[Diagnostic accuracy of blood pressure determination in clinics in control of hypertension: Proposal of new cut-off values]. / Precisión diagnóstica de la determinación de la presión arterial en consulta en el control del hipertenso: Propuesta de nuevos valores de corte.

AIM: This study seeks to determine the optimal cut-off values for the determination of the blood pressure in the clinic as a follow-up test in Primary Care practice. DESIGN: A total of 153 hypertensive patients under 80years of age who met inclusion and exclusion criteria for the study, were subjected to ambulatory monitoring of their blood pressure for 24hours (ABPM). After which two clinic-based measurements were obtained. With the results obtained from the clinic, and taking the ABMP as a reference, the ROC curve was calculated choose the optimal cut-off point. The agreement between both measurements was determined by the intraclass correlation coefficient and the Bland-Altman equation. A validation study was then carried out with the objective of diagnosing whether or not the hypertensive patient was in control. RESULTS: The optimal cut-off values were 137mmHg for systolic BP (sensitivity: 89.3%; specificity: 72.2%) and 84mmHg for diastolic blood pressure (sensitivity: 79.4%; specificity: 72.3%). The agreement in the diagnosis of control between clinic-based measurement and ABPM was 58.9% (Kappa: 0.418). CONCLUSION: The optimal cut-off value of the diastolic BP for follow-up is lower than the values currently established.

Santo Domingo's LGBT social movement: At the crossroads of HIV and LGBT activism.

The emergent Dominican LGBT movement in Santo Domingo, Dominican Republic, has been embedded in local and global structures and discourses related to HIV/AIDS, women's health, and identity. This article explores how ongoing sociocultural changes, increased international HIV funding, and elite support facilitated a surge of collective actions and the institutional reconfiguration of the movement. However, the entry of new cohorts of leaders and the alignment of leaders with global discourses of gender and human rights exposed some rifts within the movement, including over the framing of identity, confrontational tactics, and the role of health issues. While creating political opportunities, international HIV/AIDS funding also consolidated the social movement around HIV at the expense of other issues. The rapid consolidation of the LGBT movement towards HIV issues in the Dominican Republic raises questions about the role of international health funding and health-related NGOs on a movement's discourses, strategies, and consolidation, and about the recruitment of social movement leaders as public health professionals. I suggest that the trajectories of new movements, when social and political opportunities arise, are ultimately defined by their ability to bridge over generational and ideological rifts, engage in a broader spectrum of strategies, and embrace intersectional collective actions.

Persistent effects of pre-Columbian plant domestication on Amazonian forest composition.

The extent to which pre-Columbian societies altered Amazonian landscapes is hotly debated. We performed a basin-wide analysis of pre-Columbian impacts on Amazonian forests by overlaying known archaeological sites in Amazonia with the distributions and abundances of 85 woody species domesticated by pre-Columbian peoples. Domesticated species are five times more likely than nondomesticated species to be hyperdominant. Across the basin, the relative abundance and richness of domesticated species increase in forests on and around archaeological sites. In southwestern and eastern Amazonia, distance to archaeological sites strongly influences the relative abundance and richness of domesticated species. Our analyses indicate that modern tree communities in Amazonia are structured to an important extent by a long history of plant domestication by Amazonian peoples.

The Role of Institutional Placement, Family Conflict, and Homosexuality in Homelessness Pathways Among Latino LGBT Youth in New York City.

Despite the overrepresentation of Lesbian, Gay, Bisexual, and Transgender (LGBT) youth among the homeless, the processes leading to their homelessness are understudied. This ethnographic study sought to elucidate the role of sexual orientation in the pathway to housing instability among young gay men. Fieldwork included 18 months of participant observations in public spaces and at a homeless LGBT youth organization in New York City, as well as formal semistructured interviews with 14 Latino young men and five staff. Three distinct pathways emerged. Some youth became homeless after placement in state systems of care disrupted their social support systems, while others became homeless after extreme family conflict over sexual orientation. Nonetheless, most youths became homeless as a result of long-term processes of family disintegration in which normative adolescent development and disclosure of homosexuality exacerbated preexisting conflict. These findings suggest the need to examine the accumulation of risks before disclosure exacerbates family conflict and increases their risk of homelessness.

