Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial.

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. OBJECTIVE: This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. METHODS: A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. RESULTS: Of the 930 randomized patients, 805 (86.5%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. CONCLUSIONS: In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. TRIAL REGISTRATION: ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2018-028017.

Percepción de diversos sectores sociales de Colombia sobre los biobancos con fines de investigación / The perception of different social agents in Colombia regarding biobanks for research purposes

Introducción. Los biobancos con fines de investigación son un bien público que necesita de la participación activa de todas las partes interesadas, por lo cual es importante conocer la percepción que tiene el público general en Colombia sobre su intervención en un biobanco. Objetivo. Indagar en diferentes sectores sociales colombianos sobre su percepción en torno a la donación de material biológico humano para ser almacenado en biobancos con fines de investigación. Materiales y métodos. Se hizo un estudio exploratorio tanto cuantitativo como cualitativo, entre personas sanas de diferentes sectores del país mediante una encuesta anónima sobre su conocimiento y actitudes con respecto a los biobancos. Resultado. La encuesta fue respondida por 368 personas, que incluían investigadores en salud, abogados y miembros de comités de ética de la investigación. El 96 % de los sujetos expresó su voluntad de donar material biológico, aunque el 60 % manifestó tener desconfianza en que sus muestras fueran usadas en algunos tipos de investigación, especialmente en clonación humana. Cerca de la mitad de los participantes refirieron saber qué era un biobanco, sin embargo, menos del 3 % tenía claridad suficiente sobre el concepto. Conclusión. Los participantes expresaron su disposición a donar y almacenar material biológico con fines de investigación, así como su opinión sobre algunos aspectos de la gestión de los biobancos. Las opiniones del público general se deben tener en cuenta en el desarrollo de políticas que regulen la actividad de los biobancos con fines de investigación en Colombia.

Introduction: Biobanks for research purposes are public assets that require active participation from all interested parties; therefore, it is important to discern and investigate the perception that the general public in Colombia has with regards to their participation in a biobank. Objective: To question different healthy Colombian social agents about the perception they have on donating human biological material to be stored in a biobank for future research purposes. Materials and methods: We conducted an exploratory quantitative and qualitative research by means of an anonymous survey on healthy members of the Colombian community in order to evaluate their knowledge and stances related to biobanks. Results: Three hundred sixty-eight (368) individuals completed the survey, including health-care researchers, lawyers and members of research ethics committees. Ninety-six percent (96%) of the subjects stated their willingness to donate biological material to biobanks, although 60% expressed distress about their samples being used for certain research activities, mainly human cloning. Even though about half of the participants reported knowing what a biobank is, less than 3% of the individuals had a clear concept of them. Conclusion: Participants showed their willingness to donate and store their biological material for research purposes. Similarly, they expressed their opinion about issues related to the management of biobanks. It is necessary to take into account the opinions of the general public in the development of policies that regulate biobanks for research purposes in Colombia.

[Relationship between exclusive breastfeeding the first six months of life and development of insulin resistance in children and adolescents in Bucaramanga, Colombia]. / Relación entre la lactancia materna exclusiva los primeros seis meses de vida y el desarrollo de resistencia a la insulina en niños y adolescentes de Bucaramanga, Colombia.

INTRODUCTION: exclusive breastfeeding (EB) is a protective factor against the development of insulin resistance (IR) as mainstay of the metabolic syndrome. OBJECTIVE: the objective of the study was to evaluate the relationship between EB during the first six months of life and the development of IR through the Homeostasis Model Assessment (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) indexes. MATERIAL AND METHODS: a population-based cohort study included 494 adolescent participants, from whom socio-demographic, anthropometric, and cardiometabolic variables were assessed using the HOMA-IR and QUICKI indexes to determine the degree of association between EB and the development IR. The results were expressed in medians. RESULTS: the prevalence of EB was 42%. The results suggest a protective effect of EB on IR, in such a way that for each extra month of EB, the HOMA-IR index decreases in 0.32 (p = 0.005) and the index QUICKI increases in 0.70 (p = 0.008). Regarding waist circumference, body mass index and waist size index, this relationship was not significant. CONCLUSION: the bivariate and multivariate analyses indicate an epidemiologically significant relationship that demonstrates a protective effect of EB on the HOMA-IR and QUICKI indexes.

