Consideraciones especiales de la hipertensión arterial sistémica en afrodescendientes de América latina

En América Latina hacer un análisis del impactoen la prevalencia de hipertensión arterialproducto de la participación de la razanegra en su origen es complejo ya que no hay muchosestudios que analicen esta problemática y en particularporque el comportamiento migratorio que originó la presenciade la raza negra en nuestro continente no tuvo elmismo comportamiento en todos los países. Se requiereque se aumenten las estrategias para lograr la detección,aumentar la cobertura y optimizar el tratamiento en losindividuos afrodescendientes en Latinoamérica. Se necesitanestudios con suficiente tamaño de muestra para verlas diferencias según género, pureza de la raza, mestizaje,influjo social, migraciones, industrialización y severidad dela hipertensión arterial

The need for creating a unified knowledge of cardiovascular diseases in Latin America

Cardiovascular diseases (CVDs) have persistently been the principal cause of disease burden and mortality throughout the world as well as in Latin America (LATAM)[1,2]. Congruently, as CVDs continue to grow, the research production in this discipline has followed the same trend; global CVD publications have been increasing in the last decades[3,4]. However, as with other health-related topics, disparities in the quantity of research exist when comparing low- and middle-income countries with high-income nations

Efectos de un programa de ejercicio físico de 12 semanas en sujetos con revascularización coronaria o postangioplastia transluminal percutánea

ResumenObjetivoDeterminar los efectos de un programa de ejercicio físico sobre las características antropométricas y la capacidad funcional postcirugía de revascularización coronaria o postangioplastia coronaria transluminal percutánea.MétodosEstudio clínico no controlado, de antes y después, en 49 pacientes postcirugía de revascularización coronaria o angioplastia coronaria percutánea. El índice de masa corporal, perímetro abdominal, índice de cintura cadera, perímetro de la cadera y la capacidad cardiorrespiratoria a través de la caminata de los seis minutos fueron evaluados antes y al finalizar el programa de ejercicio físico. Este estuvo conformado por ejercicios aeróbicos continuos, de resistencia muscular, equilibrio y coordinación, durante 3 días a la semana, durante 12 semanas.ResultadosCon relación al perímetro abdominal en las mujeres cambió de 91,4cm a 88,4cm (p=0,003) y en los hombres de 93,6cm a 89,8 (p=0,000). Se logró un incremento significativo de la distancia caminada de 330 a 436 metros (p=0,000); del consumo energético de 3,4 a 4,1 MET (p=0,000); y la máxima capacidad de absorber, transportar y consumir el oxígeno, de 12 a 14ml/Kg/min.ConclusionesEl programa de ejercicio físico que fue utilizado en este estudio, pudo en todos los sujetos incrementar la capacidad cardiorrespiratoria y la tolerancia al ejercicio, y disminuir el perímetro abdominal. Los efectos benéficos obtenidos cambian el pronóstico de la enfermedad coronaria y disminuyen los factores de riesgo metabólicos.AbstractMotivationTo determine the effects of a physical exercise program in the anthropometric characteristics and postsurgical functional capacity after coronary revascularization or percutaneous transluminal coronary angioplasty.MethodsUncontrolled clinical before and after study, in 49 patients who has undergone coronary revascularization or percutaneous transluminal coronary angioplasty. Body mass index, abdominal girth, waist-to-hip ratio, hip perimeter and cardiorespiratory function were assessed by means of the six-minute walk test before and after the physical exercise program. It consisted of continuous aerobic, muscle resistance, balance and coordination exercises three times a week during a total of 12 weeks.ResultsAbdominal girth changed from 91.4cm to 88.4cm (p=0.003) in women and from 93.6cm to 89.8cm (p=0.000). A significant increase of the walked distance was achieved, from 330 to 436 meters (p=0.000); energy use from 3.4 to 4.1 MET (p=0.000); and maximum capacity of absorbing, transporting and consuming oxygen, from 12 to 14ml/Kg/min.ConclusionThe physical activity program used in this study contributed to an increase in all participants of the cardiorespiratory function and exercise tolerance, and to a decrease in abdominal girth. These beneficial effects change the prognosis of the coronary disease and reduce the metabolic risk factors

Clinical, microbiological, and imaging characteristics of infective endocarditis in Latin America: a systematic review

