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Caribbean and South American team-based strategy to control hypertension (CATCH): Rationale and study design of a cluster randomized trial

Rationale Hypertension disproportionately affects populations in low- and middle-income countries (LMICs), especially in Latin America and the Caribbean, due to its high prevalence and low control rate. Primary Hypothesis To close the knowledge-practice gap for blood pressure (BP) control, we are assessing the effectiveness and implementation of a team-based care strategy for BP control in primary care clinics in Colombia and Jamaica. Design The Caribbean and South American Team-based Strategy to Control Hypertension (CATCH) study is a cluster randomized trial using an effectiveness–implementation hybrid type-2 design. Clinics were randomly assigned to a team-based strategy or a provider-training strategy to implement current hypertension guidelines. The team-based strategy includes healthcare team training, care coordination, task sharing, BP audit and feedback, home BP monitoring, health coaching, single-pill combination therapy, and increased medication access. The primary clinical effectiveness outcome is difference in mean change of systolic BP from baseline to 18 months between randomized groups. The primary implementation outcome is a composite fidelity score to key implementation strategy components. Sites CATCH is conducted in 40 primary care clinics in Jamaica and Colombia. Enrollment Between February 2023 and August 2024, we recruited 1,707 participants, exceeding our planned enrollment. The planned sample size of 1,680 (42 patients per each of 40 clinics) has 90% statistical power to detect a 6.0 mm Hg difference in mean systolic BP change assuming 85% follow-up and a 2-sided significance level of 0.05. Current Status In follow-up Conclusions CATCH will provide evidence on effectiveness and implementation of a team-based care strategy to improve hypertension control in real-world, primary care settings. If proven effective, this approach can be scaled up in primary care throughout low- and middle-income countries (LMICs). Clinical Trial Registration Clinicaltrials.gov , NCT05405920 https://clinicaltrials.gov/study/ NCT05405920.

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American Heart Journal

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Reliability of the Modified Ashworth Scale in post-stroke spasticity assessment: cross-sectional study

Introduction. Spasticity evaluation in stroke survivors is crucial for effective rehabilitation. The Modified Ashworth Scale (MAS) is commonly used for this purpose, but its reliability when administered by less expe-rienced individuals like physiotherapy students remains understudied. Therefore, our objective is to assess the inter-observer reliability of the MAS among physiotherapy students for evaluating post-stroke lower limb spasticity. Methods. Thirty-two patients (24 males, 65.2 ± 13.9 years) with hemiplegia/hemiparesis at least six months post-stroke were enrolled. Extensors and flexors in the hip, knee, and ankle of each participant were assessed independently by two trained final-year physiotherapy students, approximately 5 min apart. The Weighted Cohen’s Kappa Index (K) was calculated. Results. The MAS showed substantial agreement for hip extensors (K = 0.78) and flexors (K = 0.70), knee flexors (K = 0.77), dorsiflexors (K = 0.64), and plantar flexors (K = 0.63), and fair agreement for knee extensors (K = 0.54). Conclusions. Novice physiotherapy students demonstrated reliable application of the MAS when evaluating spasticity in the lower limbs of individuals recovering from strokes. Substantial agreement in most muscle groups examined supports the use of the MAS as a valid tool for assessment, even during the initial phases of clinical education.

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Physiotherapy Quarterly

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Spinal chondrosarcoma

Chondrosarcomas are primary malignant tumors that may arise from the cranial skull base or axial skeleton and are characterized by neoplastic growth of hyaline cartilaginous tissue. Primary tumors of the spinal column are rare, and chondrosarcomas are the least frequent of these, but their propensity to recur and lack of effective chemotherapeutic options makes this a formidable tumor to treat. Despite an increased understanding of potential targets for chondrosarcoma treatment, patients must be considered for potential en bloc resection, as this is the only available option to cure the patient of this cancer. These tumors may metastasize, so all patients must undergo staging of their tumor prior to any surgical resection, as this may change the goals of surgery. In this chapter, we discuss the presentation and treatment of a patient with a chondrosarcoma of the spinal column and poll an expert panel of spine surgeons to highlight the possible management strategies.

