Cost Analysis of High-Flow Oxygen Therapy Compared with Conventional Oxygen Therapy in Severe COVID-19 in Colombia: Data from a Randomized Clinical Trial.

Background: A randomized clinical trial (HiFlo-COVID-19 Trial) showed that among patients with severe COVID-19, treatment with high-flow oxygen therapy (HFOT) significantly reduced the need for invasive mechanical ventilation support and time for clinical recovery compared with conventional oxygen therapy (COT). However, the cost of this strategy is unknown. Objective: We examined total cost of HFOT treatment compared with COT in real-world setting. Methods: We conducted a post-trial-based cost analysis from the perspective of a managed competition healthcare system, using actual records of billed costs. Cost categories include general ward, intensive care unit, procedures, imaging, laboratories, medications, supplies, and others. Results: A total of 188 participants (mean age 60, 33% female) were included. Average costs (and standard deviation) in the HFOT group were USD $7992 (7394) and in the COT group USD $ 10,190 (9402). Differences, however, did not reach statistical significance (P=0.093). However, resource use was always less costly for the HNFO group, with an overall percentage decrease of 27%. Two categories make up 72% of all savings: medications (41%) and intensive care unit (31%). Conclusion: For patients in ICU with severe COVID-19 the cost of treatment with HFOT as compared to COT is likely to be cost-saving due to less use of medications and length of stay in ICU.

Clinical atrophy patterns of filiform papillae of the tongue and their relationship with the serum levels of iron, vitamin B12 and folic acid in patients with systemic diseases.

BACKGROUND: The purpose of the study was to evaluate the clinical patterns of atrophy of the filiform papillae (FP) of the tongue and their relationship with the serum levels of iron and vitamin B12 among patients with systemic diseases, in a tertiary care center. METHODS: A cross-sectional, analytical, research study was designed. A systematic tongue examination was performed to evaluate the presence and clinical patterns of FP atrophy. We collected epidemiologic, clinical, and laboratory data. Statistical analysis included χ2 test, Fisher's exact test, Kruskal-Wallis test, and a logistic regression analysis. RESULTS: A total of 87 patients (83.9% females) were included [median age = 55 (range 20-89) years]. Endocrinopathy (60.9%) was the most frequent comorbidity. We found atrophy of the FP in 90.8% of the patients; the atrophy was mild in 83.5% of the cases, and severe in 16.5%. The most common atrophic patterns were as follows: focalized in 64 (73.6%) cases, "U"-shaped pattern in 60 (69%), and generalized in 30 (34.5%). Geographic tongue and median rhomboid glossitis were observed in 12 (13.8%) and 11 (12.6%) subjects, respectively. Lower titers of serum iron were detected in cases with focal (median = 71 vs. 110 mcg/dl) and generalized (median = 55 vs. 78 mcg/dl) FP atrophy (P = 0.03 and P = 0.009, respectively), than their counterparts. The presence of symptomatology was related to the focal pattern of atrophy (P = 0.038). CONCLUSIONS: A high frequency of filiform papillary atrophy of the tongue was observed in patients with comorbidities. Some atrophic patterns of the tongue were significantly associated with certain medical conditions.

Primer aislamiento y caracterización de la cepa prototipo del virus SARS-CoV-2 a inicios de la pandemia de la COVID-19 en el Perú

