AG. Vicerrectoría de Investigaciones

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  • Publicación
    Acceso abierto
    Application of the calculus of variations to the vertical cut off in cohesive frictionless soil
    (1981-05-02) Castillo, E.; Luceiio, A.; De Joesselin De Jong, G.
  • Publicación
    Acceso abierto
    Laser in situ keratomileusis to correct post-keratoplasty astigmatism : 1-Step versus 2-step procedure
    (2004-11) Alió, Jorge L.; Javaloy, Jaime; Osman, Amr A.; Galvis, Virgilio; Tello, Alejandro; Haroun, Hazem E.
    Purpose: To investigate the correction of post-penetrating keratoplasty (PKP) astigmatism using laser in situ keratomileusis (LASIK). Visual and refractive outcomes were evaluated after LASIK was performed in 1 step (lamellar cut and ablation in 1 procedure) or 2 steps (lamellar cut then ablation in 2 successive procedures). Setting: Department of Cornea and Refractive Surgery, Vissum–Instituto Oftalmológico de Alicante, University of Miguel Hernández, Alicante, Spain. Methods: In this prospective observational study, 22 consecutive eyes were divided into 2 groups depending on the LASIK procedure performed to correct post-PKP astigmatism. Group 1 (1-step LASIK) included 11 eyes and Group 2 (2-step LASIK), 11 eyes. The patients were followed for 6 months. Results: A statistically significant improvement was obtained in Group 2 with a mean vector analysis result of the cylinder of –4.37 diopters (D) ± 1.79 (SD) (P = .018). In Group 1, the mean astigmatism correction was 2.38 ± 1.71 D. The number of reoperations and residual refractive defects were significantly better in Group 2. Conclusion: The 2-step technique improved the accuracy of excimer laser correction of post-PKP astigmatism.
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    Double blind, randomized controlled trial, to evaluate the effectiveness of a controlled nitric oxide releasing patch versus meglumine antimoniate in the treatment of cutaneous leishmaniasis [NCT00317629]
    (2006-05-15) Silva, Sandra Y.; Rueda, Ligia C.; López Casillas, Marcos; Vélez, Iván D.; Rueda Clausen, Christian F.; Smith, Daniel J.; Muñoz, Gerardo; Mosquera, Hernando; Silva Sieger, Federico Arturo; Buitrago, Adriana; Díaz, Holger; Lopez-Jaramillo, Patricio
    Background: Cutaneous Leishmaniasis is a worldwide disease, endemic in 88 countries, that has shown an increasing incidence over the last two decades. So far, pentavalent antimony compounds have been considered the treatment of choice, with a percentage of cure of about 85%. However, the high efficacy of these drugs is counteracted by their many disadvantages and adverse events. Previous studies have shown nitric oxide to be a potential alternative treatment when administered topically with no serious adverse events. However, due to the unstable nitric oxide release, the topical donors needed to be applied frequently, making the adherence to the treatment difficult. The electrospinning technique has allowed the production of a multilayer transdermal patch that produces a continuous and stable nitric oxide release. The main objective of this study is to evaluate this novel nitric oxide topical donor for the treatment of cutaneous leishmaniasis. Methods and design: A double-blind, randomized, double-masked, placebo-controlled clinical trial, including 620 patients from endemic areas for Leishmaniasis in Colombia was designed to investigate whether this patch is as effective as meglumine antimoniate for the treatment of cutaneous leishmaniasis but with less adverse events. Subjects with ulcers characteristic of cutaneous leishmaniasis will be medically evaluated and laboratory tests and parasitological confirmation performed. After checking the inclusion/exclusion criteria, the patients will be randomly assigned to one of two groups. During 20 days Group 1 will receive simultaneously meglumine antimoniate and placebo of nitric oxide patches while Group 2 will receive placebo of meglumine antimoniate and active nitric oxide patches. During the treatment visits, the medicationswill be daily administered and the presence of adverse events assessed. During the follow-up, the research group will visit the patients at days 21, 45, 90 and 180. The healing process of the ulcer, the health of the participants, recidivisms and/or reinfection will also be assessed. The evolution of the ulcers will be photographically registered. In case that the effectiveness of the patches is demonstrated, a novel and safe therapeutic alternative for one of the most important public health problems in many countries will be available to patients.