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Comparative Management of Spine Pathology

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Understanding the Challenge of Complex Congenital Heart Palliation Follow-Up in a Middle-Income Latin American Country

Introduction. Congenital heart disease of great complexity like single ventricle are the most prevalent congenital defects, managing these requires multiple surgical procedures, usually three stages. Lethality during the interstage period has decreased due to practices as home monitoring. Given the significant resources invested in patient care, it is essential to improve long-term outcomes. There is limited research in cardiovascular disease within middle-income countries. Objective. To identify factors associated with lack of medical follow-up and lethality in children during first interstage period. Method. A retrospective cohort study was conducted including 173 children in their first interstage period after cardiovascular surgery for severe congenital heart disease. Reviewed clinical records and contacted caregivers through telephone/instant messaging software. Analysis included central tendency and dispersion measures. Associations between independent variables and the primary outcomes —loss to follow-up (LTF) and mortality during the interstage period— were evaluated using the Mann-Whitney, Chi-square or Fisher’s exact tests. Results. Of 173 patients, 65 (37.6%) patients LTF. The risk factors for LTF: rural residence (OR=5.05, CI95%1.32-19.26), lower educational level of parents. Global lethality was 13.3% (CI95%7.9-20.4) and factors associated were: rural origin (OR=22.78, CI95%3.68-140.83), malnutrition (OR=25.47, CI95%2.96-218.73), necrotizing enterocolitis (OR=13.34, CI95%2.34-75.97) and heterotaxia or situs inversus (OR=8.05, CI95%1.26-51.34). The number of visits were a protective factor for interstage lethality (OR=0.71, CI95%0.55-0.9). Conclusion. The interstage period entails significant challenges for patients and their families, which are possibly exacerbated by the socio-economic context of a middle-income country. Improving follow-up and support for caregivers of patients under similar conditions could help mitigate identified factors related to lethality.

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Revista De Investigacion E Innovacion En Ciencias De La Salud

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Striatal Nitric Oxide Activity Better Predicts Motor Disability Than Proto-Oncogenes

Extrapyramidal symptoms (EPS) are side effects observed after acute administration of D2 antagonists and nitric oxide synthase (NOS) inhibitors in rodents. To date, no study has examined NOS activity in parallel with c-Fos immunoreactivity (c-Fos-IR) following multiple doses of these compounds. The aim of the present study was to evaluate whether catalepsy and motor balance deficits resulting from specific acute doses of haloperidol (Hal), metoclopramide (MCP), and L-NOARG could correlate with changes in the number of c-Fos-IR and nNOS-positive cells, as well as NADPH-diaphorase activity in the striatum. Male Swiss mice received Hal (0.1-1 mg/kg, ip), MCP (1-45 mg/kg, ip), L-NOARG (15-45 mg/kg, ip), or saline. An increased cataleptic effect was observed in all experimental groups. All doses of Hal and the higher doses of MCP resulted in deficits in the Rota-rod test, whereas L-NOARG did not affect Rota-rod performance. Histochemical analysis revealed increased c-Fos-IR in the dorsal striatum following Hal, as well as in the dorsolateral striatum after low and intermediate clinically relevant doses of MCP. Both types of D2R antagonists led to an increase in NADPH-diaphorase activity in the dorsal striatum. Similarly, the higher catalepsy-inducing doses of L-NOARG resulted in increased NADPH-diaphorase activity in the dorsal striatum; however, these same doses also reduced c-Fos-IR in the dorsolateral striatum and nucleus accumbens (NAc). In conclusion, all drugs acutely induced catalepsy, with motor balance preserved after L-NOARG treatment. Our findings suggest that EPS side effects may be attributed to NADPH-diaphorase activity in the dorsal striatum.

