Recent Submissions

  • Sweetened beverages, snacks and overweight: findings from the Young Lives cohort study in Peru

    Alviso-Orellana, Claudia; Estrada-Tejada, Dayna; Carrillo-Larco, Rodrigo M; Bernabe-Ortiz, Antonio (Cambridge University Press, 2018-03-20)
    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.
  • Latin American Consensus for Pediatric Cardiopulmonary Resuscitation 2017

    López-Herce, Jesús; Almonte, Enma; Alvarado, Manuel; Bogado, Norma Beatriz; Cyunel, Mariana; Escalante, Raffo; Finardi, Christiane; Guzmán, Gustavo; Jaramillo-Bustamante, Juan C.; Madrid, Claudia C.; Matamoros, Martha; Moya, Luis Augusto; Obando, Grania; Reboredo, Gaspar; López, Lissette R.; Scheu, Christian; Valenzuela, Alejandro; Yerovi, Rocío; Yock-Corrales, Adriana (Lippincott Williams and Wilkins, 2018-03)
    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.
  • Association between perceived social support and induced abortion: A study in maternal health centers in Lima, Peru

    Sánchez-Siancas, Luis E.; Rodríguez-Medina, Angélica; Piscoya, Alejandro; Bernabe-Ortiz, Antonio (PLoS ONE, 2018-04-12)
    Objectives This study aimed to assess the association between perceived social support and induced abortion among young women in Lima, Peru. In addition, prevalence and incidence of induced abortion was estimated. Methods/Principal findings A cross-sectional study enrolling women aged 18–25 years from maternal health centers in Southern Lima, Peru, was conducted. Induced abortion was defined as the difference between the total number of pregnancies ended in abortion and the number of spontaneous abortions; whereas perceived social support was assessed using the DUKE-UNC scale. Prevalence and incidence of induced abortion (per 100 person-years risk) was estimated, and the association of interest was evaluated using Poisson regression models with robust variance. A total of 298 women were enrolled, mean age 21.7 (± 2.2) years. Low levels of social support were found in 43.6% (95%CI 38.0%–49.3%), and 17.4% (95%CI: 13.1%–21.8%) women reported at least one induced abortion. The incidence of induced abortion was 2.37 (95%CI: 1.81–3.11) per 100 person-years risk. The multivariable model showed evidence of the association between low perceived social support and induced abortion (RR = 1.94; 95%CI: 1.14–3.30) after controlling for confounders. Conclusions There was evidence of an association between low perceived social support and induced abortion among women aged 18 to 25 years. Incidence of induced abortion was similar or even greater than rates of countries where abortion is legal. Strategies to increase social support and reduce induced abortion rates are needed.
  • Comment to: “Laser-Assisted Liposuction (LAL) Versus Traditional Liposuction: Systematic Review”

    Centurion, P.; Caballero, G.; Weiss, M. (Springer New York LLC, 2018-03-02)
    Carta al editor
  • An evaluation of distal hair cortisol concentrations collected at delivery

    Orta, Olivia R.; Tworoger, Shelley S.; Terry, Kathryn L.; Coull, Brent A.; Gelaye, Bizu; Kirschbaum, Clemens; Sanchez, Sixto E.; Williams, Michelle A.; Harvard T.H. Chan School of Public Health, Harvard University, MA, USA;; Harvard T.H. Chan School of Public Health, Harvard University, MA, USA;; Harvard T.H. Chan School of Public Health, Harvard University, MA, USA;; Harvard T.H. Chan School of Public Health, Harvard University, MA, USA;; Harvard T.H. Chan School of Public Health, Harvard University, MA, USA;; Technische Universität Dresden, Dresden, Germany;; Facultad de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru;; Harvard T.H. Chan School of Public Health, Harvard University, MA, USA; (Taylor and Francis Ltd., 2018-04-04)
    Distal hair segments collected at delivery may allow for the assessment of maternal cortisol secretion in early pregnancy, an important time window for fetal development. Therefore, an investigation of the validity of distal hair cortisol concentrations is warranted. We examined the concordance between proximal and distal hair cortisol concentrations (HCC), both representing the first trimester of pregnancy. The study population was comprised of a random sample of 97 women participating in the Pregnancy Outcomes Maternal and Infant Study, a prospective cohort study of pregnant women attending prenatal clinics in Lima, Peru. Each participant provided two hair samples: once at enrollment [mean gestational age (GA) = 13.1 weeks] and again at full-term delivery (mean GA = 39.0 weeks). Hair segments reflecting the first trimester were: 3 cm hair segments closest to the scalp on the first hair sample (proximal) and 6–9 cm from the scalp on the second hair sample (distal). HCC was determined using Luminescence Immunoassay. A subset (N = 28) had both hair segments additionally analyzed using liquid chromatography tandem mass spectrometry (LC-MS/MS). HCC values were log-transformed (logHCC), and proximal–distal differences tested using paired sample t-tests. Concordance was evaluated within and across assay types. LogHCC, measured using immunoassay, in distal hair segments was lower compared to proximal hair segments (1.35 versus 1.64 respectively; p = .02). No difference was observed using LC-MS/MS (1.99 versus 1.83, respectively; p=.33). Proximal–distal concordance was low within assay (immunoassay: Pearson = 0.27 and κ = 0.10; LC-MS/MS: Pearson = 0.37 and κ = 0.07). High correlation was observed across assays for both distal (Pearson = 0.78, p < .001; κ = 0.64) and proximal segments (Pearson = 0.96, p < .001; κ = 0.75). In conclusion, distal first-trimester hair segments collected at delivery have lower absolute HCC compared to HCC in proximal first trimester hair segments collected in early pregnancy, and are poorly concordant with HCC in proximal segments. Findings may inform the design of future studies.
  • Letter to the Editors regarding the paper: Sociodemographic Characteristics of Indigenous Population According to the 2000 and 2010 Brazilian Demographic Censuses: A Comparative Approach