Estudio de la composición química y actividad antifouling del extracto de la esponja marina Cliona delitrix / Study of the chemical composition and antifouling activity of the marine sponge Cliona delitrix extract

El extracto crudo y la fracción orgánica de la esponja marina Cliona delitrix, recolectada en San Andrés Islas (Caribe Colombiano), muestra actividad antifouling en ensayos de campo. La fracción orgánica es separada por cromatografía en columna logrando obtener fracciones enriquecidas en glicéridos, glicolípidos, fosfolípidos, ácidos grasos libres, ésteres metílicos y monohidroxiesteroles. Cada una de las fracciones es identificada de manera preliminar por TLC y técnicas de dereplicación (RMN). Los ácidos grasos obtenidos de la hidrólisis de cada una de las fracciones de glicéridos, glicolípidos y fosfolípidos son transformados en sus correspondientes ésteres metílicos, los cuales son analizados por CGAREM; luego se convierten en sus derivados pirrolidínicos y también se analizan por CG-EM. El estudio cuidadoso de los EM, tanto del éster metílico como de las pirrolidina, y los valores de ECL permiten identificar 89 ácidos grasos diferentes. Entre éstos se destacan: el ácido 7,10,12,14-icosatetraenoico, que se reporta por primera vez, y los ácidos 5,9-hexacosadienoico y hexadecanoico, por ser los más abundantes en todas las fracciones. Adicionalmente se identifican, mediante análisis de CG-EM y H-RMN, 19 monohidroxiesteroles. Se destacan el colestanol y el clionasterol, por ser los más abundantes, y también es de notar la presencia de estanoles (cerca del 30%) que no se habían informado antes para este género.

In a field test for antifouling activity the raw extract and the organic fraction obtained from the marine sponge Cliona delitrix, collected at the San Andrés Islas (Colombia, Caribbean Sea), showed activity. The organic fraction was separated by column chromatography to obtain enriched fractions of glycerides, glycolipids, phospholipids, free fatty acids, fatty acids methyl esters (FAMEs) and monohydroxysterols identified by TLC and dereplication techniques (NMR). The glyceride, glycolipid, and phospholipid fractions were hydrolyzed, and the fatty acids methyl esters obtained, together with the initial fatty acids fraction were converted into their methyl esters and analyzed by HRGC-MS. In order to locate unsaturations and alkyl branches in fatty acids, their methyl esters derivates were transformed to the corresponding pyrrolidides and subsequently analyzed by HRGC-MS. The identification of the fatty acids was carried out using their ECL value as methyl esters, and particularly the study of their pyrrolidide spectra was used to locate unsaturations and alkyl branch positions. The analysis allowed the identification of 89 fatty acids. The main acids include the new 7,10,12,14-icosatetraenoic acid, as well as 5,9-hexacosadienoic acid and hexadecanoic acid. Additionally, 19 monohydroxysterols were identified by HRGC-MS and NMR H. Cholestanol and clionasterol were the most abundant compounds and the stanols presence (near to 30%) was not previously reported for this genus.

Estudio de prefrrmulación para el desarrollo deun gel a base de polímeros con capacidad mucoadhesiva para ensayos de alelopatía en invertebrados mriinos. / Preformulation study for the development of a polymer-based gel with mucoadhesive propierties for its use in allelopathy assays in marine invertebrates