Objectives: We aimed to describe the clinical, microbiological, and imaging characteristics of patients with infective endocarditis (IE) in studies from Latin America (LATAM). Methods: A systematic search through PubMed, EMBASE, LILACS, and SciELO from inception until Febru ary 2021 was conducted. We included observational studies that assessed adults with IE from LATAM and reported data on clinical, microbiological, or imaging characteristics. Data were independently extracted by 2 authors and the risk of bias was evaluated by study design with its respective tool. Findings were summarized using descriptive statistics. Results: Forty-four studies were included. Most cases were male (68.5%), had a predisposing condition including valve disease (24.3%), or had a prosthetic valve (23.4%). Clinical manifestations included fever (83.9%), malaise (63.2%), or heart murmur (57.7%). A total of 36.4% and 27.1% developed heart failure or embolism, respectively. Blood cultures were negative in 23.9% and S. aureus (18.6%) and the viridans group streptococci (17.8%) were the most common isolates. Most cases were native valve IE (67.3%) affecting mainly left-sided valves. Echocardiographic findings included vegetations (84.3%) and regurgitation (75.9%). In-hospital mortality was 25.1%. Conclusions: This is the first systematic review that evaluated the characteristics of IE in LATAM patients. A lack of multicenter studies reflects the need for these studies in LATAM

Impact of mandatory preventive isolation on daily physical activity and weight of children in Colombia during the SARS-cov-2 pandemic

Introducción En Colombia desde el 24 de marzo hasta el 31 de agosto de 2020 los niños y adolescentes estuvieron 162 días en total aislamiento preventivo obligatorio por la pandemia del Covid 19. Conocer y evaluar el comportamiento de ellos durante este período de confinamiento fue importante para saber las consecuencias sobre la actividad física y el aumento peso. Métodos Se elaboró una encuesta virtual abierta realizada en la plataforma de encuestas de Google, dirigida a los padres con 5 preguntas: 1. Edad de su hijo: 2. ¿Cuántos minutos por día de actividad física en casa realiza? 3. ¿Cuántos minutos de pantallas (TV, computador, celular, videojuegos, etc.) por día? 4 ¿Cuántas horas duerme en la noche? 5. ¿El peso corporal de su hijo(a) se ha elevado? ¿Cuánto? Se distribuyó en las bases de datos de la Asociación de Medicina del Deporte y de la Fundación Colombiana del Corazón a través de las redes sociales como WhatsApp y correos electrónicos. Resultados Se realizaron 1.139 encuestas virtuales . Se encontró que durante el período de aislamiento obligatorio: el 75.2% de los niños no realizó los minutos recomendados de actividad física por la Organización Mundial de la salud (OMS), que el 82.8 % superó el tiempo de 60 minutos frente a dispositivos electrónicos y que el 44 % se aumentó de peso. Conclusiones En los períodos de confinamiento es importante el diseño de estrategias y procesos educativos que promuevan en los niños estilos de vida que se puedan conservar a futuro en el adulto.Introduction In Colombia from March 24 to August 31, 2020, children and adolescents spent 162 days in total mandatory preventive isolation due to the Covid-19 pandemic. Knowing and evaluating their behavior during this period of confinement was important to know the consequences on the physical activity and weight gain. Methods An open virtual survey was developed on the Google survey platform, addressed to parents with 5 questions: 1. The age of your child: 2. How many minutes of physical activity at home do you do? 3 How many minutes of screens (TV, computer, cell phone, video games, etc.) per day? 4 How many hours do you sleep at night? 5. Has your child's body weight increased? How much?. It was distributed in the databases of the Association of Sports Medicine and the Colombian Heart Foundation through social networks such as WhatsApp and emails. Results 1,139 virtual surveys were conducted. It was found that during the mandatory isolation period: 75.2% of the children did not perform the minutes of physical activity recommended by the World Health Organization (WHO), that 82.8% exceeded the time of 60 minutes versus to electronic devices and that 44% weight gained. Conclusions In periods of confinement, it is important to design educational strategies and processes that promote healthy lifestyles in children that can be preserved in the future in adults

Effects of a 12-week exercise-based program on the quality of life among myocardial revascularization subjects with normal and reduced left ventricular ejection fraction

