Morning blood pressure surge as a predictor of cardiovascular events in patients with hypertension.

BACKGROUND: The prognostic value of ambulatory blood pressure (BP) monitoring (ABPM) is poorly understood in Latin American populations. METHODS: A prospective observational study was conducted on 1339 patients with hypertension who underwent 24-h BP monitoring between 2015 and 2019. The incidence of serious adverse cardiovascular events (MACE) was analysed using a Cox proportional hazards model adjusted for potential confounders. Three previously reported morning surge definitions were evaluated for SBP and DBP using different ABPM components: sleep-through morning surge, pre-awakening, and morning night-time difference. RESULTS: The mean age was 62 years, 52% were female, 32.8% had dyslipidaemia, 27.2% were smokers, and 7.8% had diabetes. During a median follow-up period of 32 months, 197 MACE occurred. In men, the adjusted hazard ratio (HR) was 1.84 [95% confidence interval (CI), 1.35-2.49; P < 0.001). The HR increased to 2.03 (95% CI, 1.89-2.17; P < 0.001) with a cut-off value of 35 mmHg for a 10 mmHg increase in sleep-through morning surge. The increased adjusted HR associated with the morning rise persisted for each secondary endpoint, including 21 cardiovascular deaths [HR: 2.70 (95% CI, 2.03-3.60; P < 0.001)], 78 myocardial infarctions [HR: 1.92 (95% CI, 1.72-2.15; P < 0.001)], 24 hospitalisations for heart failure [HR: 1.77 (95% CI, 1.48-2.12; P < 0.001)], 22 strokes [HR: 2.32 (95% CI, 1.85-2.91; P < 0.001)], and 52 atrial fibrillations [HR: 1.94 (95% CI, 1.71-2.20; P < 0.001)]. CONCLUSION: The morning BP rise was the most important circadian prognostic factor for MACE in patients with hypertension, which deserves more attention.

Recognizing, normalizing and articulating: An approach to highlight plural values of water ecosystem services in Colombia.

The dialectical relationship between ecosystems and society is complex; therefore, holistic approaches are required to address this complexity. This view also stands out in the ecosystem services valuation field, where different scholars and global platforms have drawn attention to the need to incorporate plural valuation initiatives at decision-making. In this sense, through a comprehensive design, we conducted a multi-layered valuation of ecosystem services, and we highlighted multiple values in two areas of the province of Caldas, Colombia. We proposed a three-phase valuation process called Recognizing, Normalizing and Articulating values. Then, in cooperation with the regional environmental authority, we obtained different water-related ecosystem services values. Our results showed some warnings: first, we found mismatches between ecosystem services values; second, people assigned high values to ecosystems but the actual capacity of ecosystems to support ES is low. Finally, monetary values were marginal compared to social and ecological values. We conclude by saying that the more strata are assessed, the more values appear in the valuation scenarios, and those values could be conflicting. Our results have political implications, since they highlight the need to incorporate plural values as a fundamental tool for planning and land use in real scenarios where conflicts of interest and values are evident.

Characterization of the Stool Microbiome in Hispanic Preschool Children by Weight Status and Time.

BACKGROUND: Variations in gut microbiota composition and diversity have been associated with childhood adiposity, although most studies describing this have been cross-sectional in nature. Our objective was to evaluate associations between body weight and the gut microbiota over time in obese preschool-age children. METHODS: Obese, preschool-age, Hispanic children provided stool samples at baseline and following a 6-month behavioral intervention. Normal-weight (NW) children also provided stool samples. Stool microbial community composition was characterized using 16S rRNA gene sequencing. Estimates of within-sample diversity were calculated on operational taxonomic unit (OTU) count data, and the Firmicutes:Bacteroidetes (F:B) ratio was determined on per-sample basis. Estimates of between-sample diversity were generated using the weighted Unifrac metric, differential abundances were evaluated using Wilcoxon rank-sum tests, and associations of microbiome features with clinical data were quantified using Spearman rank correlations. RESULTS: For the 30 obese children sampled preintervention and postintervention, a decrease in body mass index (BMI) z-score from 2.55 to 2.34 (p = 0.004, paired t-test) was observed. Bacteroides massiliensis was significantly enriched in obese children, while B. plebius was significantly enriched in NW controls. We identified significant correlations between multiple Bacteroides-like OTUs and BMI z-score, but neither F:B ratios nor OTU-level abundances were altered in conjunction with weight change in the obese children. Rather, highly individualized OTU-level responses were observed. CONCLUSIONS: Although differences exist between the gut microbiota of obese and NW children, we detected highly individualized responses of the gut microbiota of obese children over time and following weight loss.

Factors associated with the severity and complication of patients with malaria hospitalized between 2009 and 2013 in three municipalities of Colombia, case control study.

