• A comment on “Body image and paranoia”

      Jeri-Yabar, Antoine; Marin-Leiva, Javiera; Tejada, Romina A. (Elsevier Ireland Ltd, 2018-01)
      Cartas al Editor
    • A community randomised controlled trial evaluating a home-based environmental intervention package of improved stoves, solar water disinfection and kitchen sinks in rural Peru: Rationale, trial design and baseline findings

      Hartinger, S.M.; Lanata, Claudio F.; Hattendorf, J.; Gil, I.; Verastegui, H.; Ochoa, T.; Mäusezahl, D. (Elsevier B.V., 2015-03-24)
      Introduction: Pneumonia and diarrhoea are leading causes of death in children. There is a need to develop effective interventions. Objective: We present the design and baseline findings of a community-randomised controlled trial in rural Peru to evaluate the health impact of an Integrated Home-based Intervention Package in children aged 6 to 35 months. Methods: We randomised 51 communities. The intervention was developed through a community-participatory approach prior to the trial. They comprised the construction of improved stoves and kitchen sinks, the promotion of hand washing, and solar drinking water disinfection (SODIS). To reduce the potential impact of non-blinding bias, a psychomotor stimulation intervention was implemented in the control arm. The baseline survey included anthropometric and socio-economic characteristics. In a sub-sample we determined the level of faecal contamination of drinking water, hands and kitchen utensils and the prevalence of diarrhoegenic Escherichia coli in stool specimen. Results: We enrolled 534 children. At baseline all households used open fires and 77% had access to piped water supplies. E. coli was found in drinking water in 68% and 64% of the intervention and control households. Diarrhoegenic E. coli strains were isolated from 45/139 stool samples. The proportion of stunted children was 54%. Conclusions: Randomization resulted in comparable study arms. Recently, several critical reviews raised major concerns on the reliability of open health intervention trials, because of uncertain sustainability and non-blinding bias. In this regard, the presented trial featuring objective outcome measures, a simultaneous intervention in the control communities and a 12- month follow up period will provide valuable evidence.
    • 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: lallanblitz@mednet.ucla.edu. Received for publication February 21, 2017, and accepted July 30, 2017. DOI: 10.1097/OLQ.0000000000000698
    • A critical appraisal on the association and effects of magnesium and bone density on physical performance in elderly women.

      Unocc, Carla P; Valdez, Laura I; Segura, Eddy R.; laura_valdez25@hotmail.com (American Society for Nutrition, 2015-04)
      Cartas al editor
    • A middle rate of failed extubation is desirable?: Questions unanswered (reply).

      Kapnadak, Siddhartha G; Herndon, Steve E; Burns, Suzanne M; Shim, Y Michael; Enfield, Kyle; Brown, Cynthia; Truwit, Jonathon D; Vinayak, Ajeet G; aracely.silva44@gmail.com (Elsevier B.V., 2015-12)
      Cartas 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
    • A Shocking Cystory

      Cayo Quiñe, Alexandra; Bustamante Voysest, Rossi; Martínez Vargas, Valeria (Elsevier B.V., 2015-04-09)
    • A systematic review and meta-analysis of the relative efficacy and safety of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimethoprim-sulfamethoxazole a real option?

      Hernandez, Adrian V.; Thota, P; Pellegrino, D; Pasupuleti, V; Benites Zapata, Vicente A.; Deshpande, A; Penalva de Oliveira, AC; Vidal, JE; School of Medicine; Universidad Peruana de Ciencias Aplicadas (UPC); Lima Peru; Department of Medicine; Case Western Reserve University; Cleveland OH USA; Department of Infectious Diseases; Instituto de Infectologia Emilio Ribas; Sao Paulo Brazil; Department of Medicine; Case Western Reserve University; Cleveland OH USA; Center for Public Health Research; Research Institute, Faculty of Medicine; Universidad de San Martin de Porres; Lima Peru; Medicine Institute Center for Value Based Care Research; Cleveland Clinic; Cleveland OH USA; Department of Neurology; Instituto de Infectologia Emilio Ribas; Sao Paulo Brazil; Department of Neurology; Instituto de Infectologia Emilio Ribas; Sao Paulo Brazil (Blackwell Publishing Ltd, 2017-02)
      OBJECTIVES: The objective of this study was to perform a systematic review and meta-analysis of the literature to evaluate the efficacy and safety of therapies for cerebral toxoplasmosis in HIV-infected adults. The pyrimethamine plus sulfadiazine (P-S) combination is considered the mainstay therapy for cerebral toxoplasmosis and pyrimethamine plus clindamycin (P-C) is the most common alternative treatment. Although trimethoprim-sulfamethoxazole (TMP-SMX) has potential advantages, its use is infrequent. METHODS: We searched PubMed and four other databases to identify randomized controlled trials (RCTs) and cohort studies. Two independent reviewers searched the databases, identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models. RESULTS: Nine studies were included (five RCTs, three retrospective cohort studies and one prospective cohort study). In comparison to P-S, treatment with P-C or TMP-SMX was associated with similar rates of partial or complete clinical response [P-C: RR 0.87; 95% confidence interval (CI) 0.70-1.08; TMP-SMX: RR 0.97; 95% CI 0.78-1.21], radiological response (P-C: RR 0.92; 95% CI 0.82-1.03), skin rash (P-C: RR 0.81; 95% CI 0.56-1.17; TMP-SMX: RR 0.17; 95% CI 0.02-1.29), gastrointestinal impairment (P-C: RR 5.16; 95% CI 0.66-40.11), and drug discontinuation because of adverse events (P-C: RR 0.32; 95% CI 0.07-1.47). Liver impairment was more frequent with P-S than P-C (P-C vs. P-S: RR 0.48; 95% CI 0.24-0.97). CONCLUSIONS: The current evidence fails to identify a superior regimen in terms of relative efficacy or safety for the treatment of HIV-associated cerebral toxoplasmosis. Use of TMP-SMX as preferred treatment may be consistent with the available evidence and other real-world considerations. Larger comparative studies are needed.
    • Acciones de prevención y control de la legionelosis: un reto para la salud pública española.

