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  • Medical Education in Infectious Diseases. Using Smartphone Apps for Active Learning

    Valdez, Luis; Gray, Andrea; Ramos, Gaston; Siu, Hugo (Oxford University Press, 2017)
    Background Active Learning using smartphone technology can be implemented as a tool for teaching medical students (MS) and residents (Rs). The use of technology would increase participation and enhance student learning by engaging them in solving ID clinical case scenarios. Our objective was to describe the methods used and to share the opinions of the users of such active learning methods. Methods The smartphone applications used were Socrative and WhatsApp. We used Socrative during the Universidad Peruana de Ciencias Aplicadas (UPC) ID course for MS in two different ways. In selected lectures (4 of 32), teacher paced questions were asked based on clinical scenarios related to the topic reviewed, and by voluntary homework questionnaires (student paced). At the British American Hospital (BAH) Medicine Department (MS and Rs) Socrative was used similarly: during some noon lectures (teacher paced questions) and during the baseline MS exam and Rs mid-year exam and voluntary homework questions (student paced). WhatsApp is currently used at the BAH with questions send from Monday to Friday. MS /Rs answer individually via WhatsApp to the mentor in charge. The right answer is given the next day. Questions using WhatsApp deal with recent cases seen at the Wards or in the outpatient clinic, and are designed so that the MS/Rs must do quick literature searches in order to provide the right answer. Results Forty-one MS/Rs answered the survey on Socrative use, 25 of 48 (52%) of UPC MS and 16 (89%) MS/Rs from the BAH. Forty (97%) believed using Socrative had influenced their learning and all but 2 believed it promoted participation from the class. 36 (87.8%) would like to have Socrative used in other lectures and 35 (85%) in other courses. Only one person voted against Socrative use in courses or lectures. With regards to WhatsApp use 16 MS/Rs from BAH answered the survey. Six had used before WhatsApp as a teaching tool. All felt the methodology was useful for learning and promoting reading and would recommend this methodology to promote learning on a student paced way. Conclusion Socrative and WhatsApp can be used for teaching ID through MS/Rs smartphones. Most MS/Rs who were surveyed recommended the use of such methods in their education.
  • Fascioliasis in schoolchildren in the inter andean valley of Cajamarca, Peru

    Rodriguez Ulloa, Claudia; Rivera-Jacinto, Marco; Hobán Vergara, Cristian; Del Valle Mendoza, Juana Mercedes; Ortiz Oblitas, Pedro (WAAVP 2015, 2015-08)
    Fascioliasis, caused by Fasciola hepatica, is a public health problem in Peru, especially in schoolchildren. Prevalence rates in livestock are over 80% in dairy cattle reared in the Andean valley of Cajamarca, Peru. The present investigation aimed to determine the prevalence of F. hepatica infection in schoolchildren and the main risk factors involved in its presentation. Two hundred and seventy schoolchildren nine years old and over from primary public institutions from the district of Los Baños del Inca (Cajamarca) were included in the investigation. Questionnaires were applied to parents and children and fecal samples were taken and evaluated using the rapid sedimentation technique. Blood samples were also collected and analyzed. Seventeen fecal samples were positive to F. hepatica eggs, giving a prevalence of 6.3% (95% CI 3.21 - 9.38). Significant differences were found with origin of the child, history of intestinal parasitism, and the habit of chewing grass (p< 0.05). The rural origin (OR 4.8, 95% CI: 1.53-15.08) and the habit of chewing grass (OR 3.26, CI: 95% 1.07 - 9.96) were the most likely risk factors associated with the acquisition of infection. The leukocyte count of infected children varied between 3900 and 10580 cells /mm3 (mean ± SD = 6458.3 ± 2080.3). Thirty three percent of children positive to F. hepatica eggs presented eosinophilia. We conclude that the prevalence of human fascioliasis in the district of Los Baños del Inca is at the mesoendemic level and rurality provides conditions for acquiring the infection.
  • SciELO Citation Index: Una buena iniciativa pero aún no confiable, el caso del dominio peruano (2002-2014)

    Pacheco Mendoza, Josmel; Mayta-Tristan, Percy; Milanes Guisado, Yusnelkis (XVI Congreso Científico Internacional CNIC 2015, 2015-06)
  • High prevalence of Bordetella pertussis in severe acute respiratory infections in hospitalized children under 5 years in Lima, Peru

    Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2015-11-18)
    Acute respiratory infections (ARI) are the main cause of morbidity and mortality in children under 5 years worldwide. Bordetella pertussis is a highly contagious bacterium that can cause serious illness, and approximately half of infected infants less than 1 year old are hospitalized. Also, pertussis immunization series is not completed until six months of age, leaving young infants vulnerable to pertussis. In Peru, pertussis is an increasing health problem despite immunization efforts, and the role of B. pertussis in ARI is unknown. We determined the prevalence of B. pertussis among children under 5 years old admitted to Hospital Nacional Cayetano Heredia in Lima with diagnosis of ARI between Jan-2009 and Dec 2010. Epidemiological and clinical features were collected, and presence of B. pertussis was determined by PCR (pertussis toxin and IS481 gene). A total of 596 nasopharyngeal samples among children under 5 years were analyzed. In 114 (19.1%) samples were positive for B. pertussis. 32.5% of sample positive to B. pertussis were diagnosed as viral pneumonia at diagnosis. Importantly, 71.9% of cases were under 12 months of age and 58.8% have been contact with other ARI infected people. Significant differences in clinical symptoms between the total ARI cases and B. pertussis cases were not found. The most frequent symptoms in B. pertussis cases were fever (100%), rhinorrhea 78%, cough 71.9% and respiratory distress 60.5%. One child died due to the infection. B. pertussis cases showed a seasonal distribution with peaks during the months March June and November. This study shows the high prevalence of B. pertussis in infants who were hospitalized due to severe acute respiratory infections in Lima, Peru. Epidemiologic surveillance programs for B. pertussis are essential in the future in Peru
  • Direct blood analysis of Bartonella bacilliformis Multi Locus Sequence Typing in patients with Oroya’s fever during a Peruvian outbreak

    Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2015-11-18)
    The bacteria Bartonella bacilliformis is the etiological agent of Carrion’s disease, which is a neglected poverty-related disease, affecting Mountain Andean valleys of Peru, Colombia and Ecuador. This disease, in absence of treatment presents a high mortality during the acute phase, called Oroya’s Fever. The second phase is characterized by the development of dermal eruptions, known as “Peruvian wart”. This bacterium is a fastidious slow growing microorganism, being difficult and cumbersome to culture and isolate from clinical sources. Then, the available data about phylogenetic relationship in clinical samples are really scarce, but suggesting high variability. The aim of the study was to perform direct blood analysis of B. bacilliformis Multi Locus Sequence Typing (MLST), a genotyping tool, in patients with Oroya fever during an outbreak. The present study demonstrate that the direct blood MLST PCR is a technique useful in the phylogenic characterization of this fastidious microorganism endemic from Andean regions. In this study, we demonstrate that the outbreak of Oroya’s fever was caused by closely related Sequence Typing (ST) microorganisms and, additionally, new STs have been described.
  • Identification of new antigen candidates of Bartonella bacilliformis

    Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2015-11-18)
    Bartonella bacilliformis is the aetiological agent of Carrion's disease, an overlooked illness with a lethal febrile stage and a benign warty phase. Its endemic in Andean areas, mainly affecting Peru, but also reported in Ecuador, Colombia, Bolivia and Chile.
  • 7 datos sobre la Enfermedad de Carrión

    Universidad Peruana de Ciencias Aplicadas (UPC) (Universidad Peruana de Ciencias Aplicadas (UPC), 2015-08-20)
    Endémica de los valles andinos de Perú, Ecuador y Colombia, la enfermedad de Carrión, si no es tratada, resulta fatal entre el 44% y el 88% de los casos.
  • Carrion’s Disease: diagnostic and antibody levels in a northern endemic area of Peru

    Universidad Peruana de Ciencias Aplicadas (UPC) (Joint International Tropical Medicine Meeting, 2015-08-13)
    The objective of this study was to compare 2 different techniques used in Peru for diagnostic and evaluate the antibody titters for B. bacilliformis in inhabitants of both post-outbreak and one established endemic area.
  • Prevalencia de Haemophilus influenzae en lactantes hospitalizados menores de 1 año en Perú

