Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13,844 patients with hypertension.

BACKGROUND AND METHOD: To determine which SBP measure best predicts cardiovascular events (CVEs) independently, a systematic review was conducted for cohorts with all patients diagnosed with hypertension, 1+ years follow-up, and coronary artery disease and stroke outcomes. Lead investigators provided ad hoc analyses for each cohort. Meta-analyses gave hazard ratios from clinic SBP (CSBP), daytime SBP (DSBP), and night-time SBP (NSBP). Coefficients of variation of SBP measured dispersion. Nine cohorts (n = 13,844) were from Europe, Brazil, and Japan. For sleep-wake SBP classification, seven cohorts used patient-specific information. RESULTS: Overall, NSBP's dispersion exceeded DSBP's dispersion by 22.6% with nonoverlapping confidence limits. Within all nine cohorts, dispersion for NSBP exceeded that for CSBP and DSBP. For each comparison, P = 0.004 that this occurred by chance. Considered individually, increases in NSBP, DSBP, and CSBP each predicted CVEs: hazard ratios (95% confidence intervals) = 1.25 (1.22-1.29), 1.20 (1.15-1.26), and 1.11 (1.06-1.16), respectively. However, after simultaneous adjustment for all three SBPs, hazard ratios were 1.26 (1.20-1.31), 1.01 (0.94-1.08), and 1.00 (0.95-1.05), respectively. Cohorts with baseline antihypertensive treatment and cohorts with patient-specific information for night-day BP classification gave similar results. Within most cohorts, simultaneously adjusted hazard ratios were greater for NSBP than for DSBP and CSBP: P = 0.023 and 0.012, respectively, that this occurred by chance. CONCLUSION: In hypertensive patients, NSBP had greater dispersion than DSBP and CSBP in all cohorts. On simultaneous adjustment, compared with DSBP and CSBP, increased NSBP independently predicted higher CVEs in most cohorts, and, overall, NSBP independently predicted CVEs, whereas CSBP and DSBP lost their predictive ability entirely.

Human rabies and rabies in vampire and nonvampire bat species, Southeastern Peru, 2007.

After a human rabies outbreak in southeastern Peru, we collected bats to estimate the prevalence of rabies in various species. Among 165 bats from 6 genera and 10 species, 10.3% were antibody positive; antibody prevalence was similar in vampire and nonvampire bats. Thus, nonvampire bats may also be a source for human rabies in Peru.

Influenza-like illness sentinel surveillance in Peru.

BACKGROUND: Acute respiratory illnesses and influenza-like illnesses (ILI) are a significant source of morbidity and mortality worldwide. Despite the public health importance, little is known about the etiology of these acute respiratory illnesses in many regions of South America. In 2006, the Peruvian Ministry of Health (MoH) and the US Naval Medical Research Center Detachment (NMRCD) initiated a collaboration to characterize the viral agents associated with ILI and to describe the clinical and epidemiological presentation of the affected population. METHODOLOGY/PRINCIPAL FINDINGS: Patients with ILI (fever > or =38 degrees C and cough or sore throat) were evaluated in clinics and hospitals in 13 Peruvian cities representative of the four main regions of the country. Nasal and oropharyngeal swabs, as well as epidemiological and demographic data, were collected from each patient. During the two years of this study (June 2006 through May 2008), a total of 6,835 patients, with a median age of 13 years, were recruited from 31 clinics and hospitals; 6,308 were enrolled by regular passive surveillance and 527 were enrolled as part of outbreak investigations. At least one respiratory virus was isolated from the specimens of 2,688 (42.6%) patients, with etiologies varying by age and geographical region. Overall the most common viral agents isolated were influenza A virus (25.1%), influenza B virus (9.7%), parainfluenza viruses 1, 2, and 3, (HPIV-1,-2,-3; 3.2%), herpes simplex virus (HSV; 2.6%), and adenoviruses (1.8%). Genetic analyses of influenza virus isolates demonstrated that three lineages of influenza A H1N1, one lineage of influenza A H3N2, and two lineages of influenza B were circulating in Peru during the course of this study. CONCLUSIONS: To our knowledge this is the most comprehensive study to date of the etiologic agents associated with ILI in Peru. These results demonstrate that a wide range of respiratory pathogens are circulating in Peru and this fact needs to be considered by clinicians when treating patients reporting with ILI. Furthermore, these data have implications for influenza vaccine design and implementation in South America.

Experiencia con la colangiografía retrógrada endoscópica como procedimiento diagnóstico y terapéutico / Experience with the endoscopic retrograde cholangiopancreatography as a diagnostic and therapeutic procedure

La colangiopancreatografía retrógrada endoscópica (CPRE) es el procedimiento de elección actual en la patología biliopancreática principalmente en casos de obstrucción biliar y colangitis debido a que hace posible el diagnóstico y tratamiento en un alto porcentaje de ellos. También juega un rol importante en el diagnóstico de las estenosis benignas o malignas de las vías biliares, pudiendo dar manejo definitivo y/o temporal en ellas. Objetivo. El presente estudio evalúa la patología biliopancreática más frecuente diagnosticada por CPRE, el porcentaje de tratamiento endoscópico de las litiasis y estenosis, así como las complicaciones posprocedimiento en un Hospital Nacional de referencia. Material y métodos. Se evaluó a 508 pacientes de un total de 932 informes de CPRE realizadas en el periodo 2002- 2003 con sus historias clínicas con documentación completa pre y pos-CPRE. Resultados. La CPRE aplicada a población adulta mayor a 25 años (80,9 por ciento), fue realizada en una proporción 4/1 a predominio del sexo femenino; se documentó litiasis como patología más frecuente de la vía biliar (41,14 por ciento), seguida de estenosis de la vía biliar (11,81 por ciento), contando con otras causas en un menor número de casos. Se realizó papiloesfinterotomía endoscópica (PEE) en 282 casos de nuestra población de estudio correspondiendo a hallazgos de litiasis, odditis, colangitis, y estenosis (benignas o malignas); reportando la extracción total de cálculos en el 59,33 por ciento, colocación de stents en un 26,53 por ciento de las estenosis malignas. Del total de procedimientos el 6,30 por ciento tuvo complicaciones, pancreatitis en 6,10 por ciento, y hemorragia en 0,20 por ciento. Del 53,51 por ciento de pacientes sometidos a PEE, el 6,38 por ciento tuvo complicaciones, siendo la más frecuente pancreatitis 6,03 por ciento y hemorragia en el 0,35 por ciento. Conclusiones. La patología de mayor diagnóstico fue litiasis en la vía biliar, siendo el manejo...