      Gea-Izquierdo, Enrique; Mezones Holguín, Edward; Haro-García, Luis (Instituto Nacional de Salud (INS), 2014-03-20)
      Legionellosis is a respiratory disease originating in systems that produce aerosol and contain Legionella sp. In recent decades, Spain has developed a regulatory framework for prevention and control of legionellosis. This article describes the epidemiology of legionellosis and the importance of controlling the transmission of bacteria in the fight against the disease. In that regard, it becomes clear the role of reviewing critical facilities and the inclusion of new ones in the preventive legislation, the estimation of risk, and the improvement in the diagnostic processes and progress in new prevention protocols.
    • Aceptabilidad del sabor de preparaciones hiposódicas con sustitutos de sal en pacientes diabéticos e hipertensos

      Ayerbe-Azabache, Angela; Calderón-Ramírez, Nancy; Taboada,Marco; Mayta-Tristan, Percy; angela_ayer@hotmail.com (2016-12)
      l objetivo de este estudio experimental fue comparar la aceptabilidad del sabor entre diferentes preparaciones con bajo contenido de sodio en pacientes diabéticos e hipertensos. Se realizó entre abril y mayo del 2015 en el Centro de Atención Integral de Diabetes e Hipertensión (CEDHI) en Lima, Perú. Las personas evaluadas fueron 67 pacientes ambulatorios del CEDHI, mayores de 18 años de ambos géneros, diagnosticados de hipertensión arterial o diabetes tipo 2. En total fueron aplicadas 134 pruebas sensoriales y 402 muestras preparadas. Las preparaciones que fueron sometidas a evaluación fueron arroz, caldo, pollo y verduras cocidas, adicionándoles sal común, cloruro de potasio [25%] con sal común [75%] y glutamato monosódico. Para medir los resultados se utilizaron dos pruebas hedónicas, de preferencia por ordenamiento y prueba de aceptabilidad (puntuación del 1 al 5). En los resultados no se encontraron diferencias significativas a nivel global en cuanto a la aceptabilidad y preferencia de las preparaciones con bajo contenido de sodio. Por lo cual, el reemplazo de la sal común por cualquiera de los sustitutos es viable para pacientes con prescripción de dieta hiposódica (1500 mg Na/día).
    • Acerca de "Mapeo político de la discriminación y homofobia asociadas con la epidemia de VIH en México"

      Ochoa-Fernández, Andrea Carolina; Sánchez-Siancas, Johanna Edith; Ueda-Muro, Daniela Alexandra; Ugarte-Gil, César; danauedamuro@hotmail.com (Instituto Nacional de Salud Pública, 2017-02)
      Cartas al Editor
    • Acuerdo de asociación transpacífico: cuando la cura es peor que la enfermedad

      Solari, Lely; lelysol@hotmail.com (Instituto Nacional de Salud (INS), 2015-09)
      Peru is negotiating the Transpacific Partnership Agreement, a commercial treaty that could have deleterious implications for the health systems of the included partners. Transparency and Intellectual Property chapters are the most controversial elements. The first mostly because it opens the possibility for groups of interest to refuse decisions being taken by the sanitary authorities concerning the incorporation of health technologies to the public health systems. The second because it poses restrictions to the entrance of generic medical products, widening the period of data exclusivity and implementing mechanisms of opposition to their registry. Other chapters include strategies to block the states from regulating the consumption of alcohol, tobacco and processed foods. We ought to create surveillance systems to evaluate the impact of the agreement if it is signed, and generate mechanisms that prevent the little resources we already have devoted for health to be deviated to top technology that will not necessarily have a positive impact at a population level.
    • El Acuerdo Nacional como espacio de consenso para la definición de los objetivos de la reforma de salud y establecer políticas de salud en el Perú