Introducción: Actualmente los contagios por el virus del SARS-CoV-2 supera los 600 millones de casos en el mundo. Objetivo: Aislar y caracterizar el virus SARS-CoV-2 causante de la COVID-19 a inicios de la pandemia en el Perú. Materiales y métodos: Se realizó el aislamiento viral a partir de 20 muestras de hisopado nasal y faríngeo positivas a SARS-CoV-2 por RT-PCR. El aislamiento se realizó en las líneas celulares Vero ATCC CCL-81 y Vero E6, evaluando el efecto citopático, la presencia del virus por RT-PCR, inmunofluorescencia indirecta (IFI) y posterior identificación por secuenciación genómica. Posteriormente, uno de los aislamientos de mayor circulación fue seleccionado y denominado cepa prototipo (PE/B.1.1/28549/2020), realizándose 10 pasajes sucesivos en células Vero ATCC CCL-81 para evaluar la dinámica de mutaciones. Resultados: Se observaron 11 aislamientos de virus por efecto citopático confirmándose por RT-PCR e IFI, de los cuales 6 fueron secuenciados identificándose los linajes B.1, B.1.1, B.1.1.1 y B.1.205, según el comité Pango de los genomas. La cepa prototipo corresponde a la variante B.1.1 y el análisis de las secuencias de los pasajes sucesivos mostró mutaciones a nivel de la proteína de la espiga (S) del virus, sin variación en la identidad del linaje. Conclusiones: Se aislaron 4 linajes en la línea celular Vero ATCC CCL-81. Los subcultivos en la misma línea celular muestran mutaciones en la proteína de la espiga, lo que indica mayor adaptabilidad a la célula hospedera y variación de la patogenicidad in vitro, comportamiento que le permite tener más éxito de supervivencia.

Introduction: Currently, infections caused by the SARS-CoV-2 virus exceed 600 million cases in the world. Objective: Isolation and characterization of the SARS-CoV-2 virus causing COVID-19 at the beginning of the pandemic in Peru. Materials and methods: Twenty nasal and pharyngeal swab samples were isolated from SARS-CoV-2 using two cell lines, Vero ATCC CCL-81 and Vero E-6; virus identification was performed by RT-PCR and the onset of cytopathic effect (CPE) was evaluated by indirect immunofluorescence and subsequent identification by genomic sequencing. One of the most widely circulating isolates were selected and named the prototype strain (PE/B.1.1/28549/2020). Then 10 successive passages were performed on Vero ATCC CCL-81 cells to assess mutation dynamics. Results: We detected 11 virus isolates by cytopathic effect, and subsequently confirmed by RT-PCR and indirect immunofluorescence. Of these, six were sequenced and identified as the lineages B.1, B.1.1, B.1.1.1, and B.1.205 according to the Pango lineage nomenclature. The prototype strain corresponded to lineage B.1.1. The analysis of the strains from the successive passages showed mutations mainly at in the spike (S) protein of the virus without variation in the identity of the lineage. Conclusions: Four lineages were isolated in the Vero ATCC CCL-81 cell line. Subcultures in the same cell line show mutations in the spike protein indicating greater adaptability to the host cell and variation in pathogenicity in vitro, a behavior that allows it to have more survival success.

Endogenous giant viruses contribute to intraspecies genomic variability in the model green alga Chlamydomonas reinhardtii.

Chlamydomonas reinhardtii is a unicellular eukaryotic alga that has been studied as a model organism for decades. Despite an extensive history as a model system, phylogenetic and genetic characteristics of viruses infecting this alga have remained elusive. We analyzed high-throughput genome sequence data of C. reinhardtii field isolates, and in six we discovered sequences belonging to endogenous giant viruses that reach up to several 100 kb in length. In addition, we have also discovered the entire genome of a closely related giant virus that is endogenized within the genome of Chlamydomonas incerta, the closest sequenced relative of C. reinhardtii. Endogenous giant viruses add hundreds of new gene families to the host strains, highlighting their contribution to the pangenome dynamics and interstrain genomic variability of C. reinhardtii. Our findings suggest that the endogenization of giant viruses may have important implications for structuring the population dynamics and ecology of protists in the environment.

Clustering Analysis of the Multi-Microbial Consortium by Lactobacillus Species Against Vaginal Dysbiosis Among Ecuadorian Women.

