Background. High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for... more Background. High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for premature development of atherosclerosis and atherothrombosis. Adult renal transplant recipients have elevated tHcy levels. Corresponding data in pediatric, adolescent, and young adult renal transplant recipients are scarce. We investigated whether tHcy levels were elevated in stable renal transplant recipients who received kidney grafts before age 18.
Background. The morning home blood pressure (BP) rise is a significant asymptomatic target organ ... more Background. The morning home blood pressure (BP) rise is a significant asymptomatic target organ damage predictor in hypertensives. Our aim was to evaluate determinants of home-based morning-evening difference (MEdiff) in Argentine patients. Methods. Treated hypertensive patients aged ≥18 years participated in a cross-sectional study, after performing home morning and evening BP measurement. MEdiff was morning minus evening home average results. Variables identified as relevant predictors were entered into a multivariable linear regression analysis model. Results. Three hundred sixty-seven medicated hypertensives were included. Mean age was 66.2 (14.5), BMI 28.1 (4.5), total cholesterol 4.89 (1.0) mmol/L, 65.9% women, 11.7% smokers, and 10.6% diabetics. Mean MEdiff was 1.1 (12.5) mmHg systolic and 2.3 (6.1) mmHg diastolic, respectively. Mean self-recorded BP was 131.5 (14.1) mmHg systolic and 73.8 (7.6) mmHg diastolic, respectively. Mean morning and evening home BPs were 133.1 (16.5) versus 132 (15.7) systolic and 75.8 (8.4) versus 73.5 (8.2) diastolic, respectively. Significant beta-coefficient values were found in systolic MEdiff for age and smoking and in diastolic MEdiff for age, smoking, total cholesterol, and calcium-channel blockers. Conclusions. In a cohort of Argentine medicated patients, older age, smoking, total cholesterol, and use of calcium channel blockers were independent determinants of home-based MEdiff.
We aimed to determine a possible association between isolated morning hypertension (IMH) and meal... more We aimed to determine a possible association between isolated morning hypertension (IMH) and meal-induced blood pressure (BP) fall in adult treated hypertensive patients who underwent home BP measurements. A total of 230 patients were included, median age 73.6, 65.2% women. After adjusting for age, sex, number of antihypertensive drugs, office and home BP levels, the association between IMH and meal-induced BP fall was statistically significant. In conclusion, meal-induced BP fall and IMH detected through home blood pressure monitoring (HBPM) are independently associated in hypertensive patients. The therapeutic implications of such observation need to be clarified in large-scale prospective studies.
It is not clear which educational strategy is most effective in helping patients to change their ... more It is not clear which educational strategy is most effective in helping patients to change their lifestyles. This study compared the efficacy of two different educational models on reducing blood pressure (BP).This was a randomized controlled trial in ambulatory hypertensive patients >65 years of age. Workshops that aimed to develop self-management and patient empowerment (PEM) were compared to workshops that used a compliance-based model (CEM). The primary outcome was change in systolic BP at 3 months compared with basal values between groups (net reduction), measured by 24-h ambulatory BP monitoring.A total of 30 patients were educated with PEM and 30 others with CM. Both groups were statistically similar with regard to age (67 v 70 years), systolic BP (157 v 156 mm Hg) and diastolic BP (88 v 88 mm Hg), diabetes (23% v 31%), and basal natriuresis 116 v 121 mEq/day). There were more women in the PEM group (57% v 30%). The PEM group showed a significant reduction of 8 mm Hg (95% confidence interval [CI] 2 to 15), whereas the CM group showed a reduction of 3 mm Hg (95% CI −3 to 8), with a net reduction of 6 (95% CI −3 to 14). Mean net night-time systolic BP reduction was 12 mm Hg (95% CI 2 to 22). BP control was 70% in PEM group vs 45% in CM group (P = 0.045). The relative odds ratio for BP control for the PEM group after adjustment for age, sex, diabetes, basal blood pressure and changes in pharmacological treatment was 3.7 (95% CI 1.05 to 13.1).Based on these study results, the self-management education model was significantly more effective than the compliance-based model in BP control.
Arterial hypertension and transplantation are closely linked, and its association may promote imp... more Arterial hypertension and transplantation are closely linked, and its association may promote impaired graft and overall survival. Since the introduction of calcineurin inhibitors, it is observed in 50-80% of transplanted patients. However, many pathophysiological mechanisms are involved in its genesis. In this review, we intend to provide an updated overview of these mechanisms, dealing with the causes common to all kinds of transplantation and emphasizing special cases with distinct features, and to give a perspective on the pharmacological approach, in order to help clinicians in the management of this frequent complication.