    Universidad Peruana de Ciencias Aplicadas (UPC) (Asociación Panamericana de Infectología, 2015-08-13)
    Las infecciones respiratorias agudas (IRAs) constituyen una de las cinco primeras causas de morbilidad y mortalidad a nivel mundial. Una bacteria causante de infecciones respiratorias agudas, principalmente en niños menores de 5 años es Haemophilus influenzae tipo b. “Se estima que provoca por lo menos tres millones de casos de enfermedad grave al año y alrededor de 86.000 de funciones, la mayor parte se registra en países en desarrollo”.El objetivo fue identificar Haemophilus influenzae tipo b en lactantes menores de 1año hospitalizados con diagnóstico de infección respiratoria aguda y presencia de tos coqueluchoide.
  • Infectious agents, Leptospira spp. and Bartonella spp., in blood donors from Cajamarca, Peru

    Universidad Peruana de Ciencias Aplicadas (UPC) (2015-08-13)
    In blood banks the sought for a series of relevant pathogens able to be transmitted by blood transfusions is widely implemented; however the presence of a series of pathogens in blood bank donations remained understudied. This is the case of some bacteria such as Leptospira spp. or Bartonella spp. Bartonella species are bloodborne, re-emerging organisms, capable of causing prolonged infections in animals and humans. Meanwhile, Leptospirosis is recognised as an emerging public health problem worldwide. Both infections are considered neglected tropical diseases.
  • Incidencia de virus respiratorios en niños del Hospital Regional de Cajamarca en Perú

    Universidad Peruana de Ciencias Aplicadas (UPC) (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, 2015-08-08)
    Antecedentes y Objetivos: El rol de los virus respiratorios ha sido previamente sub-estimado en la comunidad. Por esta razón, el objetivo de este estudio es evaluar la incidencia y las características clínicas de las infecciones respiratorias agudas (IRA) en niños de la Región Sierra Norte del Perú (Cajamarca), para lo cual se utilizó la técnica de RT-PCR multiplex y la RT-PCR a Tiempo Real como prueba de rutina en el laboratorio. Métodos: En este estudio fueron incluidos 55 pacientes entre 0 a 17 años diagnosticados con IRA provenientes del Hospital Regional de Cajamarca (DIRESA-Cajamarca) durante los meses de agosto a diciembre del 2009. Las muestras fueron colectadas mediante hisopados nasofaríngeos y procesados para evaluar microorganismos patógenos respiratorios mediante las técnicas de amplificación de ácidos nucleicos mediante Reacción en Cadena de la Polimerasa: RT-PCR multiplex para la detección de: virus de la gripe A, B y C; virus respiratorio sincitial A y B; adenovirus; virus parainfluenza 1, 2, 3, y 4; rinovirus; enterovirus y coronavirus, RT-PCR a Tiempo Real para el diagnóstico de virus de la gripe A pandémica (H1N1) y PCR convencional para la detección de: Chlamydia pneumoniae, Mycoplasma pneumoniae, Chlamydia trachomatis y Bordetella pertussis. De acuerdo a la etiología, los resultados fueron categorizados en 4 grupos: grupo 1 (sólo detección de virus); grupo 2 (sólo detección de bacterias), grupo 3 (virus + bacterias) y grupo 4 (co-infección bacteriana). Resultados: De los 55 pacientes diagnosticados con IRA se evaluó la etiología de la siguiente manera: grupo 1, n = 29 (52,7%); grupo 2, n= 16 (20,09%); grupo 3, n = 6 (10,9%) y grupo 4, n = 2 (3,6%). De los 29 virus respiratorios identificados se observó: virus de la gripe A pandémica (H1N1) (n = 25, 45,45%), virus de la gripe A estacional (n = 3; 5,45%) y virus parainfluenza 1 (n = 1; 1,81%). De las 16 bacterias identificadas se observo: Chlamydia pneumoniae (n = 7 pacientes, 12,7%), Mycoplasma pneumoniae (n = 6 pacientes, 10,9%), Bordetella pertussis (n = 3 pacientes, 5,45%). De los 55 pacientes, 6 de ellos presentaron co-infección virus-bacteria: virus de la gripe A pandémica (H1N1) + Chlamydia pneumoniae (n = 4; 7,27), virus de la gripe A estacional + Mycoplasma pneumoniae (n = 1; 1,81%) y virus de la gripe A estacional + Bordetella pertussis (n = 1; 1,81%). Sóo 2 casos presentaron co-infección bacteriana: Mycoplasma pneumoniae + Chlamydia pneumoniae (n = 2; 3,62%). Conclusión: La técnica de amplificación de ácidos nucleicos, revela que los virus respiratorios representan el agente etiológico más común del IRA, las características clínicas no pueden distinguir entre infección viral o bacteriana. Por esta razón es importante implementar técnicas moleculares como pruebas de rutina en los laboratorios regionales para ofrecer un diagnóstico adecuado y a tiempo al paciente.
  • Prevalence of ideal cardiovascular health in Peru: The cronicas cohort study