Background/Aims/: Exercise-based cardiac rehabilitationis an effective and safe therapy to be used in themanagement of clinically stable patients following percutaneouscoronary intervention (PCI) or coronary arterybypass graft (CABG).Objectives: To determine if a 12-week physical exerciseprogram (12-WPEP), after PCI or CABG with differentleft ventricular ejection fraction (LVEF) might improve thehealth-related quality of life (HRQOL).Methods: A prospective, controlled before-after studywas conducted in a cardiac rehabilitation service with a12-WPEP. Each session had a duration between 40 to 60minutes, three times per week. Before and after a 12-WPEPwas evaluated HRQOL using the SF-36 questionnaire.Results: The 12-WPEP improve the HRQOL but did notshow differences among PCI (31 subjects) compared toCABG (18 subjects), regardless of whether the LVEF wasnormal or reduced (p<0.005).Conclusion: 12-WPEP improved HRQOL in both PCI andCABG subjects regardless of LVEF

La importancia de la evaluación de la fragilidad en el adulto mayor con enfermedad cardiovascular

La fragilidad se considera como un síndromebiológico que afecta a múltiples sistemas yórganos que conduce a la dependencia e inclusola muerte; de allí la importancia de su medición en eladulto mayor, particularmente en el sujeto con enfermedadcardiovascular. Este estudio se realizó con el objeto dedeterminar la prevalencia de la fragilidad y pre- fragilidaddel adulto mayor que acude a un programa de rehabilitacióncardiaca.Materiales y Métodos: Estudio observacional descriptivotransversal realizado en adultos mayores con enfermedadcardiovascular que asistían al programa de rehabilitacióncardiovascular. La evaluación de la fragilidad se hizomediante los cinco criterios propuestos por Fried: pérdidainvoluntaria de peso, baja energía o agotamiento, debilidadmuscular, lentitud de la marcha y baja actividad física.Los datos se estudiaron mediante el análisis de varianzade una y dos vías y se consideró significativo estadísticamenteuna p<0,05.Resultados: Se incluyeron 35 adultos mayores de 60años. Se encontró una prevalencia de fragilidad de 23% ypre-fragilidad de 54% con mayor frecuencia en mujeres,las personas frágiles y pre-frágiles se encuentran entre 60y 75 años, las mayores de 76 años son frágiles. La mayoríade los sujetos presentan entre 1 y 2 criterios siendo losde mayor prevalencia la lentitud para la marcha y la bajafuerza muscular (51,4%).Conclusión: Evaluar la fragilidad es importante en todopaciente con enfermedad cardiovascular (ECV) para detectarlay evitar dependencia. Es necesario mayor númerode estudios sobre el tema con el fin de conocer la situaciónde estos pacientes en Barranquilla

The importance of pharmacotherapeutic adherence evaluation in subjects with cardiovascular disease

En Colombia son pocos los programas de vigilancia a la ad- herencia farmacoterapéutica. El objetivo de este estudio fue evaluar la prevalencia y los predictores de no-adherencia en un programa de seguimiento farmacoterapéutico de una co- horte de sujetos con enfermedad cardiovascular y se identi- ficaron los factores asociados con mejoras en la adherencia y evitabilidad. Métodos: Estudio observacional prospectivo transversal du- rante 9 meses en sujetos con enfermedad cardiovascular de una institución de alta complejidad y se evaluó la adherencia farmacoterapeútica con las metodologías DADER, Escala de New York y criterios Stopp/Start. Resultados: Se estudiaron 265 sujetos, 72,4% con enfer- medad isquémica, 8% enfermedad valvular, 0,7% insuficien- cia cardiaca y 18,9% enfermedad cardiaca no especificada. Se informaron un total de 484 Problema Relacionado con el Uso de los Medicamentos (PRUM) y 184 Resultado Negativo asociado a la Medicación (RNM). Los PRUM de tipo inte- racción medicamentosa representaron el 56% y el 10% se caracterizó como evitable; los PRUM de tipo administración errónea del medicamento representaron el 20,7% y el 100% se caracterizó como evitable. Los RNM de tipo inseguridad no cuantitativa representaron el 30,6% y el 5% se caracterizó como evitable. Conclusiones: Se identificaron los factores susceptibles de intervención para promover el uso seguro de medicamentos, así como los asociados con la evitabilidad, la adherencia a la terapia y PRUM. Lo que permitió implementar estrategias para minimizar estos errores durante su tratamiento.In Colombia there are few surveillance programs for phar- macotherapeutic adherence. The objective of this study was to evaluate the prevalence and predictors of non-adherence in a pharmacotherapeutic follow-up program of a cohort of subjects with cardiovascular disease, and the factors associ- ated with improvements in adherence and avoidability were identified. Methods: A prospective, cross-sectional observational study over a period of 9 months in subjects with cardiovascular dis- ease from a high-complexity institution, and pharmacothera- peutic adherence was evaluated using the DADER method- ologies, the New York Scale and the Stopp / Start criteria. Results: 265 subjects were studied, 72.4% with ischemic disease, 8% valvular disease, 0.7% heart failure and 18.9% unspecified heart disease. A total of 484 Medication Use- Related Problems (PRUM) and 184 Medication-Associated Negative Result (NRM) were reported. Drug interaction type PRUMs represented 56% and 10% were characterized as avoidable; PRUMs of erroneous administration of the drug represented 20.7% and 100% were characterized as avoid- able. Non-quantitative insecurity NRMs represented 30.6% and 5% were characterized as avoidable. Conclusions: Factors susceptible to intervention to promote the safe use of medications, as well as those associated with avoidability, adherence to therapy and PRUM were identified, which allowed the implementation of strategies to minimize these errors during their treatmen

