• Deficiencias en la indicación y en el acceso a la terapia dietética en la enfermedad renal crónica en hemodiálisis: una mirada en el contexto de la inequidad.

      Izquierdo Saona, Alejandra; Gallo Carrillo, Talía; Bellido Boza, Luciana Elena; Herrera Añazco, Percy; Mezones-Holguín, Edward (Instituto Nacional de Salud (INS), 2014-03-25)
      Acceso abierto
    • Deficient Reporting and Interpretation of Non-Inferiority Randomized Clinical Trials in HIV Patients: A Systematic Review

      Hernández, Adrian V.; Pasupuleti, Vinay; Deshpande, Abhishek; Thota, Priyaleela; Collins, Jaime A.; Vidal, Jose E. (Public Library of Science (PLoS), 2014-04-30)
      Objectives: Non-inferiority (NI) randomized clinical trials (RCTs) commonly evaluate efficacy of new antiretroviral (ARV) drugs in human immunodeficiency virus (HIV) patients. Their reporting and interpretation have not been systematically evaluated. We evaluated the reporting of NI RCTs in HIV patients according to the CONSORT statement and assessed the degree of misinterpretation of RCTs when NI was inconclusive or not established. Design: Systematic review. Methods: PubMed, Web of Science, and Scopus were reviewed until December 2011. Selection and extraction was performed independently by three reviewers. Results: Of the 42 RCTs (n = 21,919; range 41–3,316) selected, 23 were in ARV-naı¨ve and 19 in ARV-experienced patients. Twenty-seven (64%) RCTs provided information about prior RCTs of the active comparator, and 37 (88%) used 2-sided CIs. Two thirds of trials used a NI margin between 10 and 12%, although only 12 explained the method to determine it. Blinding was used in 9 studies only. The main conclusion was based on both intention-to-treat (ITT) and per protocol (PP) analyses in 5 trials, on PP analysis only in 4 studies, and on ITT only in 31 studies. Eleven of 16 studies with NI inconclusive or not established highlighted NI or equivalence, and distracted readers with positive secondary results. Conclusions: There is poor reporting and interpretation of NI RCTs performed in HIV patients. Maximizing the reporting of the method of NI margin determination, use of blinding and both ITT and PP analyses, and interpreting negative NI according to actual primary findings will improve the understanding of results and their translation into clinical practice.
      Acceso abierto
    • Delivery by caesarean section and risk of childhood obesity: analysis of a Peruvian prospective cohort

      Carrillo Larco, Rodrigo M.; Miranda, J. Jaime; Bernabe-Ortiz, Antonio (PeerJ, Inc, 2015-06-24)
      Objectives. We aimed to assess if Caesarean section is a risk factor for overnutrition in early- and late-childhood, and to assess the magnitude of the effect of child- versus family-related variables in these risk estimates. Methods. Longitudinal data from Peruvian children from the Young Lives Study was used. Outcomes assessed were overweight, obesity, overnutrition (overweight plus obesity), and central obesity (waist circumference) at the age 5 (first follow-up) and 7 (second follow-up) years. The exposure of interests was delivery by Caesarean section. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated using multivariable models adjusted for child-related (e.g., birth weight) and familyrelated (e.g., maternal nutritional status) variables. Results. At baseline, mean age was 11.7 (± 3.5) months and 50.1% were boys. Children born by Caesarean section were 15.6%. The 10.5% of the children were overweight and 2.4% were obese. For the obesity outcome, data from 6,038 and 9,625 children-years was included from baseline to the first and second follow-up, respectively. Compared to those who did not experience Caesarean delivery, the risk of having obesity was higher in the group born by Caesarean: RRs were higher at early-childhood (first follow-up: 2.25; 95% CI [1.36–3.74]) than later in life (second follow-up: 1.57; 95% CI [1.02–2.41]). Family-related variables had a greater effect in attenuating the risk estimates for obesity at the first, than at the second follow-up. Conclusion. Our results suggest a higher probability of developing obesity, but not overweight, among children born by Caesarean section delivery. The magnitude of risk estimates decreased over time, and family-related variables had a stronger effect on the risk estimates at early-childhood.
      Acceso abierto
    • Demographic and health attributes of the Nahua, initial contact population of the Peruvian Amazon.