    Universidad Peruana de Ciencias Aplicadas (UPC) (The American College of Cardiology, 2015-05-21)
    Background: American Heart Association 2020 Impact Goal focuses on promotion of health and control of cardiovascular risk. We aimed to determine the prevalence of Ideal Cardiovascular Health in Peru. Methods: Ideal Cardiovascular Health is the presence of 3 ideal health factors (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/ <80 mm Hg, and untreated fasting plasma glucose <100 mg/dL) and 4 ideal health behaviors (never smoker, body mass index <25 kg/m2, high physical activity, and fruit and vegetable consumption >3 times/day). Data from the CRONICAS longitudinal study, an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings. Results: 3058 of 3618 (84.5%) of the CRONICAS cohort participants had complete information for analysis. Figure 1 shows the agestandardized prevalence estimates of ideal, intermediate and poor health metrics. No one had all 7 metrics; only 48 (15.7%) had 6 ideal health metrics and 650 (21.3%) had ≤ 1 ideal health metric. Compared to urban Lima, living in rural Puno was associated with more Ideal Cardiovascular Health (OR 2.09, 95% CI 1.49-2.91) and rural Tumbes was less ideal (OR 0.54, 95% CI 0.39-0.76) after adjusting for sex, age, education and wealth index. Conclusion: There is an alarmingly low prevalence of Ideal Cardiovascular Health in Peru and the metrics with the greatest potential for improvement are health behaviors, including diet quality, physical activity and body weight.
  • The role of viruses in the aetiology of IRA in Peruvian children

    Universidad Peruana de Ciencias Aplicadas (UPC) (Elsevier B.V., 2015-03-27)
  • Evaluation of three PCR schemes for detection of Bartonella bacilliformis in blood samples: sensitivity, specificity and applicability

    Universidad Peruana de Ciencias Aplicadas (UPC) (Elsevier B.V., 2015-03-24)
    Background: Bartonella bacilliformis is the etiological agent of Carrion’s disease, a neglected illness with a febrile lethal stage and a warty benign phase, being the human the only known reservoir. The diagnostic by microscopy in endemic areas is several times erroneous. Furthermore, the culture of this bacterium is time-consuming, being the diagnostic by PCR the easiest way to perform a correct diagnostic. The objective of this study was to evaluate the detection limit of three PCR schemes, designed to detect B.bacilliformis, both in blood and filter papers to test their potential use for transferring samples from endemic areas to reference centers. Moreover, the specificity was also observed as well as the applicability of the technique with clinical samples from different stages of the disease. Methods & Materials: Fragments of 16SrRNA and fla genes were amplified as well as the variable-intergenic region (its). The detection limit was determined by bacterial quantification with flow cytometry and performing dilutions (106cfu/ml-10cfu/ml) both in blood and filter papers. DNA was extracted and PCRs were performed. Specificity was tested by processing other bacteraemia microorganisms. Clinical samples, 12 from febrile patients, 13 from warty and 71 from healthy asymptomatic individuals living in endemic area(Mandinga-Cajamarca) were also processed. Results: The 16SrRNA PCR scheme showed the lower detection limit (5 cfu from blood and filter paper) being the PCR scheme chosen to be tested in clinical samples. All febrile patients’ samples were positive, whereas in warty individuals only 3(23%) faint bands were obtained. No amplification was obtained in samples from healthy people. Fainter bands were always obtained when PCRs were made of filter papers. All PCRs were specific for B.bacilliformis. Conclusion: The 16SrRNA PCR seems to be the best technique to detect feverish patients. However, the applicability to identify asymptomatic carriers was undetermined. Filter paper may be an alternative for easy transportation of samples but is need to consider the decreasing sensitivity of the results. It is critical to develop rapid, sensitive and specific technique capable of being applied in endemic rural areas, to avoid misdiagnosis and facilitate the detection of asymptomatic carriers that will allow progress towards the eradication of this disease.
  • Misdiagnosed outbreak of bartonella bacilliformis in Peruvian Amazon department

