Recent Submissions

  • Migration crisis in Venezuela: impact on HIV in Peru

    Rebolledo-Ponietsky, K; Munayco, C V; Mezones-Holguín, E; kirbeliz1609@gmail.com (Oxford University Press, 2019-02-01)
    Cartas al editor
    Acceso restringido temporalmente
  • Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial.

    Miranda-Medina, José; Cavigiolo, Mateo Barba; Soto, Alonso; Wolny, T; Linek, Pawel (SAGE Publications Ltd, 2019-01-28)
    Cartas al editor
    Acceso restringido temporalmente
  • Risk of community-acquired pneumonia in older adults with sarcopenia of a hospital from Callao, Peru 2010–2015

    Altuna-Venegas, Sofia; Aliaga-Vega, Raul; Maguiña, Jorge L.; Parodi, Jose F.; Runzer-Colmenares, Fernando M. (Elsevier Ireland Ltd, 2019-06)
    Introduction: Sarcopenia is a geriatric syndrome characterized by loss of muscle mass and strength. The prevalence in people between 60–70 years is about 5–13% and in adults over 80 years, between 11–50% in the USA. Sarcopenia increases the risk of mortality and nosocomial infections. Community-acquired pneumonia is the first infectious-related cause of death in elderly people. However, there is lack of evidence about the association between sarcopenia and pneumonia. The aim of our study was to determine the incidence and risk factors of community-acquired pneumonia in older adults with sarcopenia in a Peruvian hospital. Methods: A retrospective cohort study was conducted in the geriatrics service of Centro Medico Naval “Cirujano Mayor Santiago Tavara”. Sarcopenia was defined by “European Consensus of Sarcopenia” criteria. MultivariatePoisson regression model was conducted to estimate the effect of the independent association between sarcopenia and pneumonia. Results: A total of 1598 subjects were enrolled, 59.0% were male; with a mean age of 78.3 ± 8.6 years. The prevalence of sarcopenia was 15.1% (95% CI: 13.3–16.8) and the incidence of community-acquired pneumonia was 15.14% (95%CI 13.4–16.9). In the multivariate model, we found a higher incidence of pneumonia in sarcopenic compared to non-sarcopenic, RR(a) 3.88 (95% CI: 2.82–5.33). Discussion: Our study showed a higher incidence of community-acquired pneumonia in sarcopenic subject. Results provide information on the importance of detecting this syndrome because it gives us scientific evidence of the interest of a correct comprehensive geriatric assessment in older patients with a high risk of pneumonia.
    Acceso restringido temporalmente
  • Dengue diagnosis in an endemic area of Peru: Clinical characteristics and positive frequencies by RT-PCR and serology for NS1, IgM, and IgG

    Palomares-Reyes, Carlos; Silva-Caso, Wilmer; del Valle, Luis J.; Aguilar-Luis, Miguel Angel; Weilg, Claudia; Martins-Luna, Johanna; Viñas-Ospino, Adriana; Stimmler, Luciana; Mallqui Espinoza, Naysha; Aquino Ortega, Ronald; Espinoza Espíritu, Walter; Misaico, Erika; del Valle-Mendoza, Juana; juana.delvalle@upc.pe (Elsevier B.V., 2019-04)
    Background: Huánuco is a central eastern region of Peru whose geography includes high forest and low jungle, as well as a mountain range that constitutes the inter-Andean valleys. It is considered a region endemic for dengue due to the many favorable conditions that facilitate transmission of the virus. Methods: A total of 268 serum samples from patients in Huánuco, Peru with an acute febrile illness were assessed for the presence of dengue virus (DENV) via RT-PCR and NS1, IgM, and IgG ELISA during December 2015 and March 2016. Results: DENV was detected in 25% of samples via RT-PCR, 19% of samples by NS1 antigen ELISA, and 10.5% of samples by IgM ELISA. DENV IgG was detected in 15.7% of samples by ELISA. The most frequent symptoms associated with fever across all groups were headache, myalgia, and arthralgia, with no significant difference between the four test methods Conclusions: In this study, DENV was identified in up to 25% of the samples using the standard laboratory method. In addition, a correlation was established between the frequency of positive results and the serological tests that determine NS1, IgM, and IgG. There is an increasing need for point-of-care tests to strengthen epidemiological surveillance in Peru.
    Acceso abierto
  • Association between social media use (Twitter, Instagram, Facebook) and depressive symptoms: Are Twitter users at higher risk?

    Jeri-Yabar, Antoine; Sanchez-Carbonel, Alejandra; Tito, Karen; Ramirez-delCastillo, Jimena; Torres-Alcantara, Alessandra; Denegri, Daniela; Carreazo, Yhuri (SAGE Publications Ltd, 2019-02)
    Background: The purpose of this study was to determine the association between social media dependence and depressive symptoms and also, to characterize the level of dependence. It was a transversal, analytical research. Subjects and Methods: The stratified sample was 212 students from a private university that used Facebook, Instagram and/or Twitter. To measure depressive symptoms, Beck Depression Inventory was used, and to measure the dependence to social media, the Social Media Addiction Test was used, adapted from the Internet Addiction Test of Echeburúa. The collected data were subjected for analysis by descriptive statistics where STATA12 was used. Results: The results show that there is an association between social media dependence and depressive symptoms (PR [Prevalence Ratio] = 2.87, CI [Confidence Interval] 2.03–4.07). It was also shown that preferring the use of Twitter (PR = 1.84, CI 1.21–2.82) over Instagram (PR = 1.61, CI 1.13–2.28) is associated with depressive symptoms when compared to the use of Facebook. Conclusion: Excessive social media use is associated with depressive symptoms in university students, being more prominent in those who prefer the use of Twitter over Facebook and Instagram.
    Acceso restringido temporalmente
  • Comment on: Tools Measuring Quality of Death, Dying, and Care, Completed After Death: Systematic Review of Psychometric Properties

