Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial.

Background: In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. Aim: To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. Methods: A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. Results: One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). Conclusion: BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.

[Structural changes to the brain in drug-resistant juvenile myoclonic epilepsy]. / Cambios estructurales cerebrales en la epilepsia mioclónica juvenil farmacorresistente.

INTRODUCTION: The aim of this research is to determine the changes in brain structures, both cortical and subcortical, in patients with drug-resistant juvenile myoclonic epilepsy (JME), in order to contribute to the understanding of the characteristics of the drug-resistant syndrome and to offer possible answers and hypotheses for further studies and more adequate treatments. SUBJECTS AND METHODS: Observational case-control study. A convenience sample size of four cases and 16 healthy controls was defined to ensure the feasibility of the project (ratio of 4:1). The data collected for patients with drug-resistant JME came from 1.5T MRI equipment. FreeSurfer software was used to determine cortical and subcortical areas in both drug-resistant JME patients and healthy controls. RESULTS: A total of 20 participants were included in the study, of whom four (20%) were drug-resistant JME patients and 16% (80%) were healthy controls. The clusters with statistically significant differences in cortical thickness are located in the precentral gyrus, superior temporal gyrus, transverse temporal gyrus, medial temporal gyrus and supramarginal gyrus, predominantly in the left hemisphere. CONCLUSIONS: Structural brain changes are observed in patients with drug-resistant JME that may go undetected by the conventional processing techniques used in magnetic resonance imaging.

TITLE: Cambios estructurales cerebrales en la epilepsia mioclónica juvenil farmacorresistente.Introducción. El objetivo de la investigación es determinar los cambios en las estructuras cerebrales, tanto corticales como subcorticales, de pacientes con epilepsia mioclónica juvenil (EMJ) farmacorresistente, para aportar al conocimiento de las características del síndrome farmacorresistente y brindar posibles respuestas e hipótesis para nuevos estudios y tratamientos más adecuados. Sujetos y métodos. Estudio observacional de casos y controles. Se define un tamaño de muestra a conveniencia de cuatro casos y 16 controles sanos para garantizar la viabilidad del proyecto (relación 4:1). Los datos recolectados para los pacientes con EMJ farmacorresistentes provienen de un equipo de resonancia magnética de 1,5 T. Para determinar las áreas corticales y subcorticales, tanto en la EMJ farmacorresistente como en los controles sanos, se usó el software FreeSurfer. Resultados. Se incluyó a un total de 20 participantes en el estudio, de los cuales cuatro (20%) corresponden a EMJ farmacorresistentes y 16 (80 %) a controles sanos. La localización de los clústeres con diferencias estadísticamente significativas en el grosor cortical se encuentra en el giro precentral, el giro temporal superior, el giro temporal transverso, el giro temporal medial y el giro supramarginal, con predominancia en el hemisferio izquierdo. Conclusiones. Se evidencian cambios estructurales cerebrales en pacientes con EMJ farmacorresistente, cambios que pueden pasar desapercibidos por las técnicas convencionales en el procesamiento de las imágenes de resonancia magnética.

Consumer acceptability versus trained sensory panel scores of powdered milk shelf-life defects.

The objective of the present work was to correlate consumer panel acceptability versus trained sensory panel scores for appearance and flavor defects likely to appear during storage of whole milk powder. Descriptors selected for the study were: acid, caramel, cooked, dark color, lipolysis, and oxidized. For each descriptor a set of nine samples with different intensities were measured for acceptability and likelihood to consume by a 50-member consumer panel and for sensory intensity by a trained panel. Linear correlations between sensory acceptability and trained sensory panel scores were used to determine the sensory failure cut-off point for each descriptor, except caramel and cooked, which were not critical from the consumer's point of view. Differences in acceptability were found between Argentine and Uruguayan consumers for oxidized samples, while for lipolysis flavor, Argentine and Costa Rican consumers behaved similarly. For the color descriptor, significant changes in acceptability measured on a hedonic scale did not mean that consumers refused to consume the product. In contrast, for flavor descriptors, as soon as a significant decrease in acceptability occurred approximately 30% of the consumers said they would not consume the product. The sensory failure cut-off points presented in this paper can be used as a guide in future studies on the shelf life of MP and can also be of value in establishing sensory specifications for quality control programs. The methodology of correlating consumer acceptability to sensory panel scores and, thus, defining sensory failure is an improvement over more arbitrary criteria presented in most shelf-life studies.

