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A Detection Method of Ectocervical Cell Nuclei for Pap test Images, Based on Adaptive Thresholds and Local Derivatives(Science and Engineering Research Support Society, 2015-04)Cervical cancer is one of the main causes of death by disease worldwide. In Peru, it holds the first place in frequency and represents 8% of deaths caused by sickness. To detect the disease in the early stages, one of the most used screening tests is the cervix Papanicolaou test. Currently, digital images are increasingly being used to improve Pap test efficiency. This work develops an algorithm based on adaptive thresholds, which will be used in Pap smear assisted quality control software. The first stage of the method is a pre-processing step, in which noise and background removal is done. Next, a block is segmented for each one of the points selected as not background, and a local threshold per block is calculated to search for cell nuclei. If a nucleus is detected, an artifact rejection follows, where only cell nuclei and inflammatory cells are left for the doctors to interpret. The method was validated with a set of 55 images containing 2317 cells. The algorithm successfully recognized 92.3% of the total nuclei in all images collected.Acceso abierto
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Diagnosis of erectile dysfunction can be used to improve screening for Type 2 diabetes mellitus(Blackwell Publishing Ltd, 2018-11)Aims: To assess the diagnostic accuracy of four undiagnosed Type 2 diabetes mellitus risk scores accounting for erectile dysfunction status. Methods: This was a population-based cross-sectional study. Type 2 diabetes was defined according to a oral glucose tolerance test and self-reported physician diagnosis. Erectile dysfunction was defined according to the answer to the question, ‘Have you had difficulties obtaining an erection in the last 6 months?’ (yes/no). The risk scores used were the FINDRISC, LA-FINDRISC, American Diabetes Association score and the Peruvian Risk Score. A Poisson regression model was fitted to assess the association between Type 2 diabetes and erectile dysfunction. The area under the receiver-operating characteristic curve was estimated overall and by erectile dysfunction status. Results: A total of 799 men with a mean (sd) age of 48.6 (10.7) years were included in the study. The overall prevalence of Type 2 diabetes was 9.3%. Compared with healthy men, men with Type 2 diabetes had 2.71 (95% CI 1.57–4.66) higher chances of having erectile dysfunction. Having excluded men aware of Type 2 diabetes status (N=38), the area under the receiver-operating characteristic curve of three of the risk scores (not the American Diabetes Association score) improved among those who had erectile dysfunction in comparison with those who did not; for example, the area under the receiver-operating characteristic curve of the LA-FINDRISC score was 89.6 (95% CI 78.7–99.9) in men with erectile dysfunction and 76.5 (95% CI 68.5–84.4) overall. Conclusions: In a population-based study, erectile dysfunction was more common in men with Type 2 diabetes than in the otherwise healthy men. Screening for erectile dysfunction before screening for Type 2 diabetes seems to improve the accuracy of well-known risk scores for undiagnosed Type 2 diabetes.Acceso abierto
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Bioimpedance markers and tuberculosis outcome among HIV-infected patients(Obafemi Awolowo University, 2018)ackground: The changes in body composition markers (weight, fat mass, lean mass, and BMI) over time can be associated with TB treatment outcome among HIV-infected patients. The aim of this study was to investigate whether changes in fat mass and lean mass were associated with the treatment response among patients with HIV infection and pulmonary tuberculosis. Materials and Methods: This was a prospective cohort study. Data from HIV-infected patients commencing TB therapy were analyzed. This included body weight measurement using bioimpedance equipment at baseline, one month, and two months after starting TB treatment. Results: The study was conducted in 125 patients, 17 patients (13.6%) died during treatment, of which 5 died during the first month of treatment, 4 during the second month and 8 after the second month. The group of patients with good response, increased their weight by 1.3 kg (p <0.001) at the end of the first month of TB treatment and 2.6 kg in the second month (p <0.001), and body fat increase was 1.2 Kg (p <0.001) and 2.3 kg (p <0.001), the first and second month respectively. The group of patients who died had lost 2.1 kg fat mass after the first month (p <0.001) and 3.7 kg in the second month (p <0.001). Conclusions: Our results show that the weight change during TB treatment (increased fat mass) helps us predict therapeutic response. Weight loss during the first month of starting therapy should be evaluated thoroughly to identify the probable cause of treatment failure.Acceso abierto