      Culqui, Dante R; Ayuso Alvarez, Ana; Munayco, Cesar V; Quispe Huaman, Carlos; Mayta-Tristan, Percy; Campos, Juan de Mata Donado (ABRASCO - Associação Brasileira de Saúde Coletiva, 2016-02-01)
      We present the case of the Nahua population of Santa Rosa de Serjali, Peruvian Amazon's population, considered of initial contact. This population consists of human groups that for a long time decided to live in isolation, but lately have begun living a more sedentary lifestyle and in contact with Western populations. There are two fully identified initial contact groups in Peru: the Nahua and the Nanti. The health statistics of the Nahua are scarce. This study offers an interpretation of demographic and epidemiological indicators of the Nahua people, trying to identify if a certain degree of health vulnerability exists. We performed a cross sectional study, and after analyzing their health indicators, as well as the supplemental qualitative analysis of the population, brought us to conclude that in 2006, the Nahua, remained in a state of health vulnerability.
      Acceso abierto
    • Dengue complicado y miocarditis: comunicación de un caso

      Pereda, María Gracia; López, Marianelly; Mariluz, Melissa (Sociedad Chilena de Infectología, 2015-05-14)
      Hemorragic dengue fever is a prevalent infection in many countries around the world. Myocarditis is a severe manifestation of dengue virus infection. With prompt intervention and an early diagnosis, the outcome of this condition can be improve. We report a adult patient with complicated dengue, myocarditis, cardiac and respiratory insufficiency with acute renal injury.
      Acceso abierto
    • 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; [email protected] (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
    • La depresión dentro de la atención primaria, ¿dónde estamos en este tema?

      Arroyo Garate, Rodrigo; Catter, Andrés; Gismondi Altamirano, Giancarlo (Instituto Nacional de Salud Pública, 2015-11-24)
      Cartas al editor
      Acceso abierto
    • Depression symptoms and mortality in elderly peruvian navy veterans: a retrospective cohort study

      Astorga-Aliaga, A.; Díaz-Arroyo, F.; Carreazo, N. Y.; Caballero, K. C.; Rodríguez-Cuba, M. A.; Runzer-Colmenares, F.; Parodi-García, J. (Pleiades journals, 2022-03-01)
      Abstract: Our study was design to determine the association between depressive symptoms and mortality in adults over 60 years old Navy Peruvian Veterans. We performed a retrospective cohort study based on a previous cohort study. A total of 1681 patients over 60 years old were included between 2010–2015. Demographic information, self-reported information about falls, physical frailty assessment, tobacco consumption, hypertension, Type 2 Diabetes Mellitus, Chronic Obstructive Pulmonary Disease and was collected. Depression was assessed by the short form of the Geriatric Depression Scale. We found that depressive symptoms were present in 24.9% of the participants and 40.5% of them died. Mortality risk in patients with depressive symptoms, physical frailty, and male sex was: RR of 23.1 (95% CI: 11.7–45.7), 3.84 (95% CI: 2.16–6.82), and 1.37 (95% CI: 1.07–1.75) respectively. We concluded that depressive symptoms in Peruvian retired military personnel and their immediate relatives are high and are significatively associated with mortality. Also, being male and frail was associated with an increased risk of death. This reinforces that early detection and assessment of depressive symptoms could be an opportunity to improve the health status of older adults.
      Acceso abierto
    • Depressive symptoms and type 2 diabetes mellitus in outpatients of an Armed Forces hospital in Lima, Peru, 2012: a cross-sectional study.

      Urrutia Aliano, Débora; Segura, Eddy R. (2016)
      INTRODUCCIÓN: Los pacientes con diabetes mellitus tipo 2 son más propensos a una baja calidad de vida, discapacidad e incluso muerte. También, tienen una mayor predisposición a la depresión en comparación con los pacientes no diabéticos; así como una evolución favorable producto de la evaluación e intervención de su salud mental. OBJETIVOS: El objetivo de este estudio fue explorar la presencia de síntomas depresivos en una población ambulatoria con diagnóstico de diabetes mellitus tipo 2 y filiación militar. También examinar los factores asociados a la presencia de síntomas depresivos. MÉTODOS: Realizamos un estudio transversal en 108 personas con diabetes mellitus tipo 2, durante enero de 2012 en una muestra ambulatoria de un hospital de las fuerzas armadas. Los síntomas depresivos se evaluaron con el test autoaplicado de Zung. Usamos la prueba de Chi-cuadrado para examinar las asociaciones entre síntomas depresivos y los factores asociados de interés. Usamos modelos lineales generalizados crudos y ajustados para estimar las Razones de Prevalencia (RP) de la asociación entre las características clínicas y sociodemográficas con la presencