Víctor R Castillo

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.

Are nutrition-induced epigenetic changes the link between socioeconomic pathology and cardiovascular diseases?

The prevalence of cardiovascular diseases (CVD) and diabetes mellitus type 2 (DM 2) is decreasing in developed countries despite the increase in the percentage of subjects with obesity and other well-recognized cardiovascular risk factors. In contrast, the recent transition of the economic model experienced by developing countries, characterized by the adoption of a Western lifestyle, that we have named “socioeconomic pathology,” has led to an increase in the burden of CVD. It has been demonstrated that conventional cardiovascular risk factors in developed and developing countries are the same. Why then does the population of developing countries currently have a higher incidence of CVD than that of developed countries if they share the same risk factors? We have proposed the existence of a higher susceptibility to the development of systemic inflammation at low levels of abdominal obesity in the population of developing countries and the consequent endothelial dysfunction, insulin resistance, DM 2, and CVD. In contrast, an important percentage of obese people living in developed countries have a healthy phenotype and low risk of developing CVD and DM 2. Human epidemiologic studies and experimental dietary interventions in animal models have provided considerable evidence to suggest that nutritional imbalance and metabolic disturbances early in life may later have a persistent effect on an adults health that may even be transmitted to the next generations. Epigenetic changes dependent on nutrition could be key in this evolutionary health behavior, acting as a buffering system, permitting the adaptation to environmental conditions by silencing or increasing the expression of certain genes.

Patología socioeconómica como causa de las diferencias regionales en las prevalencias de Síndrome Metabólico e Hipertensión inducida por el Embarazo

La epidemia de enfermedades cardiovasculares que estan experimentando los paises del tercer mundo ha suscitado controversias acerca de la posible presencia de diferencias regionales en su etiofisiopatologia, las cuales estarian asociadas a factores socioeconomicos. La demostracion de estas diferencias es importante, pues significaria la necesidad de realizar distintos enfoques en la prevencion, el diagnostico y el tratamiento. Algunos datos ndican que hay diferencias en los mecanismos etiofisiopatologicos de la hipertension inducida por el embarazo y del sindrome metabolico en poblaciones de paises desarrollados y en via de desarrollo, asi como en el peso especifico de los factores de riesgo que determinan la presentacion de estas enfermedades. Varias observaciones realizadas en nuestra poblacion indican que el tiempo de exposicion a los cambios de habitos de vida ocasionados por la sociedad consumista (sedentarismo, dieta hipergrasa, hipercalorica) determina una respuesta biologica normal (obesidad, sindrome metabolico, diabetes), la cual aumenta el riesgo de enfermedades cardiovasculares. Proponemos utilizar el nombre de «patologia socioeconomica» para los cambios determinados por la sociedad moderna, con el fin de diferenciarlos de la consideracion aislada de «factores socioeconomicos » y «factores de riesgo», pues consideramos que la interaccion entre ellos es la causa mas importante del aumento acelerado en la incidencia de enfermedades cardiovasculares observado en los ultimos anos en los paises en vias de desarrollo.

Socioeconomic Pathology As a Cause of Regional Differences in the Prevalence of Metabolic Syndrome and Pregnancy-Induced Hypertension

The epidemic of cardiovascular disease being experienced by developing countries has resulted in a debate about the possible existence of regional differences in etiology and pathophysiology that could be associated with socio-economic factors. Clear demonstration of these differences is important because there may be a need for different approaches to prevention, diagnosis and treatment. There is some evidence that there are differences between populations in developed and developing countries in the pathophysiologic mechanisms underlying pregnancy-induced hypertension and metabolic syndrome, just as there are in the relative weightings of risk factors that predict the appearance of these conditions. Observations in our country suggest that increasing exposure to changes in lifestyle brought about by the consumer society (e.g., a lack of exercise, and a high-fat, high-calorie diet) results in a natural biological response (e.g., obesity, metabolic syndrome, and diabetes) that increases the risk of cardiovascular disease. We propose that the term socioeconomic pathology should be used to describe these changes associated with modern society so that they can be differentiated and considered in isolation from socioeconomic factors and other risk factors. We regard the interaction between these various factors as the most important cause of the rapidly increasing incidence of cardiovascular disease observed in developing countries in recent years.