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    A randomized, double blind, cross-over, placebo-controlled clinical trial to assess the effects of Candesartan on the insulin sensitivity on non diabetic, non hypertense subjects with dysglyce mia and abdominal obesity. "ARAMIA"
    (2006-09-07) Lopez-Jaramillo, Patricio; Pradilla, Lina P.; Lahera, Vicente; Silva Sieger, Federico Arturo; Rueda Clausen, Christian F.; Márquez, Gustavo
    Background: The raising prevalence of type-2 diabetes mellitus and obesity has been recognized as a major problem for public health, affecting both developed and developing countries. Impaired fasting plasma glucose has been previously associated with endothelial dysfunction, higher levels of inflammatory markers and increased risk of developing insulin resistance and cardiovascular events. Besides life-style changes, the blockade of the renin-angiotensin system has been proposed as a useful alternative intervention to improve insulin resistance and decrease the number of new type-2 diabetes cases. The aim of this clinical trial is to study the effect of the treatment with Candesartan, an angiotensin II receptor antagonist, on the insulin resistance, the plasma levels of adipoquines, oxidative stress and prothrombotic markers, in a group of non diabetic, non hypertensive, dysglycemic and obese subjects. Methods and design: A randomized, double blind, cross-over, placebo-controlled, clinical trial was designed to assess the effects of Candesartan (up to 32 mg/day during 6 months) on the Homeostasis Model Assessment (HOMA) index, lipid profile, protrombotic state, oxidative stress and plasma levels of inflammatory markers. The participants will be recruited in the "Fundación Cardiovascular de Colombia". Subjects who fullfil selection criteria will receive permanent educational, nutritional and exercise support during their participation in the study. After a 15 days-run-in period with placebo and life-style recommendations, the patients who have a treatment compliance equal or greater than 80% will be randomlly assigned to one of the treatment groups. Group A will receive Candesartan during 6 months and placebo during 6 months. Group B will receive placebo during the first 6 months, and then, Candesartan during the last 6 months.Control visits will be programed monthly and all parameters of interest will be evaluated every 6 months. Hypothesis: Treatment with Candesartan, could improve the HOMA index, the response to the oral glucose tolerance test and reduce the plasma levels of adipoquines, oxidative stress and prothrombotic markers, in non diabetic, non hypertense subjects with dysglycemia and abdominal obesity, recruited from a population at high risk of developing insulin resistance. These effects are independent of the changes in arterial blood pressure. Trial registration: NCT00319202.
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    Patología socioeconómica como causa de las diferencias regionales en las prevalencias de síndrome metabólico e hipertensión inducida por el embarazo
    (2007-02) Lopez-Jaramillo, Patricio; Pradilla, Lina P.; Castillo, Victor R.; Lahera, Vicente
    La epidemia de enfermedades cardiovasculares que están experimentando los países del tercer mundo ha suscitado controversias acerca de la posible presencia de diferencias regionales en su etiofisiopatología, las cuales estarían asociadas a factores socioeconómicos. La demostración de estas diferencias es importante, pues significaría la necesidad de realizar distintos enfoques en la prevención, el diagnóstico y el tratamiento. Algunos datos indican que hay diferencias en los mecanismos etiofisiopatológicos de la hipertensión inducida por el embarazo y del síndrome metabólico en poblaciones de países desarrollados y en vía de desarrollo, así como en el peso específico de los factores de riesgo que determinan la presentación de estas enfermedades. Varias observaciones realizadas en nuestra población indican que el tiempo de exposición a los cambios de hábitos de vida ocasionados por la sociedad consumista (sedentarismo, dieta hipergrasa, hipercalórica) determina una respuesta biológica normal (obesidad, síndrome metabólico, diabetes), la cual aumenta el riesgo de enfermedades cardiovasculares. Proponemos utilizar el nombre de «patología socioeconómica» para los cambios determinados por la sociedad moderna, con el fin de diferenciarlos de la consideración aislada de «factores socioeconómicos» y «factores de riesgo», pues consideramos que la interacción entre ellos es la causa más importante del aumento acelerado en la incidencia de enfermedades cardiovasculares observado en los últimos años en los países en vías de desarrollo.