La investigación se desarrolló con el fin de implementar una metodología que permitiera la realización de ensayos de interacciones alelopáticas entre corales y esponjas, minimizando la interacción física provocada por el uso de dispositivos que producen roce y efecto abrasivo sobre los pólipos del coral. Se llevó a cabo un estudio de preformulación utilizando polímeros con características mucoadhesivas sobre mucus que recubre los pólipos de coral, con el fin de obtener un gel, incorporando en las formulaciones un extracto de la esponja Cliona delitrix. Se caracterizaron propiedades como extensibilidad y adherencia, así como la capacidad bioadhesiva de las formulaciones propuestas, considerando su comportamiento reológico. Estas mostraron una buena estabilidad física frente a las condiciones del medio marino tanto in vitro como in situ. De igual manera, se diseñó un dispositivo que facilitó la aplicación del gel sobre la superficie de los corales por parte de los buzos en el arrecife coralino. Finalmente se estudió el comportamiento de liberación al medio acuoso simulado del gel con el extracto de la esponja objeto de estudio.

This study was carried out with the purpose of implementing a methodology to assess allelopathic interactions assays between corals and reef sponges reducing the physical interaction caused by the use of devices that involve abrasion and harm over the coral polyps. Was carried out a preformulation study using polymers with mucoadhesive on the mucus that cover the coral polyps, with the purpose of develop a gel, incorporating an extract from Cliona Delitrix into the formulations. Obtained formulations were characterized by properties such as extensibility, adherence and mucoadhesive capacity. These formulations showed great physical stability under prevalent marine conditions both in vitro and in situ. In the same way was designed a device that let the smearing of the gel over the coral surfaces carried out for the divers in the coral reefs. Finally, was studied the releasing behavior of the gel with the sponge´s extract into the sea water conditions.

Successfully establishing laparoscopic surgery programs in developing countries. Clinical results and lessons learned.

BACKGROUND: Laparoscopic surgery has not been widely established in developing countries due to the lack of access to training and lack of money. We describe our experience using on-site training programs to efficiently teach and propagate laparoscopic surgery in Leon, Nicaragua; La Paz, Bolivia; and Santa Cruz, Bolivia. METHODS: A group of well-trained and motivated local surgeons was identified in each country as the initial target for teaching. Participants were taught basic and advanced laparoscopic surgery during on-site didactics, animal laboratories, and proctoring sessions. Follow-up courses were held until the target group of surgeons was capable of independently teaching and supervising laparoscopic surgery among other surgeons in each country. RESULTS: Multiple technical and logistic difficulties were encountered. In Leon, Nicaragua, and La Paz, Bolivia, a total of eight surgeons were fully trained and proctored in laparoscopic cholecystectomy. In La Paz and Santa Cruz, Bolivia, a total of seven surgeons were instructed in advanced laparoscopic procedures. To date, over 180 patients have undergone laparoscopic cholecystectomy or advanced procedures with a morbidity similar to that reported in literature series in the United States. CONCLUSIONS: Our experience demonstrates that in spite of numerous limitations, basic and laparoscopic surgery can be efficiently and safely taught in developing countries. Many lessons were learned in how to safely and efficiently use laparoscopic equipment and instruments within strict financial constraints.

Operative enteroscopy. A useful tool in the evaluation and intervention of bilioenteric anastomoses.

Roux-en-Y hepaticojejunostomy is the procedure of choice in the management of patients with major bile duct injuries. In instances of anastomotic stricture, this anastomosis is inaccessible to conventional endoscopy. A technique is described for assessment and intervention of bilioenteric anastomoses that escape the reach of conventional endoscopy. Three cases are presented illustrating the feasibility of open and laparoscopic-assisted small-bowel endoscopy. All patients presented with recurrent cholangitis and had multiple interventions in their biliary tree prior to referral. At operation, the limb of jejunum going to the bilioenteric anastomosis was identified, an enterotomy was made, and a flexible endoscope was passed to evaluate the anastomosis. In two cases the anastomosis was revised by endoscopically excising scar tissue. In the third case the anastomosis was patent and unnecessary intervention was avoided. There was no morbidity or mortality and the patients had complete resolution of their symptoms. Operative endoscopy appears to be useful in the evaluation and intervention of bilioenteric anastomoses that cannot be evaluated by conventional endoscopy.