Currently, total hyperhomocysteinemia (tHHcy) is a well-known condition linked to a higher risk o... more Currently, total hyperhomocysteinemia (tHHcy) is a well-known condition linked to a higher risk of vascular disease. Prevalence of HHcy increases in elderly persons as the risk associated with it persists. Because factors can be potentially reduced in the elderly, it is important to carry out epidemiologic studies of HHcy.Previously we described the prevalence of hypertension control in an elder population; now, in an observational cross-sectional simple blind study, total homocysteine (tHcy) concentration was determined in 196 of 400 patients from the original cohort.Mean Hcy concentration was 13.2 μmol/L (95% confidence interval 12.4–14.0; range, 5.0 to 48.9); 15.0 μmol/L for men and 12.3 μmol/L for women. Mean serum folic acid levels were 4.9 ± 3.1 ng/mL (range, 2.0 to 20.0 ng/mL), and vitamin B12 levels were 384.8 ± 314.1 pg/mL (range, 48.0 to 1500.0 pg/mL). Taking into account the reference values established by the Third National Health and Nutrition Examination Survey III study, HHcy was detected in 69.8% of all the subjects evaluated. The study showed that 76.2% of the men and 66.4% of the women had high Hcy levels.The very high prevalence of tHHcy in the elderly population, and the consequent risks associated with it suggest that although there are no trials that effectively prove the benefit of tHcy decrease, nutritional intervention is still justified.
Para determinar la influencia del tiempo de espera sobre la satisfacción del usuario en la farmac... more Para determinar la influencia del tiempo de espera sobre la satisfacción del usuario en la farmacia central del Hospital Nacional Dos de Mayo (HNDM), se realizó un estudio transversal donde se registró los tiempos de espera por cada subproceso de atención (facturación, pago en caja y entrega de medicamentos) mediante la observación directa de los usuarios. Se evaluó el nivel de satisfacción del usuario según una escala Likert. Se incluyó 150 usuarios, 59% fueron mujeres, la edad promedio fue de 41,4±12,6 años. El promedio de tiempo total de espera fue de 37,1±14,7 minutos. El tiempo de espera fue significativamente mayor en el subproceso de facturación (p<0,001); asimismo el tiempo que los usuarios tardaron en hacer colas fue mayor que el tiempo efectivo (30,1±14.0 frente a 6,3±4,4; p<0,001). El 17,3% de los usuarios de la farmacia central del HNDM mostraron algún grado de satisfacción. El tiempo de espera menor a 20 minutos fue un predictor de satisfacción del usuario (OR: 4,6 [1,1-18,3]; p<0,05) independientemente de los otros factores. En conclusión, el tiempo de espera prolongado principalmente en el subproceso de facturación, condiciona un bajo nivel de satisfacción del usuario en la farmacia central del HNDM.
The present study compares the relationships between mean arterial pressure (MAP) and pulse press... more The present study compares the relationships between mean arterial pressure (MAP) and pulse pressure (PP) in young and older men and whether MAP determines age-related changes in PP.Impedance cardiography was used to evaluate systemic hemodynamics noninvasively in 189 unmedicated men referred to our hypertension unit. Patients were divided by age according to the median value (< and ≥40 years).In younger patients, increasing supine MAP was associated with a transition in the blood pressure pattern from systolic to diastolic, whereas in older patients, increasing MAP was associated with change from diastolic to systolic hypertension. In young patients elevation in MAP was associated with a parallel decrease in PP (P < .001) and stroke volume index (SVI) (P < .001), whereas in older patients higher MAP was associated with higher PP (P < .001) and PP/SVI ratio (P < .001), a measure of arterial stiffness. When the sample was divided according to the median value of MAP (< and ≥101 mm Hg), differences in the age-related change in PP and SVI became apparent. With a lower MAP, changes in PP and SVI remained parallel until the sixth decade, after which they began a progressive dissociation. In contrast, at higher MAP, the dissociation between PP and SVI began two decades earlier, indicating an acceleration of the age-related increase in arterial stiffness. Therefore, the relationship between MAP and PP was negative in younger men at the expense of a decrease in SVI, and positive in older men due to increasing arterial stiffness.Noninvasive hemodynamic parameters from impedance cardiography provide a useful method to characterize the mechanism of increased blood pressure.
This study investigates whether an increased brachial pulse pressure (PP) in young healthy men co... more This study investigates whether an increased brachial pulse pressure (PP) in young healthy men constitutes a representative measure of the central hemodynamic forces, or the mere expression of an exaggerated upper limb amplification. Thirty two healthy men between 17 and 28 years old underwent noninvasive evaluation of systemic hemodynamics (impedance cardiography) and pulse wave analysis (SphygmoCor). Subjects were divided into 3 predefined groups of brachial PP: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 50, 50-64, and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 65 mmHg. The brachial-central PP difference increased with increasing brachial PP (17 +/- 4, 22 +/- 4, and 29 +/- 4 mmHg, respectively P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In contrast, peripheral amplification (as measured by the brachial:central PP ratio) remained constant among the tree groups, at the expense of a concomitant widening of aortic PP (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) without difference in augmentation index. In the entire sample, central and brachial PP, and the difference between the two measures, correlated positively with cardiac output (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and stroke volume (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), and negatively with systemic vascular resistance (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), without significant relationship with heart rate. In conclusion, despite the different amplitude, central and brachial PP shared common hemodynamic determinants. A high PP among young men underlied a high output-low resistance circulatory pattern, independently of the site of measurement.
Free living amoebae are anfizoic organisms that affect people producing different pathologies. Th... more Free living amoebae are anfizoic organisms that affect people producing different pathologies. The sorts of importance are Acanthamoeba, Naegleria, Balamuthia and lastly, Sappinia. We described four cases of free living amoebae with cutaneous compromise belonging to Acanthamoeba sort. Three cases were immunocompromised and one case was immunocompetent. The immunocompromised patients presented necrotizing ulcerated lesions that did not reach to the central nervous system. The immunocompetent patient presented inferior eyelid with swelling that progressed to severe neurological commitment with fatal evolution.
Background. High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for... more Background. High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for premature development of atherosclerosis and atherothrombosis. Adult renal transplant recipients have elevated tHcy levels. Corresponding data in pediatric, adolescent, and young adult renal transplant recipients are scarce. We investigated whether tHcy levels were elevated in stable renal transplant recipients who received kidney grafts before age 18.
Journal of the American Society of Hypertension, 2013
To evaluate the spectrum of hemodynamic patterns in patients with isolated diastolic hypertension... more To evaluate the spectrum of hemodynamic patterns in patients with isolated diastolic hypertension-predominantly diastolic hypertension, we re-analyzed a previously reported cohort of 189 non-medicated hypertensive individuals that were assessed by impedance cardiography. We selected 46 patients who were less than 50 years old and had pulse pressure less than 45 mm Hg confirmed by ambulatory blood pressure monitoring. The selected cohort had a mean age of 39.7 years and was 47% men. Three distinct groups were identified: a high cardiac index (CI) ''hyperdynamic'' group, with normal to near normal systemic vascular resistance (SVR); an intermediate CI and SVR group; and a ''vasotonic'' group, with low CI and high SVR. Heart rate was similar among the three groups. Stroke volume index (SVI) was significantly higher in the hyperdynamic group (61.8, 49.7, and 39.7 mL/m 2 in the high, intermediate, and low CI groups, respectively). The hyperdynamic group had greater total arterial compliance index than the vasotonic group (1.3 AE 0.3 vs 0.92 AE 0.2 mL/m 2 mm Hg for high vs low CI, respectively; P < .001).
Postprandial hypotension (PPH) is a frequently under-recognized entity associated with increased ... more Postprandial hypotension (PPH) is a frequently under-recognized entity associated with increased morbidity and mortality. The prevalence of PPH detected through home blood pressure monitoring (HBPM) is unknown. To determine the prevalence and clinical predictors of PPH in hypertensive patients assessed through HBPM. Hypertensive patients of 18 years or older underwent home blood pressure (BP) measurements (duplicate measurements for 4 days: in the morning, 1 h before and 1 h after their usual lunch, and in the evening; OMRON 705 CP). PPH was defined as a meal-induced systolic BP decrease of ≥20 mm Hg. Variables identified as relevant predictors of PPH were entered into a multivariate logistic regression analysis. In total, 230 patients were included in the analysis, with a median age of 73.6 (interquartile range 16.9) years, and 65.2% were female. The prevalence of PPH (at least one episode) was 27.4%. Four variables were independently associated with PPH: age of 80 years or older (odds ratio (OR) 3.45, 95% confidence interval (CI) 1.35-8.82), body mass index (BMI) (OR 0.88, 95%CI 0.81-0.96), office systolic BP (OR 1.03, 95%CI 1.01-1.05) and a history of cerebrovascular disease (OR 3.29, 95%CI 1.03-10.53). PPH after a typical meal is a frequent phenomenon that can be detected through HBPM. Easily measurable parameters in the office such as older age, higher systolic BP, lower BMI and a history of cerebrovascular disease may help to detect patients at risk of PPH who would benefit from HBPM.
