Ronald G. Garcia

Inter-relationships Between Body Mass Index, C-reactive Protein and Blood Pressure in a Hispanic Pediatric Population

BACKGROUND The link between inflammation, obesity, and cardiovascular disease (CVD) has been described in adult populations but few data are available with respect to children. The aim of this study was to describe the inter-relationships between adiposity, C-reactive protein (CRP) plasma concentrations, and blood pressure levels in a Hispanic pediatric population. METHODS We included 325 schoolchildren (mean age, 10.0 years) selected from the school population of Bucaramanga, Colombia. Blood pressure, lipid profile, glucose, and CRP plasma concentration were measured using standard procedures. Body mass index (BMI) was used for evaluating the childrens nutritional condition. Correlation coefficients were calculated for all the variables using Spearmans test. RESULTS As expected, a positive correlation was found between BMI and systolic blood pressure (SBP) in both genders, and between CRP and SBP levels in boys. After a multivariate regression analysis, the association between adiposity and blood pressure remained significant, whereas the CRP concentrations were no longer associated with SBP. CONCLUSIONS The results obtained in our study of Hispanic school-age children show that adiposity is correlated with CRP concentrations and SBP values as has been earlier described in Caucasian populations. However, we failed to find a significant relationship between low-grade inflammation and SBP levels. Further studies are needed in order to explore alternative pathophysiological mechanisms linking obesity and high blood pressure in children and to define the impact of these associations on the cardiovascular risk of our pediatric population.

Calcium plus linoleic acid therapy for pregnancy-induced hypertension

Objective: To determine the effect of dietary supplementation of calcium plus conjugated linoleic acid (calcium–CLA) in reducing the incidence of vascular endothelial dysfunction in pregnant women at high risk of developing pregnancy‐induced hypertension (PIH). Patients and methods: This randomized, double‐blind, placebo‐controlled trial conducted at 4 outpatient clinics in 2 developing countries recruited 48 healthy primigravidas younger than 19 years or older than 35 years who had a family history of pre‐eclampsia and diastolic notch. Twenty‐four participants received daily elemental calcium (600 mg) plus CLA (450 mg) and 24 received placebo from week 18 to 22 of pregnancy until delivery. Results: Calcium–CLA supplementation reduced significantly the incidence of PIH (2 cases [8%] in the study group vs. 10 cases [42%] in the placebo group; relative risk, 0.20; 95% confidence interval, 0.05–0.82; P = .01). Endothelial dysfunction was also significantly reduced after calcium–CLA supplementation (in 18 women [75%] vs. 4 women [17%]; P < .001), compared with the placebo group (in 15 [63%] vs. 9 women [38%]; P = .08). Conclusion: In pregnant women at high risk for PIH, calcium–CLA supplementation decreases the incidence of PIH and improves endothelial function.

Flow‐mediated dilatation of the brachial artery in pregnancy

The endothelial release of nitric oxide (NO) has been proposed as the main responsible factor for the decreased systemic vascular resistance observed during pregnancy. In addition a decreased production or an increased inactivation of NO has been linked to the endothelial dysfunction that characterizes preeclampsia. Flow Mediated Dilatation (FMD) a non-invasive method which uses high resolution ultrasound is an established test to assess endothelial function highly dependent on the capacity of endothelial cells to release NO. To evaluate the effect of pregnancy on the endothelial function measured by FMD we sequentially enrolled 492 normotensive Hispanic pregnant women in a prospective cohort study from March 2001 to March 2005 at the Doppler Ultrasound Department of the Cardiovascular Foundation of Colombia Bucaramanga. Inclusions criteria were a normal singleton pregnancy with gestational age = 30 weeks and maternal age < 25 years. (excerpt)

A Controlled, Randomized-Blinded Clinical Trial to Assess the Efficacy of a Nitric Oxide Releasing Patch in the Treatment of Cutaneous Leishmaniasis by Leishmania ( V. ) panamensis