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European Journal of Neuroscience

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Cardioneuroablation in the management of neurocardiogenic syncope with extracranial validation: efficacy and effects on the regulation of the cardiac autonomic system – a combined retrospective–prospective cohort study

Background: Neurocardiogenic syncope (NCS), particularly cardioinhibitory and mixed subtypes, remains a clinical challenge when refractory to conventional therapy. Cardioneuroablation (CNA) targeting the parasympathetic ganglionated plexi has emerged as a novel interventional option. This study evaluates the efficacy of biatrial CNA with extracardiac vagal stimulation (ECVS) validation in preventing recurrence and modulating cardiac autonomic regulation. Methods: A single-center combined retrospective–prospective cohort study was conducted at a fourth-level institution in Colombia, including patients with cardioinhibitory or mixed-type NCS refractory to conventional treatment. CNA was performed targeting both atria with three-dimensional mapping, followed by ECVS via the internal jugular vein for pre/post validation. Primary outcome was the recurrence of syncope. Secondary outcomes included changes in heart rate variability (HRV) and quality of life (QoL) as assessed by 24-hour Holter monitoring and the SF-36 questionnaire, respectively. Mean follow-up was 24 months. Statistical analysis was performed using SPSS Statistics 28.0.0.0. Results: Fifty-three patients (mean age 42.8 ± 10.1 years, 70% cardioinhibitory type) were included. Recurrence occurred in 7 patients (13.2%), with 86.8% syncope-free survival. HRV parameters decreased after CNA (SDNN: 137.03ms vs. 83.18ms; SDANN index: 79.12 vs. 39.35; RMSSD: 38.75ms vs. 13.91ms; p < 0.001), indicating vagal suppression. QoL improved significantly (SF-36 score: 81.91 vs. 94.62, p < 0.001). No major procedural complications or mortality were reported. Conclusion: CNA with ECVS validation is effective in reducing syncope recurrence, suppressing excessive parasympathetic tone, and improving QoL in patients with refractory neurocardiogenic syncope. These findings support its use as a therapeutic option in selected patients.

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Journal of Interventional Cardiac Electrophysiology

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Criteria of the Dutch Clinical Network and genetic testing in familial hyperlipidemia in a group of Colombian patients

Introduction: hyperlipidemia is a group of diseases, both hereditary and acquired, characterized by elevated levels of lipids in the human body, especially prevalent in the western hemisphere. Methods: this study seeks to identify patients with familial hyperlipidemia using the criteria of the Dutch Clinical Network applied to the subsidized population of Bucaramanga, Colombia, and evaluate their individual profiles. Results: the prevalence of heterozygous familial hypercholesterolemia (HeFH) is estimated to be 1 in 200 to 500 people, while the prevalence of homozygous familial hypercholesterolemia (HoFH) is 1 in 300,000 to 600,000 people. In Bucaramanga, it is projected that 240,000 people could have HeFH and from 160 to 300 cases of HoFH. Conclusions: despite the estimates, the real prevalence of the disease in Colombia is unknown, which justifies carrying out this study to obtain more precise data on familial hyperlipidemia in the region.

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Revista De La Federacion Argentina De Cardiologia

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Unusual presentation of Crohn disease associated with hemophagocytic lymphohistiocytosis syndrome: a case report

Crohn\'s disease (CD) is a chronic, multifactorial inflammatory condition that can affect any part of the gastrointestinal tract and is associated with systemic, extraintestinal, and atypical manifestations. Hemophagocytic lymphohistiocytosis (HLH), also known as macrophage activation syndrome, is a rare and severe inflammatory disorder that may occur secondary to infections, malignancies, or autoimmune diseases. Its association with CD is extremely uncommon. We report the case of an 8-year-old male who initially presented with nonspecific symptoms including lower limb pain, lumbalgia, and progressive abdominal pain, evolving into respiratory failure and cardiogenic shock, which required admission to the intensive care unit (ICU). He developed bicytopenia, persistent fever, rash, bilateral pleural effusion, hyperferritinemia, hypertriglyceridemia, and signs of systemic inflammation, raising clinical suspicion for HLH. Infectious and hematologic malignancies were ruled out. The patient received intravenous immunoglobulin, broad-spectrum antibiotics, antifungal agents, and immunomodulatory treatment. Gastrointestinal symptoms included melena-like diarrhea, hematochezia, abdominal distension, and elevated fecal calprotectin levels. Abdominal CT imaging showed colonic wall thickening and mesenteric lymphadenopathy. Esophagogastroduodenoscopy, colonoscopy, and histopathological analysis confirmed the diagnosis of CD. Treatment with infliximab was initiated, leading to a favorable clinical response. This case underscores an atypical presentation of CD associated with HLH, posing significant diagnostic and therapeutic challenges.