    Cornejo Tapia, Ángela; Casabona, V.; Gomes, C.S.P.; Tinco, C.; Martinez Pucho, S.; Suárez Ognio, Luis; Ruiz, J.; Del Valle Mendoza, Juana (Elsevier B.V., 2015-03-23)
    Background: In March 2013, the presence of an outbreak of Bartonella bacilliformis in the Rodriguez de Mendoza (Amazonas department, Peru) was reported. B. bacilliformis is an endemic pathogen of the Andean region, responsible for Carrion’s disease. One of the main problems of this illness is the lack of adequate technical and human resources for proper diagnosis in endemic rural areas. The objective of this study was to characterize a supposed B. bacilliformis outbreak, internationally informed in Rodriguez de Mendoza province. Methods & Materials: Fifty-three blood samples were recovered from people diagnosed with Carrion’s disease, either by optical microscopy and/or clinical manifestations. In all cases epidemiological and clinical data were recorded. The samples were cultured on Columbia Agar adding 10% of sheep blood and incubated at 28 ◦C for a period of 10 weeks. Every 14 days the plates were visually inspected to detect any bacterial growth. Additionally, the DNA was directly extracted from blood and 2 different 16S rRNA PCR schemes were used, one specific for Bartonella genus and other using universal primers. Twenty-six amplified products of universal 16S rRNA were randomly recovered and sequenced. Results: The main clinical presentations reported were headache (51%), physical discomfort (51%), chill (32%) and fever (24, 5%). Only 3 blood cultures were positive. No positive PCR was obtained when using the Bartonella specific PCR either on blood or on cultured bacteria. However, all the PCR with the universal primers were positive. The sequenced 26 (49%) samples were identified as Sphingomonas spp. being this microorganism the causative agent of this outbreak. In 17% of the cases, patients were reported to have aquatic activities. Conclusion: Several Sphingomonas spp. infections in humans have been reported, mostly limited to sporadic case reports or intra-hospitalary outbreaks, but as far as we know this is the first outbreak of Sphingomonas spp. described in a non-hospital environment. The association between 17% of patients with aquatic activities suggests that this was the most feasible transmission way. Training of health staff and development of new diagnostic able to be implemented in rural endemic areas is urgent in order to overcome wrong diagnostics and avoid wrong treatments.
  • Assessment with liver function tests and hydroperoxides in short term very-lowbirth-weight neonatal parenteral nutrition

    Universidad Peruana de Ciencias Aplicadas (UPC) (Elsevier B.V., 2015-03-23)
    Rationale: It has been reported that PN (parenteral nutrition) in preterm neonates may have deleterious effects on hepatic function. We also studied the influence of peroxidation in PN bags, with and without light protection. Methods: 30 neonates weighing 1000 1500 g on TPN were studied prospectively. Serum samples were taken at start and at end of PN. Peroxides from 31 bags at 0, 5, 18 and 24 hours were measured. PN samples were taken from both light protected and not light protected PN bags. Results: Patients: (1) With PN: GOT = 28.63±13.00 IU; GPT = 7.37±5.10 IU; TB = 9.03±3.40 IU; DB = 0.845 ±0.43 UI; GGT = 110.41±81.87 IU. (2) Without PN: GOT = 28.73±16.36 IU; GPT = 10.53±8.38 IU; TB = 6.36±3.91 IU; DB = 1.35±1.53 IU; GGT = 128.38±75.74 IU. Significant differences: GPT, TB and DB (p < 0.05). Peroxides in bags: light protected and not, respectively, at 0 hours: 278.01±139.92 and 299.87±166.00, at 5 hours: 142.28±117.93 and 155.11±140.81, at 18 hours 183.39±115.40 and 212.92±133.72 and at 24 hours 258.58±187.81 and 284.55±162.78. At 18 hours the difference was significant (p < 0.05). Conclusions: 1. TB and 18-hour hydroperoxides concentrations were higher in serum, with PN and in light unprotected PN bags, respectively. 2. GPT and DB serum levels were lower with PN. 3. Within the conditions of this study, no association was found between hepatic function alterations and short-term TPN as well as with bag light exposure in neonates.
  • Misdiagnosed outbreak of bartonella bacilliformis in Peruvian Amazon department