  • Publicación
    Acceso abierto
    Periodontal disease severity is related to high levels of C-reactive protein in pre-eclampsia
    (2007-07) Herrera, Julián A.; Parra, Beatriz; Herrera, Enrique; Botero, Javier E.; Arce, Roger M.; Contreras, Adolfo; Lopez-Jaramillo, Patricio
    Objective Recent studies have shown that pre-eclamptic women present a high prevalence of periodontitis, suggesting that active periodontal disease may play a role in the pathogenesis of pre-eclampsia. The present study analysed the effect of periodontal disease in the concentrations of serum high-sensitivity C-reactive protein (hs-CRP), and its association with pre-eclampsia. Methods A case–control study was carried out in Cali-Colombia, comprised of 398 pregnant women (145 cases and 253 controls) who were believed to have periodontal disease, between 28 and 36 weeks of gestational age. Pre-eclampsia cases were defined as blood pressure >– 140/90 mmHg and proteinuria >– 0.3 g/24 h. Controls were pregnant women with normal blood pressure, without proteinuria, matched by maternal age, gestational age and body mass index. Sociodemographic data, obstetric risk factors, periodontal state, subgingival microbial composition and hs-CRP levels were determined in both groups. Results The case and control groups were comparable for sociodemographic characteristics. In women with pre-eclampsia and confirmed periodontal disease (n U 138), hs-CRP levels increased according to the severity of the disease (gingivitis median 4.14 mg/dl; mild periodontitis median 4.70 mg/dl; moderate/severe periodontitis median 8.8 mg/dl; P U 0.01). A similar tendency was observed in controls with periodontal disease (n U 251), but it did not reach statistical significance (gingivitis median 5.10 mg/dl; mild periodontitis median 5.12 mg/dl; moderate/severe periodontitis median 6.90 mg/dl; P U 0.07). A significant difference in hs-CRP levels was observed in pre-eclamptic women with moderate/severe periodontitis compared to controls (P U 0.01). Conclusion These findings suggest that chronic periodontitis may increase hs-CRP levels in pregnant women and lead to complications such as pre-eclampsia.
  • Publicación
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    Double blind, randomized, placebo controlled clinical trial for the treatment of diabetic foot ulcers, using a nitric oxide releasing patch : PATHON
    (2007-09-26) Silva, Sandra Y.; Rueda, Ligia C.; Márquez, Gustavo; López Casillas, Marcos; Smith, Daniel J.; Calderón, Carlos A.; Castillo, Juan C.; Matute, Jaime; Rueda Clausen, Christian F.; Orduz, Arturo; Silva Sieger, Federico Arturo; Kampeerapappun, Piyaporn; Bhide, Mahesh; Lopez-Jaramillo, Patricio
    Background: Diabetes Mellitus constitutes one of the most important public health problems due to its high prevalence and enormous social and economic consequences. Diabetic foot ulcers are one of the chronic complications of diabetes mellitus and constitute the most important cause of non-traumatic amputation of inferior limbs. It is estimated that 15% of the diabetic population will develop an ulcer sometime in their lives. Although novel therapies have been proposed, there is no effective treatment for this pathology. Naturally produced nitric oxide participates in the wound healing process by stimulating the synthesis of collagen, triggering the release of chemotactic cytokines, increasing blood vessels permeability, promoting angiogenic activity, stimulating the release of epidermical growth factors, and by interfering with the bacterial mitochondrial respiratory chain. Topically administered nitric oxide has demonstrated to be effective and safe for the treatment of chronic ulcers secondary to cutaneous leishmaniasis. However, due to their unstable nitric oxide release, the topical donors needed to be applied frequently, diminishing the adherence to the treatment. This difficulty has led to the development of a multilayer polymeric transdermal patch produced by electrospinning technique that guarantees a constant nitric oxide release. The main objective of this study is to evaluate the effectiveness and safety of this novel nitric oxide releasing wound dressing for the treatment of diabetic foot ulcers. Methods and design: A double-blind, placebo-controlled clinical trial, including 100 diabetic patients was designed. At the time of enrollment, a complete medical evaluation and laboratory tests will be performed, and those patients who meet the inclusion criteria randomly assigned to one of two groups. Over the course of 90 days group 1 will receive active patches and group 2 placebo patches. The patients will be seen by the research group at least every two weeks until the healing of the ulcer or the end of the treatment. During each visit the healing process of the ulcer, the patient's health status and the presence of adverse events will be assessed. Should the effectiveness of the patches be demonstrated an alternative treatment would then be available to patients.
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  • Publicación
    Acceso abierto
    Subclinical infection as a cause of inflammation in preeclampsia
    (2008-07) Lopez-Jaramillo, Patricio; Casas Herrera, Julián Augusto; Arenas Mantilla, Mario; Jáuregui, Isabel E.; Mendoza, Mayaris A.