[The evidence for higher blood pressures in children and adolescents of the rural interior of Galicia than in other locations in Spain]. / Evidencia de presiones arteriales más elevadas en niños y adolescentes del interior rural de Galicia que en otras localizaciones en España.

AIM: To analyze differences in blood pressure levels in children and adolescents in Galicia with those of peers living in other parts of Spain. DESIGN: Cross-sectional study done in a rural area in Galicia. PARTICIPANTS: 870 boys and girls 6 to 16 years old. They are compared with published data from the RICARDIN study, that includes 10,042 participants selected at the schools in nine centers of Spain (one was the center in Galicia). MEASUREMENTS: Standardized methodology and certification procedures were used in Galicia and Spain to measure weight, height, Quételet index, systolic (SBP) and fifth-phase diastolic blood pressure (DBP5) and sexual maturation. Data are presented by sex and age group (1 year) both in Galicia and Spain. RESULTS: From 11 years and above, girls in Galicia present higher SBP than in Spain. In boys, the difference appears later. Galicia shows higher DBP5 levels than Spain in every age-sex group. In relation to obesity, the differences are of a small magnitude in the Quételet index, again, higher values in Galicia. CONCLUSIONS: This is the first population-based study available that rules out the possibility that the observed differences, previously already suggested, could be attributed to methodological problems. The differences in blood pressure and obesity between Galicia and other areas of Spain, already previously suggested in adults, can be the reflection of differences present from childhood.

Effects of anaesthesia based on high versus low doses of opioids on the cytokine and acute-phase protein responses in patients undergoing cardiac surgery.

BACKGROUND: Cardiac surgery with cardiopulmonary bypass (CPB) evokes a systemic inflammatory response involving the proinflammatory cytokines tumor necrosis factor-alpha (TNFalpha), interleukin (IL)-1, IL-6, IL-8 and anti-inflammatory cytokines such as IL-10. Like IL-10, opioids downregulate the immune responses in vivo and in vitro, including the activity of the cytokine-producing monocytes and granulocytes. The proinflammatory cytokines are potent inducers of the hepatic acute-phase protein synthesis. The aim of the present study was to investigate if choice of anaesthesia, based on high-dose opioids (fentanyl) versus low-dose opioids influenced the release of IL-6, IL-8, and IL-10. Secondly, it was investigated whether serum amyloid P-component (SAP) is an acute-phase protein in man such as C-reactive protein (CRP), with which it is physically and structurally related. METHODS: Sixteen patients submitted to elective coronary artery bypass grafting (CABG) surgery were randomized to either low-dose opioid anaesthesia consisting of thoracic epidural analgesia combined with inhalational anaesthesia (group I) or high-dose fentanyl anaesthesia (group II). From each patient 18 blood samples were taken perioperatively. Cytokine analyses were performed with ELISA, CRP and SAP mere measured with rocket immunoelectrophoresis (RIE). RESULTS: Surgery and CPB elicited a marked, transient and almost simultaneous proinflammatory and anti-inflammatory cytokine response with no differences between the groups. The cytokine levels returned to preoperative levels 1-3 d after operation. Anaesthesia and surgery did not affect SAP plasma levels while patients showed a major increase in CRP concentrations preceding the cytokine responses. CONCLUSION: CABG performed during two different anaesthetic techniques, high-dose fentanyl versus low-dose opioid anaesthesia, elicited a well-defined cytokine response with minor variation in the time course of each cytokine. The cytokine production was not modified by type of anaesthesia. Finally, SAP is not an acute-phase protein in men.

[The serological diagnosis of HIV-1 in samples of dried blood on filter paper by the HIV-1 DAVIH Dot system]. / Diagnóstico serológico del VIH-1 en muestras de sangre seca en papel de filtro por el sistema DAVIH Dot VIH-1.

Dried blood specimens spotted on filter paper were evaluated by the HIV-1 DAVIH Dot system from DAVIH Laboratories (Havana, Cuba). The samples used, 103 positive and 105 negative, were previously confirmed by DAVIH Blot from DAVIH Laboratories. In order to use the dried blood on filter paper some modifications were made to the original procedure regarding the times of incubation of the samples and conjugate, and the agitation in both stages. Relative sensitivity and specificity of 100 and 99.05%, respectively, were attained.

Endogenous morphine levels increase following cardiac surgery as part of the antiinflammatory response?

Exogenous morphine downregulates the activity of immunocompetent cells such as lymphocytes, granulocytes and macrophages. Furthermore, morphine increases the secretion of CRH, ACTH and glucocorticoids, i.e. substances with inhibitory effects on the immune system. In the present study we tested the hypothesis that endogenous morphine production is increased as part of the antiinflammatory response to cardiac surgery. Sixteen patients submitted to elective coronary artery bypass grafting (CABG) surgery were randomized to either thoracic epidural analgesia combined with general anaesthesia (group I) or high-dose fentanyl anaesthesia (group II). Patients in group I did not receive morphine while patients in group II received systemic morphine for postoperative pain relief. From each patient 18 blood samples were taken perioperatively and tested for morphine. Furthermore, monocyte function with respect to motility and shape was determined by computer-assisted image analysis. A steep increase in plasma morphine concentrations was demonstrated on the first postoperative day in patients in group I (not given morphine). Plasma morphine levels remained significantly elevated during the following five postoperative days. Patients in group II given morphine as pain treatment showed a larger and earlier morphine peak related to the morphine administration. Computer-assisted image analysis of leukocyte behaviour revealed a biphasic increase in cell motility. In conclusion, we demonstrate for the first time that endogenous morphine levels increase after the trauma of surgery. We surmise that morphine is part of the antiinflammatory response to cardiac surgery.

[Guidelines for the elaboration of programs for the primary prevention of cardiovascular diseases. The Working Group for Primary Cardiovascular Prevention]. / Directrices para la elaboración de programs de prevención primaria de enfermedades cardiovasculares. Grupo de Trabajo de Prevención Primaria Cardiovascular.

This paper, elaborated by consensus between experts from Scientific Societies and the Health Administration, is aimed at providing general guidelines for the elaboration and prompting of cardiovascular disease primary prevention programmes, through individual risk factors screening and control. It is expected to be helpful for primary care professionals. After reviewing the rationale and logistics of the programmes starting in the Spanish context, an outline for the risk screening and assessment of the individuals attending the health services is set out. The strategies for high risk individuals control and the periodic health examination of low risk subjects are developed, emphasizing the multifactorial approach. Lastly operational criteria for the management of each risk factor taking simultaneously into account the whole risk picture, embracing definition criteria and consensus recommendations, are stated.

National standards of blood pressure for children and adolescents in Spain: international comparisons. The Spanish Group for the Study of Cardiovascular Risk Factors in Childhood and Youth.

This study determined age-specific patterns of blood pressure (BP) in Spanish children aged 1-18 years for the purpose of developing BP guidelines for this population. Age- and sex-specific BP levels were constructed by pooling data from 15 studies conducted in Spain. Pooled mean BP levels were then compared with those reported by the US Second Task Force on Blood Pressure Control in Children and those recently reported from a separate pooled analysis of the relevant published surveys collected worldwide. In the Spanish data, the average 1-year age increment in Systolic BP (SBP) was uniform for boys and girls until 13 years at 2 mmHg; for boys aged 13-18 the increase was 1.3 mmHg/year; in contrast, girls reached their maximum values at age 13 and the means remained basically unchanged for female adolescents. Fifth-phase diastolic BP (DBP5) values showed a uniform increase for both boys and girls from ages 6 to 18 years at 0.9 mmHg/year. In most age-sex subgroups, mean SBP values were higher (7-8 mmHg on average) in Spain than in the US. However, Spanish values for SBP were in general only slightly higher or approximately equal to those for the international data, from ages 6 to 18 years. The patterns of change in SBP with age differed somewhat in the three data sets. Comparisons for DBP were limited to the age groups for which readings of DBP5 were available. For DBP5, only slight differences between the Spanish and International pools were observed (ages 6-18 compared), but these values were notably higher than those from the US (ages 13-18 compared). These findings suggest that the use of any particular age-based standard to evaluate readings in children in diverse populations cannot be recommended, at least until there is a better understanding of the true differences in BP between populations.

Relationship of blood pressure levels to height, weight and sodium and potassium excretion in Spanish children.

To study the distribution of blood pressure (BP) in children we measured the BP of 1928 children (aged 6-14 years) living in Torrejón de Ardoz, Spain. Of these, 441 children, representative of all ages, supplied a 24-h urine sample from which sodium and potassium were determined. There was a progressive rise in systolic BP of 1.8 mmHg and in diastolic BP of 0.8 mmHg per year of age. The correlations between BP, height and weight were positive and almost always statistically significant. Sodium excretion varied from 159 +/- 30 mmol/day at 6-7 years to 170 +/- 40 mmol/day at 13-14 years. There was a positive correlation between BP and sodium excretion which was statistically significant for diastolic BP in girls aged 6-7 years (P < 0.01) and for systolic BP in boys aged 10-12 (P < 0.05) and 13-14 (P < 0.01) years.