    Casella-Fernández, Alfredo; Limas-Haro, Daniela; Lucchetti, Aldo; Universidad Peruana de Ciencias Aplicadas, Peru; Universidad Peruana de Ciencias Aplicadas, Peru; Universidad Peruana de Ciencias Aplicadas, Peru; Hospital Nacional Arzobispo Loayza, Perú (Fundacao Oswaldo Cruz, 2018-03-08)
    Carta al editor
  • Perceived stress and high fat intake: A study in a sample of undergraduate students

    Vidal, E. Jair; Alvarez, Daily; Martinez-Velarde, Dalia; Vidal-Damas, Lorena; Yuncar-Rojas, Kelly A.; Julca-Malca, Alesia; Bernabe-Ortiz, Antonio (Public Library of Science, 2018-03-09)
    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.
  • Endoscopic Treatment for Vesicoureteral Reflux in Recurrent Urinary Tract Infections in Kidney Transplant: Experience of One Center

    Gomez Lujan, M.; Velarde, L.; Cruzalegui, C.; Berrios, C.; Sifuentes, E.; Gálvez, J.; Soto, H.; Castañeda, E.; Bazán, G.; Nakachi, A.; Chambi, M.; Medina, C.; Torres, A. (Elsevier USA, 2018-03)
    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.
  • Identification of infection by Chikungunya, Zika, and Dengue in an area of the Peruvian coast. Molecular diagnosis and clinical characteristics

    Sánchez-Carbonel, José; Tantaléan-Yépez, Derek; Aguilar-Luis, Miguel Angel; Silva-Caso, Wilmer; Weilg, Pablo; Vásquez-Achaya, Fernando; Costa, Luis; Martins-Luna, Johanna; Sandoval, Isabel; del Valle-Mendoza, Juana (BioMed Central Ltd., 2018-03-14)
    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.
  • Development of a clinical prediction rule for the diagnosis of pleural tuberculosis in Peru

    Solari, Lely; Soto, Alonso; Van der Stuyft, Patrick (Elsevier B.V., 2018-04)
    Objectives: To develop a clinical prediction rule (CPR) for the diagnosis of pleural tuberculosis (PT) in patients with pleural exudates in Peru. Methods: Clinical and laboratory information was collected from patients with exudative pleural effusion attending two reference hospitals in Lima, Peru. Predictive findings associated with PT in a multiple logistic regression model were used to develop the CPR. A definite diagnosis of PT was based on a composite reference standard including bacteriological and/or histological analysis of pleural fluid and pleural biopsy specimens. Results: A total of 238 patients were included in the analysis, of whom 176 had PT. Age, sex, previous contact with a TB patient, presence of lymphadenopathy, and pleural adenosine deaminase (ADA) levels were found to be independently associated with PT. These predictive findings were used to construct a CPR, for which the area under the receiver operating characteristics curve (AUC) was 0.92. The single best cut-off point was a score of ≥60 points, which had a sensitivity of 88%, specificity of 92%, a positive likelihood ratio of 10.9, and a negative likelihood ratio of 0.13. Conclusions: The CPR is accurate for the diagnosis of PT and could be useful for treatment initiation while avoiding pleural biopsy. A prospective evaluation is needed before its implementation in different settings.
  • Case report: Clitoromegaly as a consequence of Congenital Adrenal Hyperplasia. An accurate medical and surgical approach

    Fernandez-Aristi, Augusto Rafael; Taco-Masias, Andre Alonso; Montesinos-Baca, Luis (Elsevier Inc, 2018-05)
    We present a case of a woman with a history of Congenital Adrenal Hyperplasia (CAH) diagnosed at the age of 12, who was referred to our unit for surgical treatment. Despite the initial diagnosis was an indirect inguinal hernia, it was a misdiagnosis. Once in our service, this was corrected into clitoromegaly secondary to CAH. Physical examination and imaging test discarded other abnormalities, such as secondary effects androgenization. Regarding surgical treatment, the techniques used were Spencer and Allen combined with Kumar, which are the most used for clitoroplasty but also less used in Peru.
  • Fibromyalgia Among Patients With Chronic Migraine and Chronic Tension-Type Headache: A Multicenter Prospective Cross-Sectional Study: A Comment