INTRODUCCIÓN: la lactancia materna exclusiva (LME) es un factor protector contra el desarrollo de resistencia a la insulina (RI) como causa del síndrome metabólico. OBJETIVO: el objetivo del estudio fue evaluar la relación entre la LME los  primeros seis meses de vida y el desarrollo de RI, mediante los índicesHomeostasis Model Assessment (HOMA-IR) y Quantitative Insulin Sensitivity Check Index (QUICKI). MATERIAL Y MÉTODOS: estudio de cohorte de tipo poblacional; se incluyeron 494 participantes adolescentes, de los cuales se evaluaron variables sociodemográficas, antropométricas y factores cardiometabólicos mediante los índices HOMA-IR y QUICKI para determinar el grado de asociación entre la LME y el desarrollo de RI. Los resultados fueron expresados en medianas. RESULTADOS: la prevalencia de LME fue del 42%. Los resultados sugieren un efecto protector de la LME sobre la resistencia a la insulina, de tal manera que por cada mes más de duración de LME, disminuye en 0,32 (p = 0,005) el índice HOMA-IR y aumenta en 0,70 (p = 0,008) el índice QUICKI. Para la circunferencia de cintura, el índice de masa corporal (IMC) y el índice-cintura talla (ICT) esta relación no fue significativa. CONCLUSIÓN: los análisis bivariados y multivariados, indican una relación epidemiológicamente significativa que demuestra un efecto protector de la Lactancia Materna Exclusiva sobre el índice HOMA-IR y el QUICKI.

The perception of different social agents in Colombia regarding biobanks for research purposes / Percepción de diversos sectores sociales de Colombia sobre los biobancos con fines de investigación

Introduction: Biobanks for research purposes are public assets that require active participation from all interested parties; therefore, it is important to discern and investigate the perception that the general public in Colombia has with regards to their participation in a biobank. Objective: To question different healthy Colombian social agents about the perception they have on donating human biological material to be stored in a biobank for future research purposes. Materials and methods: We conducted an exploratory quantitative and qualitative research by means of an anonymous survey on healthy members of the Colombian community in order to evaluate their knowledge and stances related to biobanks. Results: Three hundred sixty-eight (368) individuals completed the survey, including health-care researchers, lawyers and members of research ethics committees. Ninety-six percent (96%) of the subjects stated their willingness to donate biological material to biobanks, although 60% expressed distress about their samples being used for certain research activities, mainly human cloning. Even though about half of the participants reported knowing what a biobank is, less than 3% of the individuals had a clear concept of them. Conclusion: Participants showed their willingness to donate and store their biological material for research purposes. Similarly, they expressed their opinion about issues related to the management of biobanks. It is necessary to take into account the opinions of the general public in the development of policies that regulate biobanks for research purposes in Colombia.

Introducción. Los biobancos con fines de investigación son un bien público que necesita de la participación activa de todas las partes interesadas, por lo cual es importante conocer la percepción que tiene el público general en Colombia sobre su intervención en un biobanco.Objetivo. Indagar en diferentes sectores sociales colombianos sobre su percepción en torno a la donación de material biológico humano para ser almacenado en biobancos con fines de investigación.Materiales y métodos. Se hizo un estudio exploratorio tanto cuantitativo como cualitativo, entre personas sanas de diferentes sectores del país mediante una encuesta anónima sobre su conocimiento y actitudes con respecto a los biobancos.Resultado. La encuesta fue respondida por 368 personas, que incluían investigadores en salud, abogados y miembros de comités de ética de la investigación. El 96 % de los sujetos expresó su voluntad de donar material biológico, aunque el 60 % manifestó tener desconfianza en que sus muestras fueran usadas en algunos tipos de investigación, especialmente en clonación humana. Cerca de la mitad de los participantes refirieron saber qué era un biobanco, sin embargo, menos del 3 % tenía claridad suficiente sobre el concepto.Conclusión. Los participantes expresaron su disposición a donar y almacenar material biológico con fines de investigación, así como su opinión sobre algunos aspectos de la gestión de los biobancos. Las opiniones del público general se deben tener en cuenta en el desarrollo de políticas que regulen la actividad de los biobancos con fines de investigación en Colombia.