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Revista De Gastroenterologia Del Peru Organo Oficial De La Sociedad De Gastroenterologia Del Peru

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Eosinophilic gastroduodenitis secondary to toxocariasis: a zoonosis simulating gastric lymphoma in children

We describe the case of a pediatric patient with eosinophilic gastroduodenitis secondary to visceral toxocariasis, presenting with clinical, endoscopic, and histological features suggestive of gastric lymphoma. The patient, from a rural area, exhibited severe gastrointestinal symptoms, persistent hypereosinophilia, deep ulcerative lesions in the stomach and duodenum, as well as systemic involvement. After an extensive immunological, hematological, and infectious disease evaluation, the diagnosis was confirmed by positive serology for Toxocara canis. The patient showed favorable clinical evolution with antiparasitic therapy, immunomodulation, and intensive nutritional support. This case highlights the importance of considering infectious etiologies in the differential diagnosis of eosinophilic gastroduodenal disorders, particularly in pediatric patients with systemic involvement and a presentation mimicking malignant disease.

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Revista De Gastroenterologia Del Peru Organo Oficial De La Sociedad De Gastroenterologia Del Peru

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Viral metagenomics in mosquitoes as potential vectors of arboviruses in the Colombian Caribbean: characterisation of a \"core\" regional RNA viromeFIRST REVIEW ROUND - REVIEWERS COMMENTSAUTHORS RESPONSE TO REVIEWERSREVIEWERS COMMENTS

BACKGROUND: Mosquitoes are critical vectors in tropical regions where arboviruses like dengue and Zika are prevalent. This study focuses on characterising the RNA virome of mosquitoes in the Colombian Caribbean, emphasising the core regional virome and its role in the dynamics of arboviruses. OBJECTIVES: The objective was to identify and analyse the core RNA virome of mosquitoes across different genera and seasons in the Colombian Caribbean to understand its composition and potential influence on arbovirus transmission dynamics. METHODS: In 2023, 4,074 mosquitoes from the genera Mansonia, Coquillettidia, and Anopheles were collected across Córdoba, Sucre, Bolívar, and Magdalena during rainy and dry seasons. Specimens were pooled in groups of 50, subjected to RNA extraction, and sequenced on the MGI-G50™ platform. Bioinformatic analyses utilised the DIAMOND-MEGANizer pipeline and R packages (phyloseq, vegan, ggplot2) to identify viral communities. FINDINGS: The analysis identified 22 viral families and 24 unclassified RNA viruses. The core regional virome, consistently present across species and seasons, was dominated by insect-specific viruses (ISVs) such as Aedes aegypti to virus 1 and 2, Astopletus, and Cumbaru, alongside Picornaviridae (30% of reads), Rhabdoviridae (20%), Orthomyxoviridae, and Bunyavirales. Mansonia titillans (38 species) and Coquillettidia nigricans (21 species) exhibited the highest viral richness. No significant arboviruses were detected, highlighting ISV dominance. Virome composition varied seasonally, with greater diversity in the rainy season due to increased breeding site availability and temperature. MAIN CONCLUSIONS: The stability of the core virome suggests it modulates vector competence, potentially reducing arbovirus transmission. These findings advocate the use of metagenomics for enhanced vector surveillance and biological control strategies in neotropical ecosystems.

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Memorias do Instituto Oswaldo Cruz