Our purpose was to determine the level of awareness, treatment, and control of hypertension in a ... more Our purpose was to determine the level of awareness, treatment, and control of hypertension in a population of subjects aged 65 or more. We studied a random sample from the national health care program in Buenos Aires. Letters were mailed to 1000 selected individuals. Among those eligible, 41.4% (n ؍ 414) were enrolled. The mean age was 73.8 years and 68% were women. Prevalence of hypertension in our sample was 77.5% (n ؍ 321). Awareness of hypertension was 60.7% (n ؍ 195). Fifty-four percent (n ؍ 173) of the hypertensive subjects were receiving pharmacologic treatment and only 18.5% (n ؍ 32) of them were controlled. These results show that there is a low level of awareness, pharmacologic treatment, and control of hypertension in the studied elderly subjects.
This study investigates whether an increased brachial pulse pressure (PP) in young healthy men co... more This study investigates whether an increased brachial pulse pressure (PP) in young healthy men constitutes a representative measure of the central hemodynamic forces, or the mere expression of an exaggerated upper limb amplification. Thirty two healthy men between 17 and 28 years old underwent noninvasive evaluation of systemic hemodynamics (impedance cardiography) and pulse wave analysis (SphygmoCor). Subjects were divided into 3 predefined groups of brachial PP: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 50, 50-64, and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 65 mmHg. The brachial-central PP difference increased with increasing brachial PP (17 +/- 4, 22 +/- 4, and 29 +/- 4 mmHg, respectively P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In contrast, peripheral amplification (as measured by the brachial:central PP ratio) remained constant among the tree groups, at the expense of a concomitant widening of aortic PP (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) without difference in augmentation index. In the entire sample, central and brachial PP, and the difference between the two measures, correlated positively with cardiac output (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and stroke volume (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), and negatively with systemic vascular resistance (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), without significant relationship with heart rate. In conclusion, despite the different amplitude, central and brachial PP shared common hemodynamic determinants. A high PP among young men underlied a high output-low resistance circulatory pattern, independently of the site of measurement.
Pemphigus is an autoimmune blistering disease. According to a report, in areas of endemic pemphig... more Pemphigus is an autoimmune blistering disease. According to a report, in areas of endemic pemphigus foliaceus (EPF) in Peru there are cases of pemphigus vulgaris with epidemiologic, clinical and histopathologic characteristics similar to those of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;endemic pemphigus vulgaris&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (EPV) in Brazil. To determine the clinical and epidemiologic characteristics of endemic pemphigus and the risk factors of patients for developing complications during treatment. A study was carried out from July 2003 to March 2008. The study population was 60 patients with EPF and 7 patients with EPV evaluated in hospitals and clinics in the Peruvian Amazon and Lima. A multivariate analysis was carried out using binary logistic regression. The average age of EPF patients was 31.4 years; 55% were men; 60% presented the generalized clinical variant. Non-compliance with the treatment was seen in 57.1% of the patients. Thirty-five percent presented complications (e.g. pyodermitis and pyelonephritis) during treatment. The risk factors for developing complications during treatment were non-compliance with the treatment and having the generalized clinical form. In the EPV group, the average age was 21.7 years; 71.4% were men. All patients presented with the mucocutaneous clinical variant and the initial presentation consisted of oral mucosa lesions; 71.4% presented complications during treatment, pyodermitis being the most frequent. Non-compliance with the treatment and the generalized clinical form are risk factors for the development of complications during treatment of patients with EPF. Peru indeed has EPV cases with epidemiologic characteristics similar to EPF. Living in a rural area may represent a risk factor for the development of complications during treatment of patients with EPV.
Background. High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for... more Background. High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for premature development of atherosclerosis and atherothrombosis. Adult renal transplant recipients have elevated tHcy levels. Corresponding data in pediatric, adolescent, and young adult renal transplant recipients are scarce. We investigated whether tHcy levels were elevated in stable renal transplant recipients who received kidney grafts before age 18.
Background. The morning home blood pressure (BP) rise is a significant asymptomatic target organ ... more Background. The morning home blood pressure (BP) rise is a significant asymptomatic target organ damage predictor in hypertensives. Our aim was to evaluate determinants of home-based morning-evening difference (MEdiff) in Argentine patients. Methods. Treated hypertensive patients aged ≥18 years participated in a cross-sectional study, after performing home morning and evening BP measurement. MEdiff was morning minus evening home average results. Variables identified as relevant predictors were entered into a multivariable linear regression analysis model. Results. Three hundred sixty-seven medicated hypertensives were included. Mean age was 66.2 (14.5), BMI 28.1 (4.5), total cholesterol 4.89 (1.0) mmol/L, 65.9% women, 11.7% smokers, and 10.6% diabetics. Mean MEdiff was 1.1 (12.5) mmHg systolic and 2.3 (6.1) mmHg diastolic, respectively. Mean self-recorded BP was 131.5 (14.1) mmHg systolic and 73.8 (7.6) mmHg diastolic, respectively. Mean morning and evening home BPs were 133.1 (16.5) versus 132 (15.7) systolic and 75.8 (8.4) versus 73.5 (8.2) diastolic, respectively. Significant beta-coefficient values were found in systolic MEdiff for age and smoking and in diastolic MEdiff for age, smoking, total cholesterol, and calcium-channel blockers. Conclusions. In a cohort of Argentine medicated patients, older age, smoking, total cholesterol, and use of calcium channel blockers were independent determinants of home-based MEdiff.
We aimed to determine a possible association between isolated morning hypertension (IMH) and meal... more We aimed to determine a possible association between isolated morning hypertension (IMH) and meal-induced blood pressure (BP) fall in adult treated hypertensive patients who underwent home BP measurements. A total of 230 patients were included, median age 73.6, 65.2% women. After adjusting for age, sex, number of antihypertensive drugs, office and home BP levels, the association between IMH and meal-induced BP fall was statistically significant. In conclusion, meal-induced BP fall and IMH detected through home blood pressure monitoring (HBPM) are independently associated in hypertensive patients. The therapeutic implications of such observation need to be clarified in large-scale prospective studies.
It is not clear which educational strategy is most effective in helping patients to change their ... more It is not clear which educational strategy is most effective in helping patients to change their lifestyles. This study compared the efficacy of two different educational models on reducing blood pressure (BP).This was a randomized controlled trial in ambulatory hypertensive patients >65 years of age. Workshops that aimed to develop self-management and patient empowerment (PEM) were compared to workshops that used a compliance-based model (CEM). The primary outcome was change in systolic BP at 3 months compared with basal values between groups (net reduction), measured by 24-h ambulatory BP monitoring.A total of 30 patients were educated with PEM and 30 others with CM. Both groups were statistically similar with regard to age (67 v 70 years), systolic BP (157 v 156 mm Hg) and diastolic BP (88 v 88 mm Hg), diabetes (23% v 31%), and basal natriuresis 116 v 121 mEq/day). There were more women in the PEM group (57% v 30%). The PEM group showed a significant reduction of 8 mm Hg (95% confidence interval [CI] 2 to 15), whereas the CM group showed a reduction of 3 mm Hg (95% CI −3 to 8), with a net reduction of 6 (95% CI −3 to 14). Mean net night-time systolic BP reduction was 12 mm Hg (95% CI 2 to 22). BP control was 70% in PEM group vs 45% in CM group (P = 0.045). The relative odds ratio for BP control for the PEM group after adjustment for age, sex, diabetes, basal blood pressure and changes in pharmacological treatment was 3.7 (95% CI 1.05 to 13.1).Based on these study results, the self-management education model was significantly more effective than the compliance-based model in BP control.
Arterial hypertension and transplantation are closely linked, and its association may promote imp... more Arterial hypertension and transplantation are closely linked, and its association may promote impaired graft and overall survival. Since the introduction of calcineurin inhibitors, it is observed in 50-80% of transplanted patients. However, many pathophysiological mechanisms are involved in its genesis. In this review, we intend to provide an updated overview of these mechanisms, dealing with the causes common to all kinds of transplantation and emphasizing special cases with distinct features, and to give a perspective on the pharmacological approach, in order to help clinicians in the management of this frequent complication.