Analysis of population genetic structure from Bucaramanga (Colombia) based on gene polymorphisms associated with regulation of blood pressure / Análisis de la estructura genética poblacional a partir de polimorfismos de genes asociados con la regulación de la presión arterial en una muestra de Bucaramanga, Colombia

Introduction: In spite nearly 40% of the variability in blood pressure can be explained by genetic factors, the identification of genes associated to essential high blood pressure is difficult in populations where individuals have different genetic precedents; in these circumstances it is necessary to determinate whether the population is sub-structured because this can bias studies associated with this disease.Objectives: To determine the genetic structure of the population in Bucaramanga from genetic polymorphisms associated with the regulation of blood pressure: 448G>T, 679C>T y 1711C>T from the gene kinase 4 of the dopaminergic receptor linked to the protein G and Glu298Asp, -786T>C and the VNTR of the intron 4 of the gene of endothelial nitric oxide.Methodology: A sample of 552 unrelated individuals was studied through analysis of Restriction fragment length polymorphism. The allelic, haplotypic and genotypic frequencies were calculated, the Hardy-Weinberg equilibrium was determined and a molecular analysis of variance was performed to determine the genetic structure.Results: 38 Haplotypes were identified, with GCCTG4b as the most frequent (21.2%). The most diverse polymorphism was 448G>T with a frequency of 49.9% for heterozygous. The six polymorphisms were found in genetic equilibrium and genetic structure of populations was not evidenced (FST = 0,0038).Conclusion: The population studied does not present a genetic sub-structure and the polymorphisms analyzed were found in genetic equilibrium, this indicates that the population mixes randomly and there are no sub-groups capable of affecting the results of the association studies

Analysis of population genetic structure from Bucaramanga (Colombia) based on gene polymorphisms associated with the regulation of blood pressure.

INTRODUCTION: In spite of nearly 40% of variability in blood pressure being explained by genetic factors, the identification of genes associated with essential high blood pressure is difficult to determine in populations where individuals have different genetic backgrounds. In these circumstances it is necessary to determinate whether the population is sub-structured because this can bias studies associated with this disease. OBJECTIVE: TO DETERMINE THE GENETIC STRUCTURE OF THE POPULATION IN BUCARAMANGA FROM GENETIC POLYMORPHISMS ASSOCIATED WITH THE REGULATION OF BLOOD PRESSURE: 448G>T, 679C>T y 1711C>T from the gene kinase 4 of the dopaminergic receptor linked to the protein G and Glu298Asp, -786T>C and the VNTR of the intron 4 of the gene of endothelial nitric oxide. METHODS: A sample of 552 unrelated individuals was studied through analysis of restriction fragment length polymorphism. The allelic, haplotypic and genotypic frequencies were calculated, the Hardy-Weinberg equilibrium was determined and a molecular analysis of variance was performed to determine the genetic structure. RESULTS: Thirty-eight (38) Haplotypes were identified with GCCTG4b being the most frequent (21.2%). The most diverse polymorphism was 448G>T with a frequency of 49.9% for heterozygous. The six polymorphisms were found in genetic equilibrium and a genetic structure of populations was not evidenced (FST= 0.0038). CONCLUSION: The population studied does not present a genetic sub-structure and the polymorphisms analyzed were found in genetic equilibrium. This indicates that the population mixes randomly and there are no sub-groups capable of affecting the results of the association studies.