Setting Up an ECMO Program in a South American Country: Outcomes of the First 104 Pediatric Patients.

Background: Less than 1% of the extracorporeal life support organization (ELSO) registry patients are from South America. Extracorporeal membrane oxygenation (ECMO) is an expensive therapy not only in terms of direct financial cost but also with respect to technical and human resources. Finding a successful ECMO model that developing countries can afford is critical to the expansion of therapy to include the availability of this technology for patients in the developing world. Methods: We retrospectively studied the first 104 pediatric ECMO patients in the Fundacion Cardiovascular de Colombia between May 2007 and May 2013. We collected the ELSO registry data from electronic medical records to determine the survival rate, mortality risk factors, and complications in pediatric patients who received ECMO support for cardiac failure, respiratory failure, or ECMO for extracorporeal cardiopulmonary resuscitation in the setting of refractory cardiopulmonary resuscitation. We describe our model of ECMO care regarding staff, training process, care protocol, ECMO circuit, and costs. Results: Of 104 patients, 82 were diagnosed with congenital heart disease. Of those, 50 had biventricular and 32 had univentricular physiology, with a significantly higher survival rate at discharge in the biventricular group (44% vs 18.7%, odds ratio [OR] 3.6, 95% confidence interval [CI] = 1.28-10.52, P = .01). Pediatric patients with a cardiac indication had survival rates of 76.3% at weaning and 52.6% at discharge, which is roughly comparable to those reported by the ELSO in 2013. Univentricular physiology, ECPR, severe pre-ECMO acidosis, ECMO-associated renal failure, and duration of ECMO support were factors associated with increased mortality. Conclusion: Despite limited availability of technical and economic resources, ECMO therapy can be done successfully in a developing country. A model of care based on nurses as ECMO specialists, supported by a multidisciplinary team, is cost-effective.

Tratamiento endovascular del aneurisma de aorta descendente en el adolescente con síndrome de Marfan: Reporte de un caso

Se expone el caso de un adolescente de 14 anos de edad, con sindrome de Marfan y antecedente de tres cirugias cardiovasculares previas: valvuloplastia aortica y mitral a los cinco anos y valvuloplastia aortica y reconstruccion de la aorta toracica con tubo de pericardio bovino a sus diez anos. En primer tiempo quirurgico se realizo reemplazo valvular aortico por valvula mecanica y valvuloplastia mitral y tricuspidea, y en segundo tiempo quirurgico, durante la misma hospitalizacion, exclusion endovascular de aneurisma de aorta descendente asintomatico sin complicaciones. Antes del egreso se diagnostico una endofuga tipo II que se manejo con observacion clinica. Luego de un ano del procedimiento, los controles clinico y tomografico son satisfactorios.

Agenesia del pericardio: reporte de caso de la Fundación Cardiovascular de Colombia.

Introduccion. La agenesia de pericardio, una entidad poco frecuente, en la mayoria de los casos presenta un curso asintomatico. Sin embargo, ocasionalmente causa manifestaciones clinicas que pueden amenazar la vida del paciente. Caso clinico. Presentamos un caso de agenesia de pericardio que se detecto incidentalmente durante una cirugia de cierre de ductus y en el cual sus sintomas clinicos se podrian considerar secundarios al defecto. Comentarios. A pesar que este tipo de procedimientos estan usualmente indicados en la correccion de defectos parciales en los cuales hay un mayor riesgo de muerte subita debido a herniacion y encarcelamiento, esta cirugia se realizo con base mas en los sintomas del paciente que en su defecto anatomico.