The vaginal microbiota plays vital protection in women. This probiotic activity is caused not only by individual Lactobacillus species but also by its multi-microbial interaction. However, the probiotic activity promoted by multi-microbial consortia is still unknown. The aim of this study was the individual and collective analysis on the prevalence of five vaginal lactobacilli (Lactobacillus iners, Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus jensenii, and Lactobacillus acidophilus) among healthy women and women with bacterial vaginosis (BV) or aerobic vaginitis (AV). PCR assays were realized on 436 vaginal samples from a previous study. Chi-square, univariable, and multivariable logistic regression analyses with the Benjamini-Hochberg adjustment evaluated associations between these lactobacilli and vaginal microbiota. Multi-microbial clustering model was also realized through Ward's Minimum Variance Clustering Method with Euclidean squared distance for hierarchical clustering to determine the probiotic relationship between lactobacilli and vaginal dysbiosis. Concerning the individual effect, L. acidophilus, L. jensenii, and L. crispatus showed the highest normalized importance values against vaginal dysbiosis (100%, 79.3%, and 74.8%, respectively). However, only L. acidophilus and L. jensenii exhibited statistical values (p = 0.035 and p = 0.050, respectively). L. acidophilus showed a significant prevalence on healthy microbiota against both dysbioses (BV, p = 0.041; and AV, p = 0.045). L. jensenii only demonstrated significant protection against AV (p = 0.012). Finally, our results evidenced a strong multi-microbial consortium by L. iners, L. jensenii, L. gasseri, and L. acidophilus against AV (p = 0.020) and BV (p = 0.009), lacking protection in the absence of L. gasseri and L. acidophilus.

Neumomediastino espontáneo asociado a episodio grave y persistente de hipo / Spontaneous pneumomediastinum associated with severe and persistent episode of hiccups

Resumen Introducción: El neumomediastino espontáneo es la presencia de aire libre en el mediastino que no ocurre por un trauma torácico o esofágico directo. Es un padecimiento muy raro, que usualmente ocurre en pacientes con asma, infecciones respiratorias o aspiración de cuerpo extraño. Se reportan pocos casos asociados a eventos de singultos por reflujo grave. Caso clínico: Se presenta el caso de una paciente de 10 años con neumomediastino espontáneo y extensión al cuello secundario a un episodio grave y persistente de hipo sin antecedentes de asma, trauma, cirugía, infección aguda, aspiración de cuerpo extraño ni ejercicio intenso con Vasalva. Conclusiones: La irritación del tercio distal del esófago produjo los episodios graves y persistentes de hipo que incrementaron la presión intratorácica, que a su vez por efecto Macklin, desencadenó el neumomediastino. El diagnóstico se realiza con estudios de imagen. El tratamiento es conservador, con resolución del cuadro clínico entre 5 y 7 días después de la hospitalización.

Abstract Background: Spontaneous pneumomediastinum is the presence of free air in the mediastinum that does not occur from direct thoracic or esophageal trauma. It is a very rare condition usually related to patients with asthma, respiratory infections, or foreign body aspiration. Only a few cases are reported to be associated with severe reflux events. Case report: We present the case of a 10-year-old female with spontaneous pneumomediastinum extending to the neck secondary to severe and persistent hiccups, with no history of asthma, trauma, surgery, acute infection, foreign body aspiration, and intense exercise with Vasalva. Conclusions: The irritation of the distal third of the esophagus produced severe and persistent episodes of hiccups that increased the intrathoracic pressure, which in turn triggered the pneumomediastinum by Macklin effect. The diagnosis is made with imaging studies. The treatment is conservative with resolution of the clinical picture between five and seven days after hospitalization.

[Spontaneous pneumomediastinum associated with severe and persistent episode of hiccups.] / Neumomediastino espontáneo asociado a episodio grave y persistente de hipo.