Currently, total hyperhomocysteinemia (tHHcy) is a well-known condition linked to a higher risk o... more Currently, total hyperhomocysteinemia (tHHcy) is a well-known condition linked to a higher risk of vascular disease. Prevalence of HHcy increases in elderly persons as the risk associated with it persists. Because factors can be potentially reduced in the elderly, it is important to carry out epidemiologic studies of HHcy.Previously we described the prevalence of hypertension control in an elder population; now, in an observational cross-sectional simple blind study, total homocysteine (tHcy) concentration was determined in 196 of 400 patients from the original cohort.Mean Hcy concentration was 13.2 μmol/L (95% confidence interval 12.4–14.0; range, 5.0 to 48.9); 15.0 μmol/L for men and 12.3 μmol/L for women. Mean serum folic acid levels were 4.9 ± 3.1 ng/mL (range, 2.0 to 20.0 ng/mL), and vitamin B12 levels were 384.8 ± 314.1 pg/mL (range, 48.0 to 1500.0 pg/mL). Taking into account the reference values established by the Third National Health and Nutrition Examination Survey III study, HHcy was detected in 69.8% of all the subjects evaluated. The study showed that 76.2% of the men and 66.4% of the women had high Hcy levels.The very high prevalence of tHHcy in the elderly population, and the consequent risks associated with it suggest that although there are no trials that effectively prove the benefit of tHcy decrease, nutritional intervention is still justified.
Para determinar la influencia del tiempo de espera sobre la satisfacción del usuario en la farmac... more Para determinar la influencia del tiempo de espera sobre la satisfacción del usuario en la farmacia central del Hospital Nacional Dos de Mayo (HNDM), se realizó un estudio transversal donde se registró los tiempos de espera por cada subproceso de atención (facturación, pago en caja y entrega de medicamentos) mediante la observación directa de los usuarios. Se evaluó el nivel de satisfacción del usuario según una escala Likert. Se incluyó 150 usuarios, 59% fueron mujeres, la edad promedio fue de 41,4±12,6 años. El promedio de tiempo total de espera fue de 37,1±14,7 minutos. El tiempo de espera fue significativamente mayor en el subproceso de facturación (p<0,001); asimismo el tiempo que los usuarios tardaron en hacer colas fue mayor que el tiempo efectivo (30,1±14.0 frente a 6,3±4,4; p<0,001). El 17,3% de los usuarios de la farmacia central del HNDM mostraron algún grado de satisfacción. El tiempo de espera menor a 20 minutos fue un predictor de satisfacción del usuario (OR: 4,6 [1,1-18,3]; p<0,05) independientemente de los otros factores. En conclusión, el tiempo de espera prolongado principalmente en el subproceso de facturación, condiciona un bajo nivel de satisfacción del usuario en la farmacia central del HNDM.
The present study compares the relationships between mean arterial pressure (MAP) and pulse press... more The present study compares the relationships between mean arterial pressure (MAP) and pulse pressure (PP) in young and older men and whether MAP determines age-related changes in PP.Impedance cardiography was used to evaluate systemic hemodynamics noninvasively in 189 unmedicated men referred to our hypertension unit. Patients were divided by age according to the median value (< and ≥40 years).In younger patients, increasing supine MAP was associated with a transition in the blood pressure pattern from systolic to diastolic, whereas in older patients, increasing MAP was associated with change from diastolic to systolic hypertension. In young patients elevation in MAP was associated with a parallel decrease in PP (P < .001) and stroke volume index (SVI) (P < .001), whereas in older patients higher MAP was associated with higher PP (P < .001) and PP/SVI ratio (P < .001), a measure of arterial stiffness. When the sample was divided according to the median value of MAP (< and ≥101 mm Hg), differences in the age-related change in PP and SVI became apparent. With a lower MAP, changes in PP and SVI remained parallel until the sixth decade, after which they began a progressive dissociation. In contrast, at higher MAP, the dissociation between PP and SVI began two decades earlier, indicating an acceleration of the age-related increase in arterial stiffness. Therefore, the relationship between MAP and PP was negative in younger men at the expense of a decrease in SVI, and positive in older men due to increasing arterial stiffness.Noninvasive hemodynamic parameters from impedance cardiography provide a useful method to characterize the mechanism of increased blood pressure.