      Nepo Linares, Edgardo; Velásquez, Aníbal; gabnepo@minsa.gob.pe (Instituto Nacional de Salud (INS), 2016-09)
      After several months of arduous deliberations, the National Agreement, a policy coordination forum highest level in Peru, approved a document entitled “The objectives of health care reform.” In this article it review the work done and the product reached by consensus, which includes as priorities, among others, strengthening of SIS like public insurance, implementation of a policy of multi-year investment, strengthening the protection of health rights outlined, strengthening the primary health care and improving access to safe and effective medicines. The effect is an agreement that gives significance to a process that has the character of state policy and defines the framework within which they must develop health policies in the following years.
    • Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

      Osanai, Toshiya; Pasupuleti, Vinay; Deshpande, Abhishek; Thota, Priyaleela; Roman, Yuani; Hernández, Adrian V.; Uchino, Ken (The Public Library of Science (PLOS), 2015-05-06)
      Background Randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs. Methods We performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence. Results Ten studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] =1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] =7%; 95%CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95 % CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology. Conclusions Intra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. We need further RCTs with better design and quality to evaluate the true efficacy of endovascular therapy.
    • Adaptación cultural de la versión peruana de la Muscle Appearance Satisfaction Scale (MASS) para dismorfia muscular

      Cook-Del Aguila, Lorella; Sanchez-Castro, Ana Elena; Yacila, Giuliana A; Reyes Bossio, Mario; Mayta-Tristan, Percy; lorecook6@gmail.com (Elsevier Doyma, 2016-12)
      Carta al Editor
    • Adenocarcinoma mucinoso de apéndice. Reporte de un caso

      Wolniczak Rodriguez, Isabella; Cáceres del Águila, Alonso; Santillana Callirgos, Juan Alberto; u911055@upc.edu.pe (Sociedad de Gastroenterología del Perú (SGP), 2016-06)
      Mucinous adenocarcinoma of the appendix is a rare neoplasm with an incidence rate of 0.08% of all malignancies. The diagnosis is usually made by biopsy because its clinical presentation may mimic other diseases of structures located in the right lower quadrant. Currently, the treatment is still controversial, being surgery the best option. This report describes a patient with a history of appendectomy 27 years ago that is hospitalized for a painful mass in the lower abdomen associated with carcinoembryonic antigen of 138 ng/dl.
    • Adherencia a TARGA: enfoque multi-dimensional

      Vadillo, Sandra; López, Rosalie; Moreno, Jacqueline (Sociedad Chilena de Infectología, 2015-07-06)
      Leímos con interés el artículo de Varela y cols.1 sobre depresión y adherencia a terapia anti-retroviral en Chile, tema importante en el éxito de la terapia. Quisiéramos comentar lo siguiente: en primer lugar, muchos estudios coinciden en que las enfermedades psiquiátricas son las co-morbilidades que afectan en mayor medida a la adherencia terapia anti-retroviral de gran actividad (TARGA) directa o indirectamente2. En forma directa porque es la enfermedad psiquiátrica más diagnosticada en pacientes con infección por VIH e indirectamente porque es producto de otros factores de riesgo como uso de alcohol y drogas, efectos secundarios de fármacos, falta de soporte social y familiar, actitudes y creencias del paciente acerca del tratamiento2. Asimismo, se ha visto que la depresión afecta la adherencia al tratamiento de enfermedades crónicas3, por lo que la hipótesis de la asociación de depresión en adherencia a TARGA es a nuestro parecer válida.
    • Advanced colorectal neoplasia: The importance of adequate classification

      Parra del Riego, A.; Olivares Sparks, A.; Barreda B, F.; Carreazo, Nilton Yhuri; aparradelriego@gmail.com (Asociación Mexicana de Gastroenterología, 2016-04)
      Cartas al editor
    • Aetiology, epidemiology and clinical characteristics of acute moderate-to-severe diarrhoea in children under 5 years of age hospitalized in a referral paediatric hospital in Rabat, Morocco

      Benmessaoud, R; Jroundi, I; Nezha, M; Moraleda, C; Tligui, H; Seffar, M; Alvarez Martínez, MJ; Pons, Maria J; Chaacho, S; Hayes, EB; Vila, J; Alonso,PL; Bassat, Q; Ruiz, J (Society for General Microbiology, 2015-01-09)
      The objective of the study was to describe the aetiology, epidemiology and clinical characteristics of the principal causes of acute infectious diarrhoea requiring hospitalization among children under 5 years of age in Rabat, Morocco. A prospective study was conducted from March 2011 to March 2012, designed to describe the main pathogens causing diarrhoea in hospitalized children >2 months and less than 5 years of age. Among the 122 children included in the study, enteroaggregative Escherichia coli (EAEC) and rotavirus were the main aetiological causes of diarrhoea detected. Twelve (9.8 %) children were referred to an intensive care unit, while two, presenting infection by EAEC, and EAEC plus Shigella sonnei, developed a haemolytic uraemic syndrome. Additionally, six (4.9 %) deaths occurred, with EAEC being isolated in four of these cases. Diarrhoeagenic E. coli and rotavirus play a significant role as the two main causes of severe diarrhoea, while other pathogens, such as norovirus and parasites, seem to have a minimal contribution. Surveillance and prevention programmes to facilitate early recognition and improved management of potentially life-threatening diarrhoea episodes are needed.