Objectives: To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. Design: Expert consensus recommendations with Delphi methodology. Setting: Latin American countries. Subjects: Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. Interventions: Delphi methodology for expert consensus. Measurements and Main Results: The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7–9), moderate agreement (score 4–6), and disagreement (score 1–3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. Conclusions: This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

Objective: To determine the association between consumption of snacks and sweetened beverages and risk of overweight among children. Design: Secondary analysis of the Young Lives cohort study in Peru. Setting: Twenty sentinel sites from a total of 1818 districts available in Peru. Subjects: Children in the younger cohort of the Young Lives study in Peru, specifically those included in the third (2009) and the fourth (2013) rounds. Results: A total of 1813 children were evaluated at baseline; 49·2 % girls and mean age 8·0 (sd 0·3) years. At baseline, 3·3 (95 % CI 2·5, 4·2) % reported daily sweetened beverage consumption, while this proportion was 3·9 (95 % CI 3·1, 4·9) % for snacks. Baseline prevalence of overweight was 22·0 (95 % CI 20·1, 23·9) %. Only 1414 children were followed for 4·0 (sd 0·1) years, with an overweight incidence of 3·6 (95 % CI 3·1, 4·1) per 100 person-years. In multivariable analysis, children who consumed sweetened beverages and snacks daily had an average weight increase of 2·29 (95 % CI 0·62, 3·96) and 2·04 (95 % CI 0·48, 3·60) kg more, respectively, than those who never consumed these products, in approximately 4 years of follow-up. Moreover, there was evidence of an association between daily consumption of sweetened beverages and risk of overweight (relative risk=2·12; 95 % CI 1·05, 4·28). Conclusions: Daily consumption of sweetened beverages and snacks was associated with increased weight gain v. never consuming these products; and in the case of sweetened beverages, with higher risk of developing overweight.

Vesicoureteral reflux (VUR) after renal transplantation in adult patients has been reported. In renal transplant recipients, symptomatic urinary tract infection can cause high morbidity despite improved immunosuppressive and antibiotic treatment. In our country there have been few reported cases about use of copolymer of dextranomer and hyaluronic acid (DX-HA) injection in a renal transplant. We present 3 cases of recurrent or complicated infections with evidence of high-grade VUR, which were treated with DX-HA. Only 1 case had a partial remission; however, there were no episodes of urinary tract infection in 12 months of follow-up. Suburethral injection is an endoscopic treatment modality with low morbidity in our country.

Objectives Different studies have reported the association between perceived stress and unhealthy diet choices. We aimed to determine whether there is a relationship between perceived stress and fat intake among undergraduate medical students. Methods/Principal findings A cross-sectional study was performed including first-year medical students. The outcome of interest was the self-report of fat intake assessed using the Block Screening Questionnaire for Fat Intake (high vs. low intake), whereas the exposure was perceived stress (low/ normal vs. high levels). The prevalence of high fat intake was estimated and the association of interest was determined using prevalence ratios (PR) and 95% confidence intervals (95% CI). Models were created utilizing Poisson regression with robust standard errors. Data from 523 students were analyzed, 52.0% female, mean age 19.0 (SD 1.7) years. The prevalence of high fat intake was 42.4% (CI: 38.2%–46.7%). In multivariate model and compared with those with lowest levels of stress, those in the middle (PR = 1.59; 95%CI: 1.20–2.12) and highest (PR = 1.92; 95%CI: 1.46–2.53) categories of perceived stress had greater prevalence of fat intake. Gender was an effect modifier of this association (p = 0.008). Conclusions Greater levels of perceived stress were associated with higher fat intake, and this association was stronger among males. More than 40% of students reported having high fat consumption. Our results suggest the need to implement strategies that promote decreased fat intake.

Objective: To assess the presence of Dengue, Chikungunya, and Zika in serum samples of patients with acute febrile illness in Piura, Peru and describe the most common clinical features. Results: Dengue was the most common arbovirus detected in 170/496 (34.3%), followed by Zika in 39/496 (7.9%) and Chikungunya in 23/496 (4.6%). Among the 170 samples positive for Dengue, serotype 2 was the most predominant type present in 97/170 (57.1%) of samples, followed by the serotype 3 in 9/170 (5.3%). Headaches, muscle pain, and joint pain were the most common symptoms associated with fever in patients with Dengue and Zika. No symptoms predominance was observed in patients with Chikungunya.Dengue is considered the most frequent arbovirus in Peru and the number of cases has increased dramatically in the last 5 years. However, it is not the only arbovirus that circulates along the northern coast of Peru. It has also been determined the presence of Zika and Chikungunya in our population, which may suggest the circulation of other arboviruses that have not been detected.

Hemos leído con interés el artículo titulado: “Estrategia de uno en uno para mejorar la técnica correcta de higiene de manos” de Orozco Hernández y colaboradores, publicado en el volumen 38, número 5.1 Aunque consideramos que el estudio puede ser importante en la búsqueda de estrategias para mejorar la técnica de lavado de manos en personal de salud, nos gustaría expresarle algunas dudas que surgen y que requieren clarificación.

Cartas al editor

Carta al editor

Resumen ObjetivosEstimar la mortalidad precoz en pacientes con enfermedad renal crónica que iniciaron hemodiálisis por urgencia entre los años 2012-2014 en un hospital de referencia nacional en Lima, Perú, e identificar los factores de riesgo. Diseño, características, participantes y medicionesSe estudió una cohorte retrospectiva mediante la revisión de historias clínicas de todos los pacientes admitidos a la Unidad de Hemodiálisis del hospital en el periodo de tiempo señalado. Se evaluó mortalidad precoz, definida como la muerte dentro de los primeros 90 días luego de iniciar hemodiálisis, así como edad, sexo, etiología de enfermedad renal crónica, comorbilidades, causa de muerte, tasa de filtración glomerular estimada, acceso vascular, entre otras variables, en los pacientes que iniciaron hemodiálisis por urgencia. Se estimó la mortalidad precoz mediante frecuencias y se utilizó regresión de Poisson con varianza robusta para determinar los factores de riesgo. ResultadosSe encontró que el 43,4% fueron mujeres, el 51,5% tenían≥65 años y una mortalidad precoz del 9,3%. Los principales factores de riesgo fueron tasa de filtración glomerular estimada>10mL/min/1,73m2 (RR: 2,72 [IC 95%: 1,60-4,61]); edad≥65 años (RR: 2,51 [IC 95%: 1,41-4,48]); infección de catéter venoso central, RR: 2,25 (IC 95%: 1,08-4,67); sexo femenino, RR: 2,15 (IC 95%: 1,29-3,58); y albúmina<3,5g/dL (RR: 1,97 [IC 95%: 1,01-3,82]). ConclusionesLa mortalidad precoz fue del 9,3%. El principal factor de riesgo fue iniciar hemodiálisis con una tasa de filtración glomerular estimada>10mL/min/1,73m2.

OBJECTIVE: To perform a systematic review and meta-analysis to estimate the effect of endometriosis on preterm birth (PB) risk. METHODS: Searches were conducted in PubMed-MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, Google Scholar, and SciELO for studies published in all languages from inception through April 2017. We included cohort studies evaluating pregnant women with and without endometriosis and conception either by spontaneous conception (SC) or with assisted reproductive technology (ART). Primary outcome was PB (<37 weeks), and secondary outcomes were intrauterine growth restriction (IUGR), low birthweight, small for gestational age (SGA), and birthweight. Pooled odds ratios (ORs) and its 95% confidence interval (CI) were calculated as effects, and random-effects models were used for meta-analyses. Risk of bias was assessed with the Newcastle-Ottawa Scale, and heterogeneity of effects among studies was described with the I2 statistic. RESULTS: We identified 9 cohort studies including a total of 1 496 715 pregnancies (13 798 with endometriosis diagnosis). In women with endometriosis, the PB risk was significantly increased in both SC (OR: 1.59; 95% CI: 1.32-1.90) and ART (OR: 1.43; 95% CI: 1.14-1.79). The SGA risk was increased in women with endometriosis (OR: 1.16; 95% CI: 1.05-1.28), while the IUGR and low birthweight risks and birthweight were not affected by endometriosis. CONCLUSION: Endometriosis is associated with increased PB risk in both SC and women who obtained pregnancy using ART. Prospective studies evaluating relevant outcomes are needed to confirm these results.