INTRODUCCIÓN: A pesar que cerca del 40% de la variabilidad en la presión arterial es explicada por factores genéticos, la identificación de genes asociados a la hipertensión arterial esencial es difícil en poblaciones constituidas por individuos con antecedentes genéticos diferentes; en esta circunstancia se debe determinar si la población está sub-estructurada porque esto puede sesgar los estudios de asociación con esta enfermedad. OBJETIVO: Determinar la estructura genética de la población de Bucaramanga a partir de polimorfismos genéticos asociados con la regulación de la presión arterial: 448G>T, 679C>T y 1711C>T del gen de la quinasa 4 del receptor dopaminérgico acoplado a proteína G y Glu298Asp, -786T>C y el VNTR del intrón 4 del gen de la sintasa de óxido nítrico endotelial. MÉTODOS: Se estudió una muestra de 552 individuos no relacionados mediante análisis de polimorfismos de longitud de fragmentos de restricción. Se calcularon las frecuencias alélicas, haplotípicas y genotípicas, se determinó el equilibrio de Hardy-Weinberg y se realizó un análisis molecular de varianza para determinar la estructura genética. RESULTADOS: Se identificaron 38 haplotipos siendo GCCTG4b el más frecuente (21.2%). El polimorfismo más diverso fue el 448G>T con una frecuencia de heterocigotos del 49.9%. Los seis polimorfismos se encontraron en equilibrio genético y no se evidenció estructura genética poblacional (FST = 0.0038). CONCLUSIÓN: La población estudiada no presenta subestructura genética y los polimorfismos analizados se encontraron en equilibrio genético, lo que indica que la población se mezcla aleatoriamente y no existen subgrupos que puedan afectar los resultados de estudios de asociación.

[Impact of the new definitions in the prevalence of the metabolic syndrome in an adult population at Bucaramanga, Colombia]. / Impacto de las nuevas definiciones en la prevalencia del síndrome metabólico en una población adulta de Bucaramanga, Colombia.

INTRODUCTION: The prevalence of metabolic syndrome depends on the criteria used for its classification. Three criteria in common use are those from International Diabetes Federation (IDF), the Adult Treatment Panel (ATP-III) or its update (ATP-IIIa). OBJECTIVE: The prevalence statistic for generated metabolic syndrome was compared on the basis of each of the three criteria in an adult population. MATERIALS AND METHODS: The sample consisted of 155 teachers and employees in the school of medicine. The average age was 40.9; 54.2% were men. The three criteria were applied and the prevalences were compared with the Wilcoxon test and Cohen's kappa. RESULTS: Metabolic syndrome prevalence generated by each criterion was as follows: ATP-III was 12.3% (95%CI 7.5-18.5), ATP-IIIa was 34.8% (95%CI 27.4-42.9) and IDF 32.9% (95%CI 25.6--40.9). The prevalence indicated by ATP-III was lower than the ATP-IIIa or IDF prevalences (p < 0,001); however those of ATPIII-a and IDF were similar (p=0,083). Poor agreement was seen between ATP-III and ATP-IIIa (k=0.414, IC95% 0.409-0.420), and between ATP-III and IDF (k=0.374, IC95% 0.368-0.379); however, very good agreement was obtained between ATP-IIIa and IDF (k=0.957, IC95% 0.950-0.963). CONCLUSION: The new definitions for metabolic syndrome, ATP-IIIa and IDF, increase the prevalence statistic by three times. This occurred despite the inclusion in IDF of an obesity factor in the criteria set.

Impacto de las nuevas definiciones en la prevalencia del síndrome metabólico en una población adulta de Bucaramanga, Colombia / Impact of the new definitions in the prevalence of the metabolic syndrome in an adult population at Bucaramanga, Colombia