A topical nanofiber nitric oxide (NO) releasing patch ( approximately 3.5 mumol NO/cm(2)/day for 20 days, NOP) was compared with intramuscular meglumine antimoniate (Glucantime, 20 mg/kg/day for 20 days) for the treatment of cutaneous leishmaniasis (CL) caused by Leishmania (V.) panamensis in Santander and Tolima, Colombia. A double-blind, randomized, placebo-controlled, clinical trial was conducted to determine whether the NOP is as effective as Glucantime for the treatment of CL. Patients were randomly assigned to Glucantime and placebo patches or NOP and placebo of Glucantime. The cure rates after a 3-month follow-up were 94.8% for the group that received Glucantime compared with 37.1% in the NOP group. Despite the lower efficacy of the NOP versus Glucantime, a significantly lower frequency of non-serious adverse events and a reduced variation in serum markers were observed in patients treated with NOP. Treatment of CL with NOP resulted in a lower effectiveness compared with Glucantime; however, the low frequency of adverse events and the facility of topic administration justify the development of new generations of NOP systems for the treatment of CL.

The Somatosensory Link in Fibromyalgia: Functional Connectivity of the Primary Somatosensory Cortex Is Altered by Sustained Pain and Is Associated With Clinical/Autonomic Dysfunction

Fibromyalgia (FM) is a chronic functional pain syndrome characterized by widespread pain, significant pain catastrophizing, sympathovagal dysfunction, and amplified temporal summation for evoked pain. While several studies have demonstrated altered resting brain connectivity in FM, studies have not specifically probed the somatosensory system and its role in both somatic and nonsomatic FM symptoms. Our objective was to evaluate resting primary somatosensory cortex (S1) connectivity and to explore how sustained, evoked deep tissue pain modulates this connectivity.

Development and Validation of a Quantitative Food Frequency Questionnaire among Rural- and Urban-Dwelling Adults in Colombia.

OBJECTIVE To validate a food frequency questionnaire (FFQ) against multiple 24-hour dietary recalls (DRs) that could be used for Colombian adults. METHODS A convenience sample of 219 individuals participated in the study. The validity of the FFQ was evaluated against multiple DRs. Four dietary recalls were collected during the year, and an FFQ was administered at the end of the study along with the fourth DR. RESULTS Deattenuated correlation coefficient for FFQ against mean intake of 4 DRs varied from 0.77 for carbohydrate, 0.55 for energy, and 0.51 for protein. In rural areas, lower correlations were observed. The overall extent of agreement in each quartile of estimated nutrient intake varied from 61% to 83%. CONCLUSIONS AND IMPLICATIONS The FFQ provides moderate to high estimates for energy and nutrient intake and can be employed to rank individuals based on their habitual intake.

Plasma nitrate levels and flow-mediated vasodilation in untreated major depression.

Objective: Findings from several studies have revealed that major depression is associated with an increased cardiovascular risk. The physiopathologic mechanisms of this association remain unclear, although recently, it has been hypothesized that a decreased production of nitric oxide could be a potential contributor to vascular dysfunction in depressive patients. The objective of this study was to evaluate nitric oxide production and vascular endothelial function in treatment-naive young healthy adults with a first episode of major depression. Methods: A case-control study in 50 treatment-naive young adults with a first episode of major depression and 50 healthy control subjects was conducted. Plasma levels of nitric oxide metabolites (nitrates/nitrites) were determined using a colorimetric assay based on Griess reaction. Endothelial function was assessed by flow-mediated vasodilation measurements after reactive hyperemia. Results: The mean age of the depressed patients was 22.6 (standard deviation [SD], 4.6) years, whereas the controls were 23.4 (SD, 4.8) years. Sixteen men (32%) and 34 women (68%) were included in each group. The plasma nitrite/nitrate concentrations were significantly lower in depressive subjects compared with healthy controls (17.5 [SD, 4.9] &mgr;mol/L versus 21.6 [SD, 7.0] &mgr;mol/L, p < .001); however, flow-mediated vasodilation values were similar in both groups (13.1% [SD, 4.3%] versus 12.1% [SD, 5.0%], p = .10). Conclusions: Decreased plasma concentrations of nitric oxide metabolites are not associated with vascular endothelial dysfunction in young subjects with a first episode of major depression. Reduced nitrate/nitrite levels could reflect a decreased nitric oxide production in the central nervous system of depressed subjects. Further studies are needed to confirm this hypothesis.CVD = cardiovascular disease; CNS = central nervous system; eNOS = endothelial nitric oxide synthase; FMD = flow-mediated vasodilation; HPA = hypothalamic-pituitary-adrenocortical axis; iNOS = inducible nitric oxide synthase; MDD = major depressive disorder; nNOS = neuronal nitric oxide synthase; NO = nitric oxide; NOS = nitric oxide synthase; NOx = nitric oxide metabolites (nitrates/nitrites)

Clinical trial to assess the effect of physical exercise on endothelial function and insulin resistance in pregnant women.