    Preeclampsia, a pregnancy-exclusive hypertensive disorder, is the major cause of maternal and perinatal mortality, with a greater importance in developing countries. The role of inflammation in the pathogenesis of preeclampsia has been the object of recent studies by our group. We have described elevated levels of inflammatory markers (tumor necrosis factor alpha, interleukin-6, and C-reactive protein) in preeclamptic patients and demonstrated that Latin-American women present a higher degree of inflammation than women from developed countries. We have results that suggest that chronic subclinical infections and insulin resistance are the most probable causes of the increased inflammation in preeclampsia. Moreover, we showed that early treatment of urinary and vaginal infections decreased the incidence of preeclampsia. We also have evidence that suggests that inflammation leads to endothelial dysfunction, predisposing women to develop preeclampsia. Increased levels of inflammation markers and endothelial dysfunction are found in the early stages of pregnancy in women who later on develop preeclampsia. Appropriate prenatal care programs, including screening and treatment of urinary, vaginal, and periodontal infections in early pregnancy and prevention of factors that predispose to insulin resistance, such as excessive weight gain during pregnancy, may reduce the incidence of preeclampsia in Latin-American women.
  • Publicación
    Acceso abierto
    Are nutrition-induced epigenetic changes the link between socioeconomic pathology and cardiovascular diseases?
    (2008-07) Lopez-Jaramillo, Patricio; Silva, Sandra Y.; Rodríguez Salamanca, Narella; Durán Hernández, Álvaro-Hernán; Mosquera, Walter; Castillo, Victor R.
    The prevalence of cardiovascular diseases (CVD) and diabetes mellitus type 2 (DM 2) is decreasing in developed countries despite the increase in the percentage of subjects with obesity and other wellrecognized cardiovascular risk factors. In contrast, the recent transition of the economic model experienced by developing countries, characterized by the adoption of a Western lifestyle, that we have named ‘‘socioeconomic pathology,’’ has led to an increase in the burden of CVD. It has been demonstrated that conventional cardiovascular risk factors in developed and developing countries are the same. Why then does the population of developing countries currently have a higher incidence of CVD than that of developed countries if they share the same risk factors? We have proposed the existence of a higher susceptibility to the development of systemic inflammation at low levels of abdominal obesity in the population of developing countries and the consequent endothelial dysfunction, insulin resistance, DM 2, and CVD. In contrast, an important percentage of obese people living in developed countries have a healthy phenotype and low risk of developing CVD and DM 2. Human epidemiologic studies and experimental dietary interventions in animal models have provided considerable evidence to suggest that nutritional imbalance and metabolic disturbances early in life may later have a persistent effect on an adult’s health that may even be transmitted to the next generations. Epigenetic changes dependent on nutrition could be key in this evolutionary health behavior, acting as a buffering system, permitting the adaptation to environmental conditions by silencing or increasing the expression of certain genes.
  • Publicación
    Acceso abierto
    The role of the L-arginine-nitric oxide pathway in preeclampsia
    (2008-08-01) Lopez-Jaramillo, Patricio; Arenas, William D.; García, Ronald G.; Rincón, Melvin Y.; López Casillas, Marcos
    : Preeclampsia (PE) is a major cause of maternal and perinatal mortality, especially in developing countries. Its etiology involves multiple factors, but no specific cause has been identified. Evidence suggests that clinical manifestations are caused by endothelial dysfunction. Nitric oxide (NO), which is synthesized from L-arginine in endothelial cells by the endothelial nitric oxide synthase (eNOS), provides a tonic dilator tone and regulates the adhesion of white blood cells and platelet aggregation. Alterations in the L-arginine-NO pathway have been associated with the development of PE. Various studies, reporting decreased, elevated or unchanged levels of nitrite (NO2) and nitrate (NO3), two end products of NO metabolism, have been published. Our group contributed to those contradictory reports describing cases of PE with both elevated and decreased levels of NO2 and NO3. Apparently, diminished levels of NO could be related to deficiencies in the ingestion of dietary calcium associated to low levels of plasma ionic calcium, which is crucial to the eNOS’ activity. Also, low levels of NO could be associated with the presence of eNOS polymorphisms or the presence of increased levels of ADMA, the endogenous inhibitor of NO. High levels of NO associated to low levels of cGMP suggest a decreased bioactivity of NO, which is probably related to an increased degradation of NO caused by a high production of superoxide in states of infection and inflammation. The present article analyses and reviews the reported paradoxical roles of the L-arginine-NO pathway in PE and gives a possible explanation for these results.
