Helicity and Vorticity of Pulmonary Arterial Flow in Patients With Pulmonary Hypertension: Quantitative Analysis of Flow Formations.

BACKGROUND: Qualitative and quantitative flow hemodynamic indexes have been shown to reflect right ventricular (RV) afterload and function in pulmonary hypertension (PH). We aimed to quantify flow hemodynamic formations in pulmonary arteries using 4-dimensional flow cardiac magnetic resonance imaging and the spatial velocity derivatives helicity and vorticity in a heterogeneous PH population. METHODS AND RESULTS: Patients with PH (n=35) and controls (n=10) underwent 4-dimensional flow magnetic resonance imaging study for computation of helicity and vorticity in the main pulmonary artery (MPA), the right pulmonary artery, and the RV outflow tract. Helicity and vorticity were correlated with standard RV volumetric and functional indexes along with MPA stiffness assessed by measuring relative area change. Patients with PH had a significantly decreased helicity in the MPA (8 versus 32 m/s2; P<0.001), the right pulmonary artery (24 versus 50 m/s2; P<0.001), and the RV outflow tract-MPA unit (15 versus 42 m/s2; P<0.001). Vorticity was significantly decreased in patients with PH only in the right pulmonary artery (26 versus 45 1/s; P<0.001). Total helicity computed correlated with the cardiac magnetic resonance imaging-derived ventricular-vascular coupling (-0.927; P<0.000), the RV ejection fraction (0.865; P<0.0001), cardiac output (0.581; P<0.0001), mean pulmonary arterial pressure (-0.581; P=0.0008), and relative area change measured at the MPA (0.789; P<0.0001). CONCLUSIONS: The flow hemodynamic character in patients with PH assessed via quantitative analysis is considerably different when compared with healthy and normotensive controls. A strong association between helicity in pulmonary arteries and ventricular-vascular coupling suggests a relationship between the mechanical and flow hemodynamic domains.

Flowers that threaten Funza.

PIP: Water shortages have resulted from agricultural development in a rural area outside Bogota, Colombia. These shortages have increased women's work load and caused problems in managing households because the water must be boiled before ingestion. In the community of Funza, women must obtain clean water in buckets at night from the main valve, which has insufficient water pressure and a slow stream. Some barrios collect water on a weekly basis. The local restaurant in town obtains water once a week from a tanker; the town is lucky to receive water three times a week. Men assume that women will take care of the problem. The mayor says that the piped water from Bogota will soon be connected and that each barrio will have its own valve. Women are concerned that the supply, even with new valves, will be limited and mixed with dirty lagoon water. Experts are saying that the water shortage and quality problems that began seven years ago will lead to rationing within three to six years. The flower companies, that came to the area 22 years age, are blamed for the water problems. People say that the flower companies have piped clean water from the area's supply in the San Patricia and that underground sources of water have been used up as well. The industry provides jobs and income, which have improved the standard of living, but there is little consideration given to the water supply. The community shifted water sources to the lagoon at a time when the water was being contaminated by sewage and pesticides and chemicals from the flower companies.^ieng

Baru fishermen band together for a better life. View from the village 3.

PIP: An example of how Baru, Colombia families are struggling to survive in fishing communities on the Caribbean coast is presented. Population pressure, economics fluctuations in the coconut industry, tourism, pollution of the lagoon, inadequate water supply, and mangrove destruction are some of the issues confronting villagers. The copra boom of the 1930 and 1940 and good coconut harvests contributed to good times in the past. Tourism has the advantage of providing jobs close at hand and a market for fishing catches, but the disadvantages are closed access to beaches, cutting of mangroves to make beaches, and pollution of waterways. Land has been appropriated for tourism development and what is left is unsuitable for grazing or growing fruit trees. Families are large. Fishing is no longer close to shore and catches are smaller. Large fishing boats take all the fish in their big nets. There are up to 10 dry months a year; water must be collected from Cartagena, 40 km north of Baru. Efforts have been made to improve conditions. A contraceptive post provides services (pills, injections, and condoms) to the 67% of couples in the 2500 population in Baru. Condoms have become popular since several Baru residents have died of AIDS. Sexual activity may begin as early as 14 years. A few secondary school classes provide health and sex information. A health center is well-equipped with a full-time physician and a dentist. Community projects have engaged people in artisan crafts production and dressmaking. A fishing cooperative of 30-40 has been formed. New methods are being taught. The concentration of fishermen, the decimation of fish from too many years of dynamiting for bait, and the pollution along the coast from industrial waste and city drains mean fewer fish. Fishing and tourism are the main sources of income. Large new luxury hotels are planned for the area but impact assessments have not been made. For instance, electricity has just been brought into the village, and a secure water supply is needed. Intense lobbying effort, time, and money are required to obtain a pipeline connection.^ieng