Background: Spontaneous pneumomediastinum is the presence of free air in the mediastinum that does not occur from direct thoracic or esophageal trauma. It is a very rare condition usually related to patients with asthma, respiratory infections, or foreign body aspiration. Only a few cases are reported to be associated with severe reflux events. Case report: We present the case of a 10-year-old female with spontaneous pneumomediastinum extending to the neck secondary to severe and persistent hiccups, with no history of asthma, trauma, surgery, acute infection, foreign body aspiration, and intense exercise with Vasalva. Conclusions: The irritation of the distal third of the esophagus produced severe and persistent episodes of hiccups that increased the intrathoracic pressure, which in turn triggered the pneumomediastinum by Macklin effect. The diagnosis is made with imaging studies. The treatment is conservative with resolution of the clinical picture between five and seven days after hospitalization.

Introducción: El neumomediastino espontáneo es la presencia de aire libre en el mediastino que no ocurre por un trauma torácico o esofágico directo. Es un padecimiento muy raro, que usualmente ocurre en pacientes con asma, infecciones respiratorias o aspiración de cuerpo extraño. Se reportan pocos casos asociados a eventos de singultos por reflujo grave. Caso clínico: Se presenta el caso de una paciente de 10 años con neumomediastino espontáneo y extensión al cuello secundario a un episodio grave y persistente de hipo sin antecedentes de asma, trauma, cirugía, infección aguda, aspiración de cuerpo extraño ni ejercicio intenso con Vasalva. Conclusiones: La irritación del tercio distal del esófago produjo los episodios graves y persistentes de hipo que incrementaron la presión intratorácica, que a su vez por efecto Macklin, desencadenó el neumomediastino. El diagnóstico se realiza con estudios de imagen. El tratamiento es conservador, con resolución del cuadro clínico entre 5 y 7 días después de la hospitalización.

Methyl jasmonate-induced resistance to Delia platura (Diptera: Anthomyiidae) in Lupinus mutabilis.

BACKGROUND: Andean lupin (Lupinus mutabilis Sweet) is an important leguminous crop from South America with a high protein content. In Ecuador, lupin yields are severely affected by the infestation of Delia platura larvae on germinating seeds. The application of elicitor molecules with activity against herbivorous insects to control D. platura infestation constitutes an unexplored and promising alternative for chemical insecticides. In this study, methyl jasmonate (MeJA), hexanoic acid, menadione sodium bisulfite, and DL-ß-aminobutyric acid were evaluated for their ability to induce resistance against D. platura in three commercial lupin cultivars. RESULTS: Only seeds pretreated with MeJA significantly impaired insect performance during choice and no-choice assays. Additionally, fitness indicators such as seed germination and growth were not affected by MeJA treatment. To investigate the molecular mechanisms behind the MeJA-mediated resistance, RT-qPCR assays were performed. First, RT-qPCR reference genes were validated, showing that LmUBC was the most stable reference gene. Next, expression analysis over time revealed that MeJA application up-regulated the activity of the jasmonic acid biosynthetic genes LmLOX2 and LmAOS, together with other jasmonate-related defense genes, such as LmTPS1, LmTPS4, LmPI2, LmMBL, LmL/ODC, LmCSD1, and LmPOD. CONCLUSION: This study indicates that MeJA can be used as an environmentally friendly elicitor molecule to protect Andean lupin from D. platura attack without fitness cost. MeJA application induces plant defense responses to insects in Andean lupin that may be modulated by the onset of terpenoid biosynthesis, proteinase inhibitors, lectins, polyamines, and antioxidative enzymes. © 2021 Society of Chemical Industry.

Presence of SARS-CoV-2 RNA on Surfaces of Public Places and a Transportation System Located in a Densely Populated Urban Area in South America.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible RNA virus that causes COVID-19. Being aware of the presence of the virus on different types of surfaces and in different environments, and having a protocol for its detection, is important to understand the dynamics of the virus and its shedding patterns. In Ecuador, the detection of viral RNA in urban environmental samples has not been a priority. The present study analyzed samples from two densely populated neighborhoods and one public transportation system in Quito, Ecuador. Viral RNA presence was assessed using RT-LAMP. Twenty-eight out of 300 surfaces tested positive for SARS-CoV-2 RNA (9.33%). Frequently touched surfaces, especially in indoor spaces and on public transportation, were most likely to be positive for viral RNA. Positivity rate association for the two neighborhoods and for the surface type was not found. This study found viral RNA presence on urban surfaces; this information provides an insight into viral dissemination dynamics. Monitoring environmental SARS-CoV-2 could support the public health prevention strategies in Quito, Ecuador.

Localization of the culprit artery in inferior myocardial infarction: Influence of the point of measurement of ST segment.

BACKGROUND: There are several approaches widely used in the localization of the responsible artery in inferior myocardial infarction. However, the existing papers show differences in the point where the ST segment is measured. The purpose of our investigation is to analyse the influence of the point at which elevation of the ST segment is measured on the results of these algorithms. METHODS: We analysed the 12­lead electrocardiograms of 90 consecutive patients with inferior myocardial infarction. The ST segment elevation or depression was measured at the J-point and at 80 ms, and three algorithms were applied to predict the culprit artery with both measurements. Sensitivity, specificity, the area under the curve, and the kappa index of agreement were analysed to compare each algorithm at the J-point and at 80 ms. RESULTS: The area under the curve was better at the J-point than at 80 ms in two algorithms (0.696 vs. 0.635, p < 0.043, and 0.754 vs. 0.661, p < 0.045) and did not change in one. Agreement between the J-point and 80 ms was suboptimal in all three algorithms (0.71, 0.65, and 0.58). CONCLUSIONS: The result of different algorithms to detect the culprit artery in inferior STEMI patients can change significantly depending on the point where ST elevation or depression is measured.

Data analysis of incomplete repeated measures using a multivariate extension of the Brown-Forsythe procedure.

BACKGROUND: A multivariate extension of the Brown-Forsythe (MBF) procedure can be used for the analysis of partially repeated measure designs (PRMD) when the covariance matrices are arbitrary. However, the MBF procedure requires complete data over time for each subject, which is a significant limitation of this procedure. This article provides the rules for pooling the results obtained after applying the same MBF analysis to each of the imputed datasets of a PRMD. METHOD: Montecarlo methods are used to evaluate the proposed solution (MI-MBF), in terms of control of Type I and Type II errors. For comparative purposes, the MBF analysis based on the complete original dataset (OD-MBF) and the covariance pattern model based on an unstructured matrix (CPM-UN) were studied. RESULTS: Robustness and power results showed that the MI-MBF method performed slightly worse than tests based on CPM-UN when the homogeneity assumption was met, but slightly better when that assumption was not met. We also note that without assuming equality of covariance matrices, little power was sacrificed by using the MI-MBF method in place of the OD-MBF method. CONCLUSIONS: The results of this study suggest that the MI-MBF method performs well and could be of practical use.

The (Ir)Responsibility of (Under)Estimating Missing Data.

It is practically impossible to avoid losing data in the course of an investigation, and it has been proven that the consequences can reach such magnitude that they could even invalidate the results of the study. This paper describes some of the most likely causes of missing data in research in the field of clinical psychology and the consequences they may have on statistical and substantive inferences. When it is necessary to recover the missing information, analyzing the data can become extremely complex. We summarize the experts' recommendations regarding the most powerful procedures for performing this task, the advantages each one has over the others, the elements that can or should influence our choice, and the procedures that are not a recommended option except in very exceptional cases. We conclude by offering four pieces of advice, on which all the experts agree and to which we must attend at all times in order to proceed with the greatest possible success. Finally, we show the pernicious effects produced by missing data on the statistical result and on the substantive or clinical conclusions. For this purpose we have planned to lose data in different percentage rates under two mechanisms of loss of data, MCAR and MAR in the complete data set of two very different real researchs, and we proceed to analyze the set of the available data, listwise deletion. One study is carried out using a quasi-experimental non-equivalent control group design, and another study using a experimental design completely randomized.

Computed tomography in hemodynamically unstable severely injured blunt and penetrating trauma patients.

BACKGROUND: Dynamic and efficient resuscitation strategies are now being implemented in severely injured hemodynamically unstable (HU) patients as blood products become readily and more immediately available in the trauma room. Our ability to maintain aggressive resuscitation schemes in HU patients allows us to complete diagnostic imaging studies before rushing patients to the operating room (OR). As the criteria for performing computed tomography (CT) scans in HU patients continue to evolve, we decided to compare the outcomes of immediate CT versus direct admission to the OR and/or angio suite in a retrospective study at a government-designated regional Level I trauma center in Cali, Colombia. METHODS: During a 2-year period (2012-2013), blunt and penetrating trauma patients (≥ 15 years) with an Injury Severity Score (ISS) greater than 15 who met criteria of hemodynamic instability (systolic blood pressure [SBP] <100 mm Hg and/or heart rate >100 beats/min and/or ≥ 4 U of packed red blood cells transfused in the trauma bay) were included. Isolated head trauma and patients who experienced a prehospital cardiac arrest were excluded. The main study outcome was mortality. RESULTS: We reviewed 171 patients. CT scans were performed in 80 HU patients (47%) immediately upon arrival (CT group); the remaining 91 patients (53%) went directly to the OR (63 laparotomies, 20 thoracotomies) and/or 8 (9%) to the angio suite (OA group). Of the CT group, 43 (54%) were managed nonoperatively, 37 (46%) underwent surgery (15 laparotomies, 3 thoracotomies), and 2 (5%) underwent angiography (CT OA subgroup). None of the mortalities in the CT group occurred in the CT suite or during their intrahospital transfers. CONCLUSION: There was no difference in mortality between the CT and OA groups in HU patients. CT scan was attainable in 47% of HU patients and avoided surgery in 54% of the cases. Furthermore, CT scan was helpful in deciding definitive/specific surgical management in 46% scanned HU patients who necessitated surgery after CT. LEVEL OF EVIDENCE: Therapy/care management study, level IV.

[Hantavirus pulmonary syndrome (Rio Mamore virus) in the Peruvian Amazon region]. / Síndrome pulmonar por Hantavirus (Virus Río Mamoré) en la Amazonía Peruana.

Hantavirus infection is a viral zoonotic infection borne by rodents which most letal form clinical is the Hantavirus Pulmonary Syndrome (SPH, Spanish abbreviation). The Mamore River variant originates in South America and was found in rodents without any association to human diseases. Two cases of SPH were identified in the Peruvian Amazon region in November 2011. In both cases, a molecular diagnostic testing was conducted by the Instituto Nacional de Salud from Peru. A phylogenetic analysis of a viral genome fragment and a histopathological evaluation were conducted. Both patients developed adult respiratory distress syndrome and refractory shock. A patient died and another one recovered 12 days later.

Síndrome pulmonar por Hantavirus (Virus Río Mamoré) en la Amazonía Peruana / Hantavirus pulmonary syndrome (Rio Mamore Virus) in the Peruvian Amazon region

La hantavirosis es una infección viral zoonótica transmitida por roedores cuya forma clínica más letal es el síndrome pulmonar por Hantavirus (SPH). La variante río Mamoré es autóctona de Sudamérica y fue descrita en roedores sin asociarla a enfermedad en humanos. Se presenta dos casos de SPH causados por hantavirus río Mamoré en la Amazonía peruana en noviembre de 2011. En ambos casos, el diagnóstico confirmatorio fue molecular, efectuados en el Instituto Nacional de Salud de Perú. Se realizó análisis filogenético del fragmento de genoma viral y la evaluación histopatológica. Ambos pacientes evolucionaron a síndrome de distrés respiratorio del adulto y estado de choque refractario. Un paciente falleció y el otro se recuperó a los doce días.