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    Cardiovascular prevention in high-risk patients with type 2 diabetes mellitus : When to start it?
    (2008-08-29) García, Ronald G.; Lopez-Jaramillo, Patricio
  • Publicación
    Acceso abierto
    Uso de aspirina en la prevención de enfermedades cardiovasculares
    (2008-09) Lopez-Jaramillo, Patricio; García, Ronald G.
    En los últimos años diversos estudios demostraron que la profilaxis con aspirina es efectiva en la reducción del riesgo de enfermedad coronaria y enfermedad cerebrovascular isquémica en hombres y mujeres respectivamente. Este beneficio supera el riesgo de complicaciones hemorrágicas en sujetos con un riesgo cardiovascular mayor o igual a 10% a diez años según la escala de Framingham, que reciben bajas dosis de aspirina (75-160 mg/dL). A pesar de esto, el uso de aspirina como estrategia de prevención de la enfermedad cardiovascular, aún es muy bajo. La población colombiana podría beneficiarse de la aplicación de las recomendaciones actuales de prevención con aspirina, en especial por la evidencia que muestra una mayor susceptibilidad a presentar niveles elevados de inflamación crónica de bajo grado asociados a mayor riesgo cardiovascular. Sin embargo, se requerirían más estudios que confirmaran esta apreciación empírica.
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    Acceso abierto
    Intensive and critical care nursing perspectives
    (2009) Williams, G.F.; Fulbrook, P.R.; Alexandrov, A.W.; Cañón Montañez, Wilson; Salisu-Kabara, H.M.; Chan, D.W.K.
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    Leishmaniasis cutánea diseminada. Reporte de dos casos en Santander, Colombia
    (2009-01) Rincón, Melvin Y.; Silva, Sandra Y.; Dueñas, Ruby E.; Lopez-Jaramillo, Patricio
    Leishmaniasis is a zoonosis produced by the transmission of the protozoan leishmania caused by the bite of sand-flies from the Lutzomya specie. Several clinical manifestations present themselves, depending on the infecting strain and the host’s immune response; the most frequent variety is localised cutaneous leishmaniasis. Atypical forms sometimes develop, such as the diffuse variety, in which the number of ulcers is greate than 10, thereby affecting several body areas requiring special considerations in its diagnosis and management. This article reports two cases of patients from endemic areas of Santander suffering from diffuse cutaneous leishmaniasis produced by the L. panamensis strain. Protocols for the active search of this type of case in endemic areas throughout Colombia should be implemented.
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    Análisis de las mutaciones más frecuentes del gen BRCA1 (185delAG y 5382insC) en mujeres con cáncer de mama en Bucaramanga, Colombia
    (2009-01) Sanabria, María Carolina; Muñoz, Gerardo; Vargas, Clara Inés
    Introduction. Breast cancer is considered a worldwide public health problem, and, in Santander Province, Colombia, it is the first leading cause of morbidity and mortality by cancer in women. All cancers are considered genetic diseases, and mutations in BRCA (BReast CAncer) genes raises the risk for breast cancer by 60%-80%. The current study searched for the two most frequent BRCA1 mutations reported in the Breast Cancer Core Information database. Objective. The presence of specific mutations (185delAG, exon 2 and 5382insC, exon 20) was determined for the BRCA1 gene in women with familial/hereditary breast cancer. Materials and methods. The sample included 30 female patients using the oncology services in Bucaramanga, eastern Colombia; an informed consent, a questionnaire and a blood sample were obtained from each. The molecular analysis was done with PCR-Mismatch, to detect the insertion or eliminatation of a restriction site, and enzymatic digestion methods (HinfI or DdeI). Results. Two of the most frequent BRCA1 mutations in the international database were not found in the 30 patients studied. Conclusion. Additional mutation screening techniques are necessary involving the entire BRCA1 gene, are necessary in order to better characterize the molecular epidemiology of breast cancer in Bucaramanga, Santander, Colombia.