BACKGROUND: Malaria worldwide annual reported cases range between 250 and 500 million and nearly half a million deaths are reported every year. Colombia has a vast expanse of territory with environmental and social conditions conducive to malaria transmission, which is the reason why it has second place in Latin America for the number of cases of malaria. METHODS: This is a retrospective, paired, case-control study that compares patients with severe malaria and malaria patients without mention of complication. Medical records of patients with confirmed malaria diagnosis were reviewed. The objective of this study was to identify factors associated with complicated malaria in three municipalities of Colombia during the period 2009-2013. RESULTS: A total sample of 180 medical records was collected, 60 corresponding to cases and 120 to controls following a 1:2 ratio. From the total sample, 88.33 % (159) of subjects were originally from Tumaco, 7.78 %, most of the patients of the study (104) were diagnosed and treated in 2013. Among the laboratory findings, the platelet count was found to have statistically significant differences between cases and controls; this was also true for total bilirubin value and transaminases. The most prevalent severity finding was clinical jaundice, followed by elevated bilirubin (25 %) and elevated transaminases (44.4 %). Thrombocytopenia was found in 11/44 cases (20 %) and only five of 60 patients (8.3 %) presented severe anaemia. The multivariate analysis showed that a platelet count <100,000 and clinical jaundice not associated with organ failure, were the two variables associated with severe malaria in the patients described. CONCLUSIONS: Most of the cases studied, despite meeting criteria of severity, were shown not to be as morbid or severe as in other countries. Clinical jaundice and thrombocytopaenia are associated with severe malaria, and they can be used by general practitioners or primary care physicians to promptly identify patients who may have severe malaria.

A descriptive study of 16 severe Plasmodium vivax cases from three municipalities of Colombia between 2009 and 2013.

BACKGROUND: Plasmodium vivax, the most geographically distributed cause of malaria, accounts for more than 70% of cases in the Americas. In Colombia, P. vivax was responsible for 67.3% of cases in the last five years. Despite vivax malaria impact worldwide, historically it has been neglected and considered to be a benign disease. In the last decade medical literature reports have emerged countering this benign outlook. This study pretends to describe the clinical and paraclinical profile of severe vivax malaria cases hospitalized in Tumaco, Cali, Buenaventura between 2009 and 2013, to contribute to the knowledge regarding the behaviour and clinical expression of this disease. METHODS: This is a descriptive, retrospective case-series study of 16 severe malaria vivax cases, hospitalized between 2009 and 2013, in Colombian municipalities of Tumaco, Buenaventura and Cali. Severe malaria vivax cases were defined using criteria adapted from the national guidelines. Descriptive analyses of reason for consultation, signs and symptoms, diagnosis, treatment, paraclinical characteristics, complications, and time hospitalized, were conducted. RESULTS: Sixteen cases of severe P. vivax were analysed. Fever, chills and headache were shown to be the main admission symptoms. Elevation of total bilirubin levels in 18.75%, and severe thrombocytopaenia in 25% of cases were the main complications presented during hospitalization. All cases responded to treatment, there were no deaths. CONCLUSIONS: The following questions derived from this study could be the basis for future research: 1) Does the time to consultation have an impact on the number of days hospitalized and how cases progress during hospitalization, 2) Are the severity criteria in WHO guidelines sensitive enough to be used in clinical practice compared to national guidelines, and 3) How does malnutrition contribute to anaemia in malaria-endemic regions.

Anemia hemolítica autoinmune postinfección por virus de la hepatitis A: informe de caso / Autoimmune haemolytic anaemia associated to hepatitis A: case report

La anemia hemolítica autoinmune se asocia con una variedad de virus hepatotrópicos, en particular citomegalovirus (CMV), virus del Epstein-Barr y de la hepatitis B. No es frecuente dentro de la historia natural de la hepatitis A, la aparición de anemia hemolítica, y cuando se presenta, generalmente se asocia a deficiencia de glucosa-6-fosfato deshidrogenasa. Presentamos el caso de un paciente de sexo masculino sin hemólisis previa, con astenia e ictericia de dos meses de evolución y hepatomegalia 14 cm por debajo del reborde costal derecho. Los hallazgos en los exámenes de laboratorios mostraron anemia hemolítica con Coombs directo positivo, anticuerpos tipo inmunoglobulina M contra el virus de la hepatitis A positivos, niveles de bilirrubinas 20 veces y aminotrasferasas cuatro veces por arriba del rango normal; con estos datos el paciente fue diagnosticado como hepatitis A complicada con anemia hemolítica y probable hepatitis autoinmune asociada, por lo que se inició manejo con corticoides, alcanzándose mejoría clínica. Resaltamos la importancia de descartar la infección por el virus de la hepatitis A como posible etiología de anemia hemolítica autoinmune.