The effect of comorbidities on glycemic control among Colombian adults with diabetes mellitus: a longitudinal approach with real-world data

Background: Achieving an optimal glycemic control has been described to reduce the incidence of diabetes mellitus (DM) related complications. The association between comorbidities and glycemic control remains unclear. Our aim is to evaluate the effect of comorbidities on glycemic control in people living with DM. Methods: A retrospective longitudinal study on data from the National Registry of Chronic Kidney Disease from 2014 to 2019 in Colombia. The outcome was poor glycemic control (PGC = HbA1c ≥7.0%). The association between each comorbidity (hypertension (HTN), chronic kidney disease (CKD) or obesity) and PGC was evaluated through multivariate mixed effects logistic regression models. The measures of effect were odds ratios (OR) and their 95% confidence intervals (CI). We also evaluated the main associations stratified by gender, insurance, and early onset diabetes as well as statistical interaction between each comorbidity and ethnicity. Results: From 969,531 people at baseline, 85% had at least one comorbidity; they were older and mostly female. In people living with DM and CKD, the odds of having a PGC were 78% (OR: 1.78, CI 95%: 1.55-2.05) higher than those without CKD. Same pattern was observed in obese for whom the odds were 52% (OR: 1.52, CI 95%: 1.31-1.75) higher than in non-obese. Non-significant association was found between HTN and PGC. We found statistical interaction between comorbidities and ethnicity (afro descendant) as well as effect modification by health insurance and early onset DM. Conclusions: Prevalence of comorbidities was high in adults living with DM. Patients with concomitant CKD or obesity had significantly higher odds of having a PGC

The collaborative work between engineers and health staff for development of digital health projects: a vision to the future to achieve success

Las tendencias en tecnologías de la información y la comunicación (TIC) han fomentado el trabajo en conjunto entre el personal de la salud y los ingenieros, con el fin de desarrollar dispositivos que permitan el intercambio de datos en un espacio que propicie la facilidad de interacción y obtención de la información del paciente. Sin embargo, no es un campo explícito en las investigaciones de tecnología de la información en salud. Actualmente se ha estado fortaleciendo este campo de medicina digital, pero todavía es un campo que requiere una buena estrategia de trabajo colaborativo para el diseño de plataformas móviles, nubes de información, plataformas web entre otras. Por lo cual este artículo está basado en la identificación de los atributos de un buen trabajo colaborativo. Para ello, se realizó una revisión sistemática de la literatura sobre el trabajo en equipo interdisciplinario entre investigadores, tales como ingenieros y personal de la salud para implementar un sistema digitalizado que permita prevenir, dar terapias y diagnosticar, usando las tecnologías mencionadas anteriormente. Esta revisión presenta una visión general del trabajo colaborativo respondiendo a tres preguntas generadas durante el estudio.The trends in Information and Communication Technology (ICT) have fomented a joint work between health team and engineers, with the purpose of develop devices that allow the exchange of data in a space that facilitates the interaction and obtaining patient information. However, this is not an explicit field in the technology of health information research. At present, the e-health has been strengthened, but this field still requires an enhanced strategy for improving collaborative work to design of mobile platforms, information clouds, web platforms etc. To this, we realize a systematic review about interdisciplinary teamwork between different researches, such as engineers and some areas of health workers to implement a digital system to prevent, diagnose and provide, using technologies mention above. This review presents an overview of the collaborative work responding to three questions generated during the study