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    Estudio de la consistencia interna y estructura factorial de la escala de impacto de los estresores en mujeres colombianas víctimas de violencia
    (2009-01) Contreras Pezzotti, Leddy; Arteaga Medina, Juan; Campo Arias, Adalberto
    Antecedentes: la Escala de Impacto de los Estresores es un instrumento para identificar posibles casos de Trastorno por Estrés Postraumático en la práctica clínica. Sin embargo, se desconoce el comportamiento psicométrico de esta herramienta en colombianas. Objetivo: conocer la consistencia interna y la estructura factorial de la escala de impacto de los estresores en mujeres remitidas para evaluación forense debido a violencia en Bucaramanga, Colombia. Método: un grupo de 310 mujeres de entre 18 y 65 años participó en el estudio. La edad promedio de las participantes fue 31.6 años (DE = 10.7), la escolaridad promedio fue 8.8 años (DE = 4.1); el 59.1% eran empleadas, 58.7% informaron tener una pareja estable, 60.6% residían en estrato socioeconómico bajo y 52.3% informó haber sido víctima de ataque o golpes. A la escala se le calculó el alfa de Cronbach y se realizó un análisis factorial exploratorio mediante el método de componentes principales. Resultados: la consistencia interna de la escala fue 0.80 y una estructura multidimensional de tres factores (reexperiencia, evitación y afecto restringido) responsables de aproximadamente el 50% de la varianza. Conclusiones: La Escala de Impacto de los Estresores presenta alta consistencia interna y tres factores responsables de un porcentaje importante de la varianza.
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    Acceso abierto
    Etiología y susceptibilidad bacteriana a los antimicrobianos en niños con infecciones urinarias
    (2009-03) Bautista Amorocho, Henry; Suárez Fragozo, Nailibeth Dayan; Támara Urrutia, Ana Milena; Rodríguez Villamizar, Laura Andrea
    Objetivo. Conocer la frecuencia de bacterias asociadas a infecciones urinarias y el patrón de susceptibilidad en niños. Material y métodos. A 603 niños que a lo largo de 12 meses los médicos tuvieron la sospecha clínica de infección en las vías urinaria (IVU) se les obtuvo una muestra de orina para estudio bacteriológico y determinación de la susceptibilidad bacteriana a los antibióticos. Resultados. En 212 (35%) de los niños se confirmó el diagnóstico de IVU y la Escherichia coli se encontró en 144 (66%) de éstos, el Proteus sp ocupó el segundo lugar con 36 (17%). Se encontró una resistencia antimicrobiana mayor de 50% para amoxilina, cotrimoxazol y cefalotina. Conclusiones. Como en otros estudios la Escherichia coli es la bacteria más frecuentemente asociada con las IVU, por lo que se deben emplear cefaloesporinas de segunda generación, aminoglucósidos y fluoroquinonas, antimicrobianos para los que fueron sensibles.
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    Inflammation but not endothelial dysfunction is associated with the severity of coronary artery disease in dyslipidemic subjects
    (2009-04) Rueda Clausen, Christian F.; Lopez-Jaramillo, Patricio; Luengas, Carlos; Oubiña, Maria del Pilar; Cachofeiro, Victoria; Lahera, Vicente
    Endothelial dysfunction and inflammation play a key role in the development of atherosclerosis. The present study evaluated endothelial function, inflammatory parameters, and carotid intima-media thickness (IMT) in dyslipidemic patients with or without coronary artery disease (CAD). Methods. Metabolic profile and inflammatory parameters were determined in dyslipidemic patients with (+CAD, n = 33) and without (−CAD, n = 69) symptomatic CAD. Endothelial function was evaluated by flow mediated dilatation (FMD) and plasma concentration of nitrites and nitrates. Carotid IMT was measured by ultrasound. Results. No significant differences were observed in anthropometric hemodynamic or metabolic parameters between the groups. After adjusting by age and medication usage, some inflammatory markers were significantly higher in +CAD; however. no significant differences in FMD or plasma levels of nitrites were observed. Conclusions. In subjects with dyslipidemia, the presence of CAD is associated with an elevation of certain inflammatory markers and carotid IMT but not with further endothelial dysfunction.
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    Acceso abierto
    Appropriate prenatal care system : The best way to prevent preeclampsia in Andean countries
    (2009-04) Lopez-Jaramillo, Patricio; García, Ronald G.; Reyes, Laura M.; Ruiz, Silvia L.
    The main cause of maternal mortality in Colombia is preeclampsia; even though it is a major public health problem its etiology and physiopathology remain unknown. However it is believed that endothelial dysfunction plays a central role in the development of this disease. Many clinical trials have been carried out to demonstrate the effect of certain interventions to prevent preeclampsia and improve pregnancy outcomes. Our hypothesis is that the reduction of preeclampsia risk could be achieved through an appropriate health system that would provide an opportune and effective prenatal care to pregnant women allowing early diagnosis and treatment of frequent nutritional and health related problems.