorptiometry and for 1 year with abdominal ultrasound studies at a clinical research institute in Quito, Ecuador.The study included 21 subjects ages 3.2-15.9 years with GH insensitivity due to the same splice site mutation on the GH receptor gene.Subjects were allocated to receive 120 (n = 14) or 80 (n = 7) g/kg IGF-I twice daily.Height velocity, osseous maturation, height SD scores (SDS), body composition, abdominal organ growth, and side effects were assessed.There were no differences in growth velocity or height SDS increment by dosage, and the SDS increase was greater than in other reported series. Osseous maturation over 3 years with the high dose was nearly twice as rapid as with the lower dose (P < .001) and correlated with an increase in percentage body fat (r = .64; P < .001) and with adrenal size increase over 1 year (r = .32; P = .03). The ratio of bone age to height age was lower in the high-dose group after 3 years of treatment (P = .007).The commonly used IGF-I dosage of 120 g/kg twice a day is excessive in comparison to a dose of 80 g/kg twice a day, disproportionately accelerating osseous maturation, probably from the combined effects of obesity and inappropriate adrenal growth, thus likely compromising adult height potential. Moreover, the lower dose decreases direct treatment cost by one-third.


PubMed | Institute Endocrinologia and San Francisco de Quito University
Type: | Journal: Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society | Year: 2016

In the present pandemics of obesity and insulin resistant diabetes mellitus (DM), the specific contribution of etiological factors such as shifts in nutritional and exercise patterns, genetic and hormonal, is subject of ongoing research. Among the hormonal factors implicated, we selected obesity-driven insulin resistance for further evaluation. It is known that growth hormone (GH) has profound effects on carbohydrate metabolism. In consequence, we compared the effects of the lack of the counter-regulatory effects of GH, in a group of subjects with GH receptor deficiency (GHRD) due to a mutated GH receptor vs. that of their normal relatives. It was found that, despite their obesity, subjects with GHRD, have diminished incidence of diabetes, lower glucose and insulin concentrations, and lower values of indexes indicative of insulin resistance such as HOMA-IR. The GHRD subjects were also capable of appropriately handling glucose or mixed meal loads despite diminished insulin secretion. These observations allow us to suggest that the association of obesity with increased risk for diabetes appears to be dependent on intact growth hormone signaling.

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