BackgroundPreeclampsia (PE) is a common maternal disease that complicates 5 to 10% of pregnancies and remains as the major cause of maternal and neonatal mortality. Cost-effective interventions aimed at preventing the development of preeclampsia are urgently needed. However, the pathogenesis of PE is not well known. Multiple mechanisms such as oxidative stress, endothelial dysfunction and insulin resistance may contribute to its development. Regular aerobic exercise recovers endothelial function; improves insulin resistance and decreases oxidative stress. Therefore the purpose of this clinical trial is to determine the effect of regular aerobic exercise on endothelial function, on insulin resistance and on pregnancy outcome.Methods and design64 pregnant women will be included in a blind, randomized clinical trial, and parallel assignment. The exercise group will do regular aerobic physical exercise: walking (10 minutes), aerobic exercise (30 minutes), stretching (10 minutes) and relaxation exercise (10 minutes) in three sessions per week. Control group will do the activities of daily living (bathing, dressing, eating, and walking) without counselling from a physical therapist.Trial registrationNCT00741312.

Aged Garlic Extract Improves Adiponectin Levels in Subjects with Metabolic Syndrome: A Double-Blind, Placebo-Controlled, Randomized, Crossover Study

Background. Garlic (Allium sativum) has been shown to have important benefits in individuals at high cardiovascular risk. The aim of the present study was to evaluate the effects of the administration of aged garlic extract (AGE) on the risk factors that constitute the cluster of metabolic syndrome (MS). Methods and Design. Double-blind, crossover, randomized, placebo-controlled clinical trial to assess the effect of 1.2 g/day of AGE (Kyolic), for 24 weeks of treatment (12 weeks of AGE and 12 weeks of placebo), on subjects with MS. Results. The administration of AGE increased the plasma levels of adiponectin (P = 0.027). No serious side effects associated with the intervention were reported. Conclusion. The present results have shown for the first time that the administration of AGE for 12 weeks increased plasma adiponectin levels in patients with MS. This suggests that AGE might be a useful, novel, nonpharmacological therapeutic intervention to increase adiponectin and to prevent cardiovascular (CV) complications in individuals with MS.

Risk factors for preeclampsia in women from Colombia: a case-control study.

Background Preeclampsia (PE) is a multi-causal disease characterized by the development of hypertension and proteinuria in the second half of pregnancy. Multiple risk factors have been associated with the development of PE. Moreover, it is known that these risk factors vary between populations from developed and developing countries. The aim of this study is to identify which risk factors are associated with the development of preeclampsia (PE) among Colombian women. Methods A multi-centre case-control study was conducted between September 2006 and July 2009 in six Colombian cities. Cases included women with PE (n = 201); controls were aged-matched pregnant women (n = 201) without cardiovascular or endocrine diseases for a case-control ratio of 1∶1. A complete medical chart, physical examination and biochemical analysis were completed before delivery. Multivariable logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) of potential risk factors associated with PE. Results The presence of factors present in the metabolic syndrome cluster such as body mass index >31 Kg/m2 (OR = 2.18; 1.14–4.14 95% CI), high-density lipoprotein <1.24 mmol/L (OR = 2.42; 1.53–3.84 95% CI), triglycerides >3.24 mmol/L (OR = 1.60; 1.04–2.48 95% CI) and glycemia >4.9 mmol/L (OR = 2.66; 1.47–4.81 95%CI) as well as being primigravidae (OR = 1.71; 1.07–2.73 95% CI) were associated with the development of PE, after adjusting for other variables. Conclusion Factors present in the cluster of metabolic syndrome and primigravidity were associated with a greater risk of PE among Colombian women. Understanding the role of this cluster of risk factors in the development of PE is of crucial importance to prevent PE and remains to be determined.