    Cornejo Tapia, Ángela; Casabona, V.; Gomes, C. S. P.; Tinco, C.; Martinez Puchol, S.; Suárez Ognio, Luis; Ruiz, J.; Del Valle Mendoza, Juana (International Society for Infectious Diseases, 2014-10-03)
    Background: In March 2013, the presence of an outbreak of Bartonella bacilliformis in the Rodriguez de Mendoza (Amazonas department, Peru) was reported. B. bacilliformis is an endemic pathogen of the Andean region, responsible for Carrion’s disease. One of the main problems of this illness is the lack of adequate technical and human resources for proper diagnosis in endemic rural areas. The objective of this study was to characterize a supposed B. bacilliformis outbreak, internationally informed in Rodriguez de Mendoza province. Methods & Materials: Fifty-three blood samples were recovered from people diagnosed with Carrion's disease, either by optical microscopy and/or clinical manifestations. In all cases epidemiological and clinical data were recorded. The samples were cultured on Columbia Agar adding 10% of sheep blood and incubated at 28°C for a period of 10 weeks. Every 14 days the plates were visually inspected to detect any bacterial growth. Additionally, the DNA was directly extracted from blood and 2 different 16S rRNA PCR schemes were used, one specific for Bartonella genus and other using universal primers. Twenty-six amplified products of universal 16S rRNA were randomly recovered and sequenced. Results: The main clinical presentations reported were headache (51%), physical discomfort (51%), chill (32%) and fever (24, 5%). Only 3 blood cultures were positive. No positive PCR was obtained when using the Bartonella specific PCR either on blood or on cultured bacteria. However, all the PCR with the universal primers were positive. The sequenced 26 (49%) samples were identified as Sphingomonas spp. being this microorganism the causative agent of this outbreak. In 17% of the cases, patients were reported to have aquatic activities. Conclusion: Several Sphingomonas spp. infections in humans have been reported, mostly limited to sporadic case reports or intra-hospitalary outbreaks, but as far as we know this is the first outbreak of Sphingomonas spp. described in a non-hospital environment. The association between 17% of patients with aquatic activities suggests that this was the most feasible transmission way.Training of health staff and development of new diagnostic able to be implemented in rural endemic areas is urgent in order to overcome wrong diagnostics and avoid wrong treatments.
  • Porcentaje de adecuación de la Nutrición Enteral Total de pacientes adultos postoperados en INCOR, 2012

    Carreño, Talia; Piñarreta, Perlita (Asociación Argentina de Nutrición Enteral y Parenteral, 2014-09-01)
    Objetivo: Determinar el porcentaje de adecuación de la Nutrición Enteral Total (NET) de los pacientes adultos postoperados en INCOR-EsSalud en el periodo de junio a diciembre de 2012. Método: Estudio descriptivo, retrospectivo, cuantitativo, de corte transversal. Se incluyeron 22 pacientes. Resultados: El NE para pacientes renales post diálisis recibe 117,4% más de lo requerido, los otros nutrientes no completaron el 100%. Con respecto al tipo de fórmula enteral de mayor prevalencia fue la indicada para Intolerancia a glucosa en el 55% de los pacientes. Más de la mitad de los pacientes 64% no cubre el requerimiento energético total, Sólo 4% alcanza el 95 al 100% de sus requerimientos. Distribución intercuartil de los valores para el porcentaje de adecuación de la NET en los pacientes evaluados. Asimismo, existe mayor porcentaje de pacientes en los que no se cumple con la adecuación de su dieta a sus requerimientos, ya sea por defecto o por exceso. Conclusiones: Es importante el registro tanto de la nutrición enteral indicada como la administrada, como parte del monitoreo nutricional.

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