Life and love in the barrios.

PIP: Although migrant pressure on metropolitan areas has begun easing in Colombia, migrants from the departments of Boyaca and Cundinamarca continue to stream into the capital city of Bogota, where they face severe hardships. In Colombia, the social conditions for rural inhabitants have been improving. Per capita income has increased, family size has decreased, and women have begun to find greater opportunities. The rate of vaccination and contraceptive prevalence are now almost the same for urban and rural populations. These changes have lessened the incentive to migrate to the city. But in Boyaca and Cundinamarca, where over-intensive farming has aggravated poverty, people continue to leave Bogota. Many of the new arrivals already have relatives or friends who help them get established. But for those who don't, life is difficult. The article tells the story of Hermencia, who left Boyaca at age 12. Now 59, Hermencia has worked as a maid most of her life, changing from job to job. She has had 6 children from 3 different fathers. Luckily for Hermencia, her patrons helped her find a permanent home, and her family has maintained a network. And none of her children ended up in the street, as did Frankie, an 18 year-old from Cundinamarca. Frankie arrived in Bogota with his father, who became the bodyguard of a drug trafficker and was subsequently killed. Frankie has lived 6 years in the streets. Frankie is known to the police for mugging and drug abuse. He has a 16 year-old girlfriend who is pregnant. This is not uncommon. Women living in immigrant barrios average 4-5 children, compared to 2-3 in other low-income areas in Bogota.^ieng

Colombia: crusading efforts bring signs of progress.

PIP: Colombia, like many developing countries, has not committed resources to fight the AIDS problem. They have used the media for condom promotion and other sexually transmitted diseases. There have been 151 deaths caused by AIDS by the end of 1988; 344 cases are known, and 130 additional have tested positive to the virus. Health officials were reluctant to recognize the problem, thinking it was outside their country and that they would not be affected by it. Since then, they have tried to target high risk groups and educate them and assist with testing and counseling. There is a move to make the new drug zidovudine available, but few could afford its high price. The authorities have put transvestite prostitutes in jail and kept them for AIDS testing, but few woman prostitutes have been tested. Up until 1986, only 30% of the Red Cross blood bank supplies were being tested; now 80% are, although it comprises only about 40% of the total supply. Drugs are used heavily, but mostly smoked, in Colombia, yet there is some concern about increased use of needles. The majority of cases in Columbia have been homosexual and bisexual men, but prostitution among men and women is prevalent in large cities such as Bogota. Health officials state that education is the best deterrent, but must be perpetuated so people will be constantly reminded.^ieng

Latin American conference increases AIDS awareness.

PIP: A recent conference on acquired immunodeficiency syndrome (AIDS) in the Americas, held in Quito, Ecuador, and organized by PAHO, showed that most governments have accepted the gravity of the situation and the need for action in Latin America and the Caribbean. The conference supplied up-to-date information for scientists, health workers and policy markers, as well as helping to educate the general public, and it allowed people from all over the region to ask questions on research, drugs, health care, and related subjects. The AIDS pattern in the region appears similar to the 1st stage in developed countries, involving a high % of homosexual and bisexual men. Few female cases have been reported in Latin American nations, but in the Caribbean, where AIDS prevalence is much higher, more women are affected. Blood transfusions are a major source of infection in Latin America, and most countries do not have the equipment or organization needed to test all donors. Overall, Latin American data are still far too fragmentary for accurate forecasting, but 1 indicator at least shows that people are heeding educational efforts: condom sales in Brazil increased by nearly 50% during 1986, while street sellers in Bogota say AIDS has done wonders for their condom business.^ieng