    Montoya-Medina, José E.; Poletti-Jabbour, Giordana; Urrunaga, Nicole; Jiménez, Heyson A.; jmontoyam96@gmail.com; yhuroc@gmail.com (Springer International Publishing, 2019-02)
    Cartas al editor.
    Acceso restringido temporalmente
  • Association of antepartum suicidal ideation during the third trimester with infant birth weight and gestational age at delivery

    Gelaye, Bizu; Domingue, Amber; Rebelo, Fernanda; Friedman, Lauren E; Qiu, Chunfang; Sanchez, Sixto E; Larrabure-Torrealva, Gloria; Williams, Michelle A; bgelaye@hsph.harvard.edu (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.
    Acceso restringido temporalmente
  • Comments on “Affective instability in those with and without mental disorders: A case control study” by Marwaha et al.

    Cornejo-Rojas, Diego A; Castillo-Soto, Ana; Araujo-Castillo, Roger V; diegocr96@gmail.com (Elsevier B.V., 2019-03)
    This letter has the purpose to comment the article by Marwaha et al. regarding affective instability and mental disorders. We wish to highlight the importance to report the proper measures of association in case-control studies, and the impact of adjusting the results when finding associations with possible confounders in the bivariate analysis.
    Acceso restringido temporalmente
  • Diagnosis of erectile dysfunction can be used to improve screening for Type 2 diabetes mellitus

    Carrillo Larco, RM; Luza Dueñas, A.C; Urdániga Hung, M.c; Bernabé Ortiz, A (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
  • Bioimpedance markers and tuberculosis outcome among HIV-infected patients

    Montalvo, R; Bernabe Ortiz, A; Kirwan, D; Gilman, R; otivo3@hotmail.com (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
  • Síndrome metabólico en pacientes con infección por VIH: ¿oportunidad para la suplementación nutricional?

    Valdivia-Caramantín, Wendy; Mezones-Holguín, Edward; michellvc@gmail.com (Sociedad Chilena de Infectologia, 2018)
    “Cartas al editor”
    Acceso abierto
  • Estrategia de uno en uno para mejorar la técnica correcta de higiene de manos

    Carpio Rodríguez, A; Mercado Gonzáles, S; sofimg2311@gmail.com (Instituto Nacional de Pediatria, 2018-01)
    Acceso abierto
  • 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

    Martinez Merizalde Balarezo, Nelson; Monroe Rivera, Mark; Tejada, Romina A.; nelson.mmb1402@gmail.com (Elsevier B.V., 2018-03)
    “Cartas al editor”
    Acceso restringido temporalmente
  • 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

    Marin-Leiva, Javiera; Jeri-Yabar, Antoine; Hernandez Fernandez, Wendy; Damian Bello, Edwin; U201314846@upc.edu.pe (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
  • “All citizens of the world can save a life” — The World Restart a Heart (WRAH) initiative starts in 2018

    Böttiger, B.W.; Lockey, A.; Aickin, R.; Castren, M.; de Caen, A.; Escalante, R.; Kern, K.B.; Lim, S.H.; Nadkarni, V.; Neumar, R.W.; Nolan, J.P.; Stanton, D.; Wang, T.-L.; Perkins, G.D.; bernd.boettiger@uk-koeln.de (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
  • Response

    Khunger, Monica; Hernandez, Adrian V.; Velcheti, Vamsidhar; velchev@ccf.org (Elsevier Inc, 2018-10)
    Carta al editor
    Acceso abierto
  • Polypoid angiodysplasia mimicking diverticular disease

    Cálamo-Guzmán, Bernardo; De Vinatea-Serrano, Luis; Piscoya, Alejandro; bernardocalamoguzman@gmail.com (Ediciones Doyma, S.L., 2018-11)
  • Understanding drivers of domestic public expenditure on reproductive, maternal, neonatal and child health in Peru at district level: an ecological study

    Huicho, Luis; Hernandez, Patricia; Huayanay-Espinoza, Carlos A.; Segura, Eddy R.; Niño de Guzman, Jessica; Flores-Cordova, Gianfranco; Rivera-Ch, Maria; Friedman, Howard S.; Berman, Peter; lhuicho@gmail.com; patricia.hernandez.consultancy@gmail.com; carlos.huayanay@upch.pe; eddysegura@gmail.com; jninodeguzman@mef.gob.pe; g.flores.cordova@gmail.com; maria.rivera.c@upch.pe; friedman@unfpa.org; pberman@hsph.harvard.edu (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
  • Premature clinical trial discontinuation in the era of immune checkpoint inhibitors

    Khunger, Monica; Rakshit, Sagar; Hernandez, Adrian V.; Pasupuleti, Vinay; Glass, Kate; Galsky, Matthew D.; Grivas, Petros; pgrivas@uw.edu (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.
  • Association of antepartum suicidal ideation during the third trimester with infant birth weight and gestational age at delivery

    Gelaye, Bizu; Domingue, Amber; Rebelo, Fernanda; Friedman, Lauren E; Qiu, Chunfang; Sanchez, Sixto E; Larrabure-Torrealva, Gloria; Williams, Michelle A; bgelaye@hsph.harvard.edu (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.

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