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Blueberry supply chain in Peru: Planning, integration and execution(ExcelingTech, 2018)The Blueberry situation in Peru is in a stage of development, in which it is necessary to incorporate good management practices as well as productive to raise the competitiveness of the enterprises. The findings were synthesized and analyzed, to propose improvements and to support the growth of the small companies in the long term. The improvement proposal is based on the best practices and supply chain models applied in the industry. Also, the research was based on sources of information from researchers with experience in evaluating and analyzing the supply chain of the perishable sector in different scenarios worldwide.Acceso restringido temporalmente
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Síndrome metabólico en pacientes con infección por VIH: ¿oportunidad para la suplementación nutricional?(Sociedad Chilena de Infectologia, 2018)“Cartas al editor”Acceso abierto
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Estrategia de uno en uno para mejorar la técnica correcta de higiene de manos(Instituto Nacional de Pediatria, 2018-01)Acceso abierto
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Re: Maud Rijnders, Ronald de Wit, Joost L. Boormans, Martijn P.J. Lolkema, Astrid A.M. van der Veldt. Systematic Review of Immune Checkpoint Inhibition in Urological Cancers. Eur Urol. 2017;72:411–23(Elsevier B.V., 2018-03)“Cartas al editor”Acceso restringido temporalmente
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Statistical model and taxonomy of devices for assessing the level of VR penetration in the development of applications(International Institute of Informatics and Systemics, IIIS, 2018)Acceso restringido temporalmente
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Maturity model for the strategic management of the corporate scaling of family businesses in the services sector(International Institute of Informatics and Systemics, IIIS, 2018)Acceso restringido temporalmente
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Waste optimization model based on Lean Manufacturing to increase productivity in micro- and small-medium enterprises of the textile sector(International Institute of Informatics and Systemics, IIIS, 2018)Acceso restringido temporalmente
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Biliary peritonitis due to a ruptured amebic liver abscess mimicking a periampullary tumor and liver metastases with the elevation of CA 19-9 and CA 125: a case report(S. Karger AG, 2018-06)Introduction: An amebic liver abscess is the most common presentation of extraintestinal amebiasis. This condition is the result of a parasite infection caused by Entamoeba histolytica. Materials and Methods: We report a case of a 53-year-old male who presented with abdominal pain in the right upper quadrant, jaundice, and a 10-kg weight loss within a 1-month span. Results and Conclusion: A wide range of symptoms and findings in the imaging tests suggestive of neoplasia, elevated levels of CA 19-9 and CA 125, and the presentation of biliary peritonitis as a complication makes this case a challenge for its approach and management.Acceso abierto
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Wearable technology model to control and monitor hypertension during pregnancy(IEEE Computer Society, 2018-06-27)In this paper, we proposed a wearable technology model to control and monitor hypertension during pregnancy. We enhanced prior models by adding a series of health parameters that could potentially prevent and correct hypertension disorders in pregnancy. Our proposed model also emphasizes the application of real-time data analysis for the healthcare organization. In this process, we also assessed the current technologies and systems applications offered in the market. The model consists of four phases: 1. The health parameters of the patient are collected through a wearable device; 2. The data is received by a mobile application; 3. The data is stored in a cloud database; 4. The data is analyzed on real-time using a data analytics application. The model was validated and piloted in a public hospital in Lima, Peru. The preliminary results showed an increased-on number of controlled patients by 11% and a reduction of maternal deaths by 7%, among other relevant health factors that allowed healthcare providers to take corrective and preventive actions.
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“All citizens of the world can save a life” — The World Restart a Heart (WRAH) initiative starts in 2018(Elsevier Ireland Ltd, 2018-07)“All citizens of the world can save a life”. With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative – World Restart a Heart (WRAH) – to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim's collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two- to fourfold is early CPR by lay bystanders and by “first responders”. Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5 to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year. In order to achieve this goal, all seven ILCOR councils have agreed to participate in WRAH 2018. Besides schoolchildren education in CPR (“KIDS SAVE LIVES”), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.Acceso abierto
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Suicide risk assessment: examining transitions in suicidal behaviors among pregnant women in Perú(Springer-Verlag Wien, 2018-07)The goals of this research were to characterize suicidal behavior among a cohort of pregnant Peruvian women and identify risk factors for transitions between behaviors. The World Health Organization Composite International Diagnostic Interview suicide questionnaire was employed to assess suicidal behavior. Discrete-time survival analysis was used to study the cumulative age-of-onset distribution. The hazard function was calculated to assess the risk of onset of each suicidal behavior. Among 2062 participants, suicidal behaviors were endorsed by 22.6% of participants; 22.4% reported a lifetime history of suicidal ideation, 7.2% reported a history of planning, and 6.0% reported attempting suicide. Childhood abuse was most strongly associated with suicidal behavior, accounting for a 2.57-fold increased odds of suicidal ideation, nearly 3-fold increased odds of suicide planning, and 2.43-fold increased odds of suicide attempt. This study identified the highest prevalence of suicidal behavior in a population of pregnant women outside the USA. Diverse populations of pregnant women and their patterns of suicidal behavior transition must be further studied. The association between trauma and suicidal behavior indicates the importance of trauma-informed care for pregnant women.
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Simulation of suicide tendency by using machine learning(IEEE Computer Society, 2018-07)Suicide is one of the most distinguished causes of death on the news worldwide. There are several factors and variables that can lead a person to commit this act, for example, stress, self-esteem, depression, among others. The causes and profiles of suicide cases are not revealed in detail by the competent institutions. We propose a simulation with a systematically generated dataset; such data reflect the adolescent population with suicidal tendency in Peru. We will evaluate three algorithms of supervised machine learning as a result of the algorithm C4.5 which is based on the trees to classify in a better way the suicidal tendency of adolescents. We finally propose a desktop tool that determines the suicidal tendency level of the adolescent.
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Polypoid angiodysplasia mimicking diverticular disease(Ediciones Doyma, S.L., 2018-11)
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Understanding drivers of domestic public expenditure on reproductive, maternal, neonatal and child health in Peru at district level: an ecological study(BioMed Central Ltd., 2018-11)Background: Peru has increased substantially its domestic public expenditure in maternal and child health. Peruvian departments are heterogeneous in contextual and geographic factors, underlining the importance of disaggregated expenditure analysis up to the district level. We aimed to assess possible district level factors influencing public expenditure on reproductive, maternal, neonatal and child health (RMNCH) in Peru. Methods: We performed an ecological study in 24 departments, with specific RMNCH expenditure indicators as outcomes, and covariates of different hierarchical dimensions as predictors. To account for the influence of variables included in the different dimensions over time and across departments, we chose a stepwise multilevel mixed-effects regression model, with department-year as the unit of analysis. Results: Public expenditure increased in all departments, particularly for maternal-neonatal and child health activities, with a different pace across departments. The multilevel analysis did not reveal consistently influential factors, except for previous year expenditure on reproductive and maternal-neonatal health. Our findings may be explained by a combination of inertial expenditure, a results-based budgeting approach to increase expenditure efficiency and effectiveness, and by a mixed-effects decentralization process. Sample size, interactions and collinearity cannot be ruled out completely. Conclusions: Public district-level RMNCH expenditure has increased remarkably in Peru. Evidence on underlying factors influencing such trends warrants further research, most likely through a combination of quantitative and qualitative approaches.Acceso abierto
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Premature clinical trial discontinuation in the era of immune checkpoint inhibitors(Wiley-Blackwell, 2018)Background: Clinical trial completion is critical for new cancer therapies. Premature trial termination or withdrawal is common and impairs progress. We assessed factors of early terminated/withdrawn oncology trials focusing on trials with immune checkpoint inhibitors (ICI), hypothesizing that the latter may be associated with lower rates of premature discontinuation. Materials and Methods: We reviewed all adult, intervention, oncology trials registered in ClinicalTrials.gov (November 16, 2011, to April 16, 2015) to identify all terminated/withdrawn trials and reasons for termination. Logistics regression model was used to identify factors associated with early termination/withdrawal. Discontinuation rate was compared in trials with and without ICI. Results: We identified 12,875 trials (35% industry funded, 12% federal funded), of which 8.5% were prematurely terminated (5%) or withdrawn (3.5%); the main reasons were poor accrual (33%) and logistical (24%). ICI trials (n = 350) had a nonsignificant lower rate of termination or withdrawal compared with all other oncology trials (5.4% vs. 8.5%; p =.9) and were less likely to discontinue due to poor accrual (nonsignificant difference: 21% vs. 33%; p =.4). ICI trials were also less likely to discontinue compared with all other oncology drug trials (e.g., chemotherapy, targeted inhibitors, antiangiogenesis, biologics; 5.4% vs. 7.9%, respectively, nonsignificant difference). The 4-year cumulative incidence of failing to complete for reasons unrelated to toxicity or efficacy was 18% (95% confidence interval 16%–20%). There was no association between annual incidence across different tumor types or accrual goal and rate of trial termination. Conclusion: Poor accrual represents the main cause of early cancer trial termination. Premature termination/withdrawal rate was not significantly lower in ICI compared with other trials. Clinical trial completion remains a high priority and can be influenced by provider and patient factors. Implications for Practice: Clinical trial completion is critical for new cancer therapies. Premature trial termination or withdrawal is common and impairs progress. This study assessed factors of early terminated/withdrawn oncology trials, focusing on trials with immune checkpoint inhibitors (ICI), and found that poor accrual represents the main cause of early cancer trial termination. Premature termination/withdrawal rate was not significantly lower in immune checkpoint inhibitor trials compared to other trials. The discussion herein is focused on measures taken by the National Cancer Institute and other institutions to improve clinical trial accrual and prevent premature clinical trial discontinuation.
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Association of antepartum suicidal ideation during the third trimester with infant birth weight and gestational age at delivery(Routledge, 2019-02)Antepartum suicidal behaviors are a leading cause of maternal injury and death. Previous research has not investigated associations between antepartum suicidal ideation and perinatal complications. Our study objective was to evaluate the relationship of antepartum suicidal ideation with low infant birthweight, small for gestational age, and preterm birth. A cohort study was conducted among 1,108 women receiving prenatal care in Peru. Suicidal ideation was measured using the Patient Health Questionnaire-9 during pregnancy. Birth outcomes were extracted from medical records. Linear regressions and multivariable logistic regressions were used to estimate were used to investigate associations between suicidal ideation and pregnancy outcomes. The prevalence of suicidal ideation was 8.7%, preterm delivery was 5.7%, low birthweight was 4.4%, and small for gestational age was 3.4%. In an adjusted model, infant birthweight was 94.2 grams lower for mothers with antepartum suicidal ideation (95% CI: −183.0, −5.5, p = 0.037) compared with those without suicidal ideation. After adjusting for confounders including depression, participants with suicidal ideation had a nearly four-fold increased odds of delivering a small for gestational age infant (OR: 3.73; 95% CI: 1.59–8.74). These findings suggest suicidal ideation during pregnancy is associated with adverse perinatal outcomes, especially low infant birthweight.