This study investigates whether an increased brachial pulse pressure (PP) in young healthy men co... more This study investigates whether an increased brachial pulse pressure (PP) in young healthy men constitutes a representative measure of the central hemodynamic forces, or the mere expression of an exaggerated upper limb amplification. Thirty two healthy men between 17 and 28 years old underwent noninvasive evaluation of systemic hemodynamics (impedance cardiography) and pulse wave analysis (SphygmoCor). Subjects were divided into 3 predefined groups of brachial PP: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 50, 50-64, and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 65 mmHg. The brachial-central PP difference increased with increasing brachial PP (17 +/- 4, 22 +/- 4, and 29 +/- 4 mmHg, respectively P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In contrast, peripheral amplification (as measured by the brachial:central PP ratio) remained constant among the tree groups, at the expense of a concomitant widening of aortic PP (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) without difference in augmentation index. In the entire sample, central and brachial PP, and the difference between the two measures, correlated positively with cardiac output (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and stroke volume (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), and negatively with systemic vascular resistance (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), without significant relationship with heart rate. In conclusion, despite the different amplitude, central and brachial PP shared common hemodynamic determinants. A high PP among young men underlied a high output-low resistance circulatory pattern, independently of the site of measurement.
Free living amoebae are anfizoic organisms that affect people producing different pathologies. Th... more Free living amoebae are anfizoic organisms that affect people producing different pathologies. The sorts of importance are Acanthamoeba, Naegleria, Balamuthia and lastly, Sappinia. We described four cases of free living amoebae with cutaneous compromise belonging to Acanthamoeba sort. Three cases were immunocompromised and one case was immunocompetent. The immunocompromised patients presented necrotizing ulcerated lesions that did not reach to the central nervous system. The immunocompetent patient presented inferior eyelid with swelling that progressed to severe neurological commitment with fatal evolution.
Background. High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for... more Background. High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for premature development of atherosclerosis and atherothrombosis. Adult renal transplant recipients have elevated tHcy levels. Corresponding data in pediatric, adolescent, and young adult renal transplant recipients are scarce. We investigated whether tHcy levels were elevated in stable renal transplant recipients who received kidney grafts before age 18.
Journal of the American Society of Hypertension, 2013
To evaluate the spectrum of hemodynamic patterns in patients with isolated diastolic hypertension... more To evaluate the spectrum of hemodynamic patterns in patients with isolated diastolic hypertension-predominantly diastolic hypertension, we re-analyzed a previously reported cohort of 189 non-medicated hypertensive individuals that were assessed by impedance cardiography. We selected 46 patients who were less than 50 years old and had pulse pressure less than 45 mm Hg confirmed by ambulatory blood pressure monitoring. The selected cohort had a mean age of 39.7 years and was 47% men. Three distinct groups were identified: a high cardiac index (CI) ''hyperdynamic'' group, with normal to near normal systemic vascular resistance (SVR); an intermediate CI and SVR group; and a ''vasotonic'' group, with low CI and high SVR. Heart rate was similar among the three groups. Stroke volume index (SVI) was significantly higher in the hyperdynamic group (61.8, 49.7, and 39.7 mL/m 2 in the high, intermediate, and low CI groups, respectively). The hyperdynamic group had greater total arterial compliance index than the vasotonic group (1.3 AE 0.3 vs 0.92 AE 0.2 mL/m 2 mm Hg for high vs low CI, respectively; P < .001).
Postprandial hypotension (PPH) is a frequently under-recognized entity associated with increased ... more Postprandial hypotension (PPH) is a frequently under-recognized entity associated with increased morbidity and mortality. The prevalence of PPH detected through home blood pressure monitoring (HBPM) is unknown. To determine the prevalence and clinical predictors of PPH in hypertensive patients assessed through HBPM. Hypertensive patients of 18 years or older underwent home blood pressure (BP) measurements (duplicate measurements for 4 days: in the morning, 1 h before and 1 h after their usual lunch, and in the evening; OMRON 705 CP). PPH was defined as a meal-induced systolic BP decrease of ≥20 mm Hg. Variables identified as relevant predictors of PPH were entered into a multivariate logistic regression analysis. In total, 230 patients were included in the analysis, with a median age of 73.6 (interquartile range 16.9) years, and 65.2% were female. The prevalence of PPH (at least one episode) was 27.4%. Four variables were independently associated with PPH: age of 80 years or older (odds ratio (OR) 3.45, 95% confidence interval (CI) 1.35-8.82), body mass index (BMI) (OR 0.88, 95%CI 0.81-0.96), office systolic BP (OR 1.03, 95%CI 1.01-1.05) and a history of cerebrovascular disease (OR 3.29, 95%CI 1.03-10.53). PPH after a typical meal is a frequent phenomenon that can be detected through HBPM. Easily measurable parameters in the office such as older age, higher systolic BP, lower BMI and a history of cerebrovascular disease may help to detect patients at risk of PPH who would benefit from HBPM.