Iron bioavailability from diets consumed by different socioeconomic strata of the Venezuelan population.

The iron bioavailability from three typical diets consumed by socioeconomic stratum IV (SES IV--working class) of the Venezuelan population was determined by the extrinsic label method. Although the iron content of the SES IV diets was about the same (250 mumol/d) as that of upper (SES I-III) and lower (SES V) socioeconomic strata diets, iron-replete subjects absorbed 43 and 61% more iron from the SES I-III diets than from the SES IV and V diets, respectively, and absorption from the main meal of the SES I-III diets was 100% greater. However, iron deficient subjects absorbed about the same amount of iron (45 mumol/d) from the SES IV diets as from the SES I-III diets. The SES I-III diets contained more iron absorption enhancers (ascorbic acid and meat protein) and less of the inhibitor phytate, than the SES IV and V diets. Iron absorption from the meals of four diets consumed at different times during the day was also measured. There was no significant difference in the percentage iron absorption from the same meals eaten in the morning after an overnight fast, and when eaten at the customary time of day.

Sigmoid volvulus in the high altitude of the Andes. Review of 230 cases.

Sigmoid volvulus (SV) is uncommon in the United States. Little has been published in the English literature about the high incidence of SV among rural areas of the Bolivian and Peruvian Andes at 13,000 feet above sea level. A review of 230 cases of SV in a Bolivian hospital is presented. SV accounted for 79 percent of all intestinal obstructions. Nonoperative reduction was attempted in all patients except those with peritonitis. Nonoperative reduction alone was performed in 31 percent of the patients, and 69 percent underwent surgical intervention, 66 percent as an emergency and 3 percent electively. Surgical treatment consisted of sigmoidectomy and primary anastomosis (50 percent), Hartmann's procedure (12 percent), and operative detorsion with sigmoid plication (38 percent). Overall mortality was 13.5 percent. Fifty-seven of the surgically treated patients developed significant complications. The etiology of SV is unclear. High altitude, along with other etiologic factors, may play an important role in SV. To our knowledge, this series represents the highest incidence of SV in bowel obstruction.

Heparin effect on plasma fibrinogen in the thrombophilic syndrome.

The effects of heparin were studied in a group of 42 patients with preinfarction angina (PA) and acute myocardial infarction (AMI) whose plasma fibrinogen was increased. Plasma fibrinogen was measured by the turbidimetric method in timol turbidimetric units. Statistically significant results proved that heparin reduces the plasma fibrinogen progressively over a treatment period of 6 weeks. During the first three weeks a dose of 1 cc (50 mg or 5000 IU) was given by intravenous injection at 6-h intervals, this was followed by a dose of 2 cc (100 mg or 10,000 IU) given by subcutaneous injection at 12-h intervals for a further three weeks. Hyperfibrinogenemia is perhaps one of the most important factors in the thrombophilic syndrome, and at the same time it is one of the fundamental physiopathological alterations observed in AMI and PA. Because heparin reduces hyperfibrinogenemia it has a beneficial effect in these diseases.

Use of flecainide acetate in the treatment of premature ventricular contractions.

Flecainide acetate, a new benzamide antiarrhythmic agent, was studied after single-dose intravenous administration to 35 male and female patients with nonlife-threatening premature ventricular contractions (PVCs). Prior Holter monitoring established that each patient had "stable" PVCs of at least 600/12 hr. PCV in 80% of the patients was attributed to underlying coronary heart disease and/or Chagas' disease. After bolus injections of flecainide acetate, cardiac rhythm was again monitored by Holter ECG recording for 24 hours. All patients had 100% suppression of PVCs, ranging from 60 to 1440 minutes in duration. The average duration of suppression for all patients was more than 8 hours (498 minutes). Follow-up at 6, 12, 18, and 24 hours showed statistically significant PVC reductions (p less than 0.01) when compared with control rates. Side effects were trivial. The extended half-life of this new agent (about 20 hours in cardiac patients) may allow a convenient twice-daily dosage schedule.