Hantavirus infection is a viral zoonotic infection borne by rodents which most letal form clinical is the Hantavirus Pulmonary Syndrome (SPH, Spanish abbreviation). The Mamore River variant originates in South America and was found in rodents without any association to human diseases. Two cases of SPH were identified in the Peruvian Amazon region in November 2011. In both cases, a molecular diagnostic testing was conducted by the Instituto Nacional de Salud from Peru. A phylogenetic analysis of a viral genome fragment and a histopathological evaluation were conducted. Both patients developed adult respiratory distress syndrome and refractory shock. A patient died and another one recovered 12 days later.

Myopericytoma and arterial intimal thickening: the relationship between myopericytes and myointimal cells.

BACKGROUND: Myopericytomas with intravascular growth have been reported and have been occasionally documented as intraarterial. In a retrospective study, we assessed intraarterial growth in myopericytomas, co-existence with arterial intimal thickening (IT) and the relationship between the two. METHODS: This retrospective study was undertaken using 11 myopericytomas evaluated in serial microscopical sections. The results in light microscopy, electron microscopy and immunohistochemistry [including α-smooth muscle actin (SMA), desmin and h-caldesmon] were evaluated. RESULTS: In four myopericytomas, we found intraarterial growth, with large areas of disrupted arterial wall and attachment of veins and venules, exhibiting angiogenic phenomena. Arterial IT was present and partially incorporated within the tumor (simulating medium-sized vessels). The neointimal (myointimal) cells shared morphological and immunohistochemical phenotype with the myopericytoma myoid cells, including α-SMA positivity and desmin negativity. Four of the remaining myopericytomas showed structures similar to arterial IT within the tumor. CONCLUSIONS: The findings shown here, including the association between myopericytomas and arterial IT, the incorporation of the latter into the tumor and the similar phenotype of their respective myoid and myointimal cells, support a close relationship between these processes. Histogenically, the pericytes of the penetrating neovasculature originating from the attached venules and veins may contribute to both lesions.

[Cardiovascular risk factor progression in young males at 15-year follow-up in the General Military Academy of Zaragoza (AGEMZA) Study]. / Evolución de los factores de riesgo cardiovascular en jóvenes varones tras 15 años de seguimiento en el estudio Academia General Militar de Zaragoza (AGEMZA).

INTRODUCTION AND OBJECTIVES: The AGEMZA cohort comprises military men whose risk factors were studied in 1985 when they were 20 years old. As these men reached the age of 35 years, we investigated the stability of or changes in anthropometric measures, lipid levels and arterial pressure, and looked for interrelationships between any changes. METHODS: In 2000, we collected new data (by cross-sectional study) on body mass index (BMI), cholesterol, cholesterol fractions, triglycerides and blood pressure, which could be compared with the original data. Persistence or tracking was evaluated using standardized regression coefficients and odds for persistence within the same quintile. Current data were modelled using multivariate regression models. RESULTS: In the 250 subjects studied, significant changes were observed in the following variables: weight +12.1 kg, BMI +3.9 kg/m(2), cholesterol +68.0 mg/dL, HDL cholesterol -5.2 mg/dL, LDL cholesterol +57.9 mg/dL, and triglycerides +76.3 mg/dL. The degree of persistence was high for all variables, except for diastolic blood pressure. Persistence was most pronounced for BMI, cholesterol, and LDL cholesterol. The changes observed indicate an increase in cardiovascular risk that adds to the effect of aging. The change in lipid profile was mainly influenced by the increase in BMI experienced, whereas blood pressure was mainly influenced by the final BMI attained. In addition, being a current smoker was associated with worse cholesterol fractions and triglyceride levels. CONCLUSIONS: Cardiovascular risk factors increase during the third decade of the life. Early evaluation (after adolescence) enables the identification of individuals who will later be at an increased risk. Modifiable risk factors were identified, such as weight increase and smoking. Preventive measures should be designed for these groups.

