IntroductionEndothelial function at high altitude has been measured only in populations that are genetically adapted to chronic hypoxia. The objective of this study was to evaluate endothelial dysfunction (ED) in a nongenetically adapted high-altitude population of the Andes mountains, in Huancayo, Peru (3,250 meters above sea level).MethodsParticipants included 61 patients: 28 cases and 33 controls. The cases were subjects with hypertension, diabetes mellitus, obesity, or a history of stroke or coronary artery disease. Flow-mediated vasodilation (FMD) of the brachial artery was measured in the supine position, at noon, after 5 minutes of resting. The brachial artery was identified above the elbow. Its basal diameter was measured during diastole, and FMD was tested after 5 minutes of forearm ischemia. Intima–media complex in the right carotid artery was also determined. An increase in the artery’s baseline diameter <10% indicated a positive test. Endothelium-independent vasodilation was evaluated with sublingual nitrate administration. The intima–media complex in the right carotid artery was also measured.Results100% of diabetics had ED; ED was also found in 68.8% of obese individuals, 55% of hypertensive patients, and 46.5% of controls. Age, height, body mass index, and waist diameter were higher in the cases as compared with the controls. A total of 57.9% (n=11) of the cases and 45.2% (n=19) of the controls presented ED. Patients without ED had a mean increase in brachial artery diameter of 23.16%, while in those with ED it was only 3.84%. Individuals with diabetes or hypertension had a greater thickness of the carotid artery intima media layer (1.092 versus 0.664 cm) (p=0.037). A positive test for ED was associated with a greater basal diameter of the brachial artery (4.66±0.62 versus 4.23±0.59 cm) (p=0.02). A total of 7 patients presented paradoxical response, developing posthyperemia vasoconstriction.DiscussionThe proportion of ED was high among controls and among patients with risk factors. Controls showed better FMD profiles than subjects studied in Tibet and the Himalayas.

Physicians are required to advocate for and counsel patients based on the best science and the interests of the individual while avoiding discrimination, ensuring equal access to health and mental services. Nonetheless, the communication gap between physician and patients has long been observed. To this end, the Institute for the Public Understanding of Health and Medicine of the Rutgers University New Jersey Medical School has expanded its efforts. This report describes two new programs: a legacy lecture series for medical students and an international “experience”, in Huancayo, Peru, for medical students and faculty. The MiniMed outreach program, now in its ninth year and first described in this journal in 2012, was designed to empower the powerless to communicate more effectively with clinicians, thus improving both the effectiveness of the physician–patient relationship and health care outcomes. The approach of the two new programs and their effects on patients, particularly the underserved, and medical students and faculty, are outlined in the following article.

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"altitude." This we find pivotal because the organism of high altitude residents going down to sea level, has to adapt to the "relative hyperoxic environment." It is wrongly assumed that for high altitude residents, going to a lower altitude where there is more oxygen pressure, as a result of a higher barometric pressure, is beneficial. We strongly question this, as high altitude residents, being born, developed, and carrying out normal lives in the mountain cities of the world living in perfect harmony with our environment. We, as Andean high altitude residents, have higher hematocrit and hemoglobin values, as the fundamental compensating biological response. All living beings, humans, animals and plants and presumably other microscopic organisms suffer biologic changes on barometric pressure changes. In other words, physical changes in the environment, induce biological changes. The rules governing physics are imbedded within biology. The formula of adaptation is not only useful for high altitude adaptation, but rather can be used for any type of adaptation, where the organism in order to survive, needs to find the most energy efficient, fastest rebuild or healing process of the organic systems. An example can be found with a wound in the skin. When the two borders are sutured, the healing process takes around 1 week. This would be: healing adaptation ¼ time/tissue. This formula changes in time if the tissue is skin or bone, the later requiring a longer time of a few months. This formula also varies with age, taking longer for the older people: Adaptation to healing ¼ time/age. It should be well understood, that the healthier the subject, the better the adaptation. But it also applies to allergic reactions to mosquito bites in those not habituated to them in comparison to those living in those areas. Likewise, a viral aggression like flu, has a latent period of immunity that follows the same rule: Adaptation to viral aggression ¼ time/type of viral agent. This formula has other additional variables like nutrition, stress and aggressiveness of the viral agent. Furthermore it also applies to adaptation to smell. When a new perfume is smelled for the first time it is very strong, but persistent use of it changes the capacity of sensing it: Adaptation to smell ¼ time/scent. Muscle adaptation to exercise also follows the same formula: Adaptation to exercise ¼ time/exercise Δ. The more exercise, the greater the hypertrophy of the muscles and vice-versa. In conclusion the Adaptation Formula is a fundamental formula that applies to all biological adaptation processes in the multiple survival mechanisms of all living beings, and can be generalized as: Adaptation ¼ time/change.

"altitude." This we find pivotal because the organism of high altitude residents going down to sea level, has to adapt to the "relative hyperoxic environment." It is wrongly assumed that for high altitude residents, going to a lower altitude where there is more oxygen pressure, as a result of a higher barometric pressure, is beneficial. We strongly question this, as high altitude residents, being born, developed, and carrying out normal lives in the mountain cities of the world living in perfect harmony with our environment. We, as Andean high altitude residents, have higher hematocrit and hemoglobin values, as the fundamental compensating biological response. All living beings, humans, animals and plants and presumably other microscopic organisms suffer biologic changes on barometric pressure changes. In other words, physical changes in the environment, induce biological changes. The rules governing physics are imbedded within biology. The formula of adaptation is not only useful for high altitude adaptation, but rather can be used for any type of adaptation, where the organism in order to survive, needs to find the most energy efficient, fastest rebuild or healing process of the organic systems. An example can be found with a wound in the skin. When the two borders are sutured, the healing process takes around 1 week. This would be: healing adaptation ¼ time/tissue. This formula changes in time if the tissue is skin or bone, the later requiring a longer time of a few months. This formula also varies with age, taking longer for the older people: Adaptation to healing ¼ time/age. It should be well understood, that the healthier the subject, the better the adaptation. But it also applies to allergic reactions to mosquito bites in those not habituated to them in comparison to those living in those areas. Likewise, a viral aggression like flu, has a latent period of immunity that follows the same rule: Adaptation to viral aggression ¼ time/type of viral agent. This formula has other additional variables like nutrition, stress and aggressiveness of the viral agent. Furthermore it also applies to adaptation to smell. When a new perfume is smelled for the first time it is very strong, but persistent use of it changes the capacity of sensing it: Adaptation to smell ¼ time/scent. Muscle adaptation to exercise also follows the same formula: Adaptation to exercise ¼ time/exercise Δ. The more exercise, the greater the hypertrophy of the muscles and vice-versa. In conclusion the Adaptation Formula is a fundamental formula that applies to all biological adaptation processes in the multiple survival mechanisms of all living beings, and can be generalized as: Adaptation ¼ time/change.