Introducción. La prevalencia de síndrome metabólico depende de los criterios de clasificación empleados, como son los de la International Diabetes Federation y el Adult Treatment Panel o su modificación.Objetivo. Comparar la prevalencia del síndrome metabólico generada por cada una de las tres definiciones en una población de adultos. Materiales y métodos. Se estudiaron 155 personas (54,2 por ciento varones, edad promedio de 40,9 años). Se aplicaron las tres definiciones y se comparó la prevalencia con la prueba de Wilcoxon y la concordancia con kappa de Cohen. Resultados. La prevalencia de síndrome metabólico según el Adult Treatment Panel-III (ATP-III) fue 12,3 por ciento (IC95 por ciento 7,5-18,5), según el Adult Treatment Panel-IIIa (ATP-IIIa), 34,8 por ciento (IC95 por ciento 27,4-42,9) y según la International Diabetes Federation (IDF), 32,9 por ciento (IC95 por ciento 25,6-40,9). La prevalencia por ATP-III es inferior a la vista por ATP-IIIa e IDF (p<0,001), pero entre estas dos últimas es similar (p=0,083). Hay pobre concordancia entre ATP-III y ATP-IIIa (k=0,414, IC95 por ciento 0,409-0,420), y entre ATP-III e IDF (k=0,374, IC95 por ciento 0,368–0,379), pero muy buena entre ATP-IIIa e IDF (k=0,957, IC95 por ciento 0,950–0,963). Conclusión. Las nuevas definiciones para el síndrome metabólico (ATP-IIIa e IDF) aumentan tres veces la prevalencia del diagnóstico, sin encontrar diferencias entre ellas, a pesar de que la última organización incluye la obesidad central como un criterio necesario para el diagnóstico, cuando en la primera no se hace igual ponderación.

Introduction. The prevalence of metabolic syndrome depends on the criteria used for its classification. Three criteria in common use are those from International Diabetes Federation (IDF), the Adult Treatment Panel (ATP-III) or its update (ATP-IIIa). Objective. The prevalence statistic for generated for metabolic syndrome was compared for on the basis of each of the three criteria. Materials and methods. The sample consisted of 155 teachers and employees in the school of medicine. The average age was 40.9; 54.2% were men. The three criteria were applied and the prevalences were compared with the Wilcoxon test and Cohen’s kappa. Results. Metabolic syndrome prevalence generated by each criterion was as follows: ATP-III was 12.3% (95%CI 7.5-18.5), ATP-IIIa was 34.8% (95%CI 27.4-42.9) and IDF 32.9% (95%CI 25.6--40.9). The prevalence indicated by ATP-III was lower than the ATP-IIIa or IDF prevalances (p < 0,001); however those of ATPIII-a and IDF were similar (p=0,083). Poor agreement was seen between ATP-III and ATP-IIIa (k=0.414, IC95% 0.409-0.420), and between ATP-III and IDF (k=0.374, IC95% 0.368-0.379); however, very good agreement was obtained between ATP-IIIa and IDF (k=0.957, IC95% 0.950-0.963). Conclusion. The new definitions for metabolic syndrome, ATP-IIIa and IDF, increase the prevalence statistic by three times. This occurred despite the inclusion in IDF of an obesity factor in the criteria set.

Estado actual del diagnóstico de la toxoplasmosis en la mujer embarazada y su feto / Present state of toxoplasmosis diagnosis on pregnant women and in her fetus

La toxoplasmosis adquirida por la mujer embarazada tiene la mayoría de las veces una presentación subclínica, y su diagnóstico se basa en exámenes serológicos sistemáticos, para verificar sí la gestante está inmunizada, o si es susceptible al Toxoplasma. Las gestantes no inmunizadas (seronegativas), conforman un grupo de especial cuidado, en las cuales la repetición de las pruebas serológicas debe permitir un diagnóstico precoz y un manejo apropiado de las primoinfecciones. Por otro lado la infección congénita con Toxoplasma gondii puede producir alteraciones serias del desarrollo fetal; con el fin de reducir las graves secuelas mediante tratamiento antiparasitario oportuno, se hace necesario la implementación de herramientas que permitan realizar un diagnóstico temprano de la infección fetal, con técnicas que sean altamente específicas y de gran sensibilidad y además, que en lo posible sean inocuas para el feto. La presente revisión describe las principales secuencias metodológicas desarrolladas, y actualmente utilizadas en diversos países para la detección serológica de la seroconversión de las madres gestantes, y la manera de descartar la transmisión congénita del parásito

Diagnóstico genético preimplantación / Genetic diagnosis Preimplantation

Las técnicas de diagnóstico preimplantación representan una alternativa del diagnóstico prenatal, logrando establecer alteraciones genéticas en los preembriones antes de ser implantados en el útero materno. Para su aplicación requieren de la combinación de programas de reproducción asistida y biología molecular, y es lo bastante sensible y segura, lo que permite detectar un número considerable de patologías genéticas frecuentes