Evolución de los factores de riesgo cardiovascular en jóvenes varones tras 15 años de seguimiento en el estudio Academia General Militar de Zaragoza (AGEMZA) / Cardiovascular risk factor progression in young males at 15-Year follow-up in the General Military Academy of Zaragoza (AGEMZA) Study

Introducción y objetivos. La cohorte AGEMZA son varones militares cuyos factores de riesgo fueron estudiados en 1985 a la edad de 20 años. A la edad de 35 años se estudian la antropometría, los lípidos y la presión arterial y se investiga su estabilidad, sus cambios y la interdependencia en su evolución. Métodos. En 2000, se obtuvieron datos (encuesta transversal) que se compararon con los originales: índice de masa corporal (IMC), colesterol y sus fracciones, triglicéridos y presiones arteriales. La persistencia o tracking se evalúa mediante el coeficiente de regresión estandarizado y la permanencia en quintiles. Se crearon modelos de regresión multivariante para los datos actuales. Resultados. Tras estudiar a 250 sujetos, se observaron modificaciones significativas de los siguientes factores: peso, +12,1 kg; IMC, +3,9 kg/m², colesterol, +68,0 mg/dl; colesterol unido a lipoproteínas de alta densidad, -­5,2 mg/dl; colesterol unido a lipoproteínas de baja densidad (cLDL), +57,9 mg/dl, y triglicéridos, +76,3 mg/dl. Todos los factores presentaron una persistencia elevada, excepto la presión arterial diastólica. Es más pronunciada la persistencia de IMC, colesterol y cLDL. Estos cambios suponen un peor riesgo cardiovascular independientemente de la diferente edad. El perfil de lípidos se vio influido por el incremento del IMC experimentado y los valores de presión arterial por el IMC alcanzado. Ser fumador activo también se asoció a peores valores de las fracciones de colesterol y triglicéridos. Conclusiones. Durante la tercera década de la vida los factores de riesgo cardiovascular se incrementan. Estudios precoces (en la postadolescencia) permiten identificar sujetos con mayor riesgo posterior. Se constató la influencia en el perfil final de circunstancias modificables (incremento ponderal, tabaquismo). Es razonable planificar medidas preventivas orientadas a estos colectivos

Introduction and objectives. The AGEMZA cohort comprises military men whose risk factors were studied in 1985 when they were 20 years old. As these men reached the age of 35 years, we investigated the stability of or changes in anthropometric measures, lipid levels and arterial pressure, and looked for interrelationships between any changes. Methods. In 2000, we collected new data (by cross-sectional study) on body mass index (BMI), cholesterol, cholesterol fractions, triglycerides and blood pressure, which could be compared with the original data. Persistence or tracking was evaluated using standardized regression coefficients and odds for persistence within the same quintile. Current data were modelled using multivariate regression models. Results. In the 250 subjects studied, significant changes were observed in the following variables: weight +12.1 kg, BMI +3.9 kg/m², cholesterol +68.0 mg/dL, HDL cholesterol ­-5.2 mg/dL, LDL cholesterol +57.9 mg/dL, and triglycerides +76.3 mg/dL. The degree of persistence was high for all variables, except for diastolic blood pressure. Persistence was most pronounced for BMI, cholesterol, and LDL cholesterol. The changes observed indicate an increase in cardiovascular risk that adds to the effect of aging. The change in lipid profile was mainly influenced by the increase in BMI experienced, whereas blood pressure was mainly influenced by the final BMI attained. In addition, being a current smoker was associated with worse cholesterol fractions and triglyceride levels. Conclusions. Cardiovascular risk factors increase during the third decade of the life. Early evaluation (after adolescence) enables the identification of individuals who will later be at an increased risk. Modifiable risk factors were identified, such as weight increase and smoking. Preventive measures should be designed for these groups