    Leiva-Calderón, Alvaro; Mayorga-Moreno, Renzo J.; Escuela de Medicina; Universidad Peruana de Ciencias Aplicadas; Lima Peru; Escuela de Medicina; Universidad Peruana de Ciencias Aplicadas; Lima Peru (Wiley Publishing Asia Pty Ltd, 2018-02)
    Cartas al editor
  • The mortality-incidence ratio as an indicator of five-year cancer survival in metropolitan Lima

    Stenning Persivale, Karoline Andrea; Savitzky Franco, Maria Jose; Cordero-Morales, Alejandra; Cruzado-Burga, José; Poquioma, Ebert; Díaz Nava, Edgar; Payet, Edouardo (Cancer Intelligence, 2018-01-18)
    Introduction: The Mortality–Incidence Ratio complement [1 – MIR] is an indicator validated in various populations to estimate five-year cancer survival, but its validity remains unreported in Peru. This study aims to determine if the MIR correlates directly with five-year survival in patients diagnosed with the ten most common types of cancer in metropolitan Lima. Materials and methods: The Metropolitan Lima Cancer Registry (RCLM in Spanish) for 2004–2005 was used to determine the number of new cases and the number of deaths of the following cancers: breast, stomach, prostate, thyroid, lung, colon, cervical, and liver cancers, as well as non-Hodgkin’s lymphoma and leukaemia. To determine the five-year survival, the five-year vital status of cases recorded was verified in the National Registry of Identification and Civil Status (RENIEC in Spanish). A linear regression model was used to assess the correlation between [1 – MIR] and total observed five-year survival for the selected cancers. Results: Observed and estimated five-year survival determined by [1 – MIR] for each neoplasia were thyroid (66.7%, 86.7%), breast (69.6%; 68%), prostate (64.3%, 63.8%) and cervical (50.1%, 58.5%), respectively. Pearson’s r coefficient for the correlation between [MIR – 1] and observed survival was = 0.9839. Using the coefficient of determination, it was found that [1 – MIR] (X) captures the 96.82% of observed survival (Y). Conclusion: The Mortality–Incidence Ratio complement [1 – MIR] is an appropriate tool for approximating observed five-year survival for the ten types of cancers studied. This study demonstrates the validity of this model for predicting five-year survival in cancer patients in metropolitan Lima.
  • A Cost Analysis of Gyrase A Testing and Targeted Ciprofloxacin Therapy Versus Recommended 2-Drug Therapy for Neisseria gonorrhoeae Infection

    Allan-Blitz, Lao-Tzu; Hemarajata, Peera; Humphries, Romney M.; Wynn, Adriane; Segura, Eddy R.; Klausner, Jeffrey D. (Lippincott Williams and Wilkins, 2018-02)
    From the *Division of Infectious Diseases, Department of Medicine, †Department of Laboratory Medicine, David Geffen School of Medicine, Department of Medicine, ‡Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA; §Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; and ¶Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA Conflict of Interest and Sources of Funding: None declared. This research was supported by the United States National Institutes of Health grants R21AI117256 and R21AI109005 as well as the South American Program in HIV Prevention Research NIH/NIMH R25MH087222. Correspondence: Lao-Tzu Allan-Blitz, MD Candidate, 2018, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095. E‐mail: Received for publication February 21, 2017, and accepted July 30, 2017. DOI: 10.1097/OLQ.0000000000000698
  • Carta al editor en relación al artículo: “Estrategia de uno en uno para mejorar la técnica correcta de higiene de manos”

    Carpio Rodríguez, Antonella; Mercado Gonzáles, Sofía (Instituto Nacional de Pediatria, 2018-01-18)
    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.
  • Letter to the Editor: Influence of Intestinal Microbiota on Body Weight Gain: a Narrative Review of the Literature

    Taco-Masias, Andre Alonso; Fernandez-Aristi, Augusto Rafael (Springer New York LLC, 2018-01-19)
    Cartas al Editor
  • Carta al editor en relación al artículo: “Estrategia de uno en uno para mejorar la técnica correcta de higiene de manos”

    Carpio-Rodríguez A; Mercado-Gonzáles S. (Instituto Nacional de Pediatría, 2018-01)
    Carta al Editor
  • A population-based study of cervical cytology findings and human papillomavirus infection in a suburban area of Thailand

    Phoolcharoen, Natacha; Kantathavorn, Nuttavut; Sricharunrat, Thaniya; Saeloo, Siriporn; Krongthong, Waraphorn (Elsevier B.V., 2017-08)
    Cartas al Editor

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