Our purpose was to determine the level of awareness, treatment, and control of hypertension in a ... more Our purpose was to determine the level of awareness, treatment, and control of hypertension in a population of subjects aged 65 or more. We studied a random sample from the national health care program in Buenos Aires. Letters were mailed to 1000 selected individuals. Among those eligible, 41.4% (n ؍ 414) were enrolled. The mean age was 73.8 years and 68% were women. Prevalence of hypertension in our sample was 77.5% (n ؍ 321). Awareness of hypertension was 60.7% (n ؍ 195). Fifty-four percent (n ؍ 173) of the hypertensive subjects were receiving pharmacologic treatment and only 18.5% (n ؍ 32) of them were controlled. These results show that there is a low level of awareness, pharmacologic treatment, and control of hypertension in the studied elderly subjects.
This study investigates whether an increased brachial pulse pressure (PP) in young healthy men co... more This study investigates whether an increased brachial pulse pressure (PP) in young healthy men constitutes a representative measure of the central hemodynamic forces, or the mere expression of an exaggerated upper limb amplification. Thirty two healthy men between 17 and 28 years old underwent noninvasive evaluation of systemic hemodynamics (impedance cardiography) and pulse wave analysis (SphygmoCor). Subjects were divided into 3 predefined groups of brachial PP: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 50, 50-64, and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 65 mmHg. The brachial-central PP difference increased with increasing brachial PP (17 +/- 4, 22 +/- 4, and 29 +/- 4 mmHg, respectively P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). In contrast, peripheral amplification (as measured by the brachial:central PP ratio) remained constant among the tree groups, at the expense of a concomitant widening of aortic PP (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) without difference in augmentation index. In the entire sample, central and brachial PP, and the difference between the two measures, correlated positively with cardiac output (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and stroke volume (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01), and negatively with systemic vascular resistance (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), without significant relationship with heart rate. In conclusion, despite the different amplitude, central and brachial PP shared common hemodynamic determinants. A high PP among young men underlied a high output-low resistance circulatory pattern, independently of the site of measurement.
Pemphigus is an autoimmune blistering disease. According to a report, in areas of endemic pemphig... more Pemphigus is an autoimmune blistering disease. According to a report, in areas of endemic pemphigus foliaceus (EPF) in Peru there are cases of pemphigus vulgaris with epidemiologic, clinical and histopathologic characteristics similar to those of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;endemic pemphigus vulgaris&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (EPV) in Brazil. To determine the clinical and epidemiologic characteristics of endemic pemphigus and the risk factors of patients for developing complications during treatment. A study was carried out from July 2003 to March 2008. The study population was 60 patients with EPF and 7 patients with EPV evaluated in hospitals and clinics in the Peruvian Amazon and Lima. A multivariate analysis was carried out using binary logistic regression. The average age of EPF patients was 31.4 years; 55% were men; 60% presented the generalized clinical variant. Non-compliance with the treatment was seen in 57.1% of the patients. Thirty-five percent presented complications (e.g. pyodermitis and pyelonephritis) during treatment. The risk factors for developing complications during treatment were non-compliance with the treatment and having the generalized clinical form. In the EPV group, the average age was 21.7 years; 71.4% were men. All patients presented with the mucocutaneous clinical variant and the initial presentation consisted of oral mucosa lesions; 71.4% presented complications during treatment, pyodermitis being the most frequent. Non-compliance with the treatment and the generalized clinical form are risk factors for the development of complications during treatment of patients with EPF. Peru indeed has EPV cases with epidemiologic characteristics similar to EPF. Living in a rural area may represent a risk factor for the development of complications during treatment of patients with EPV.
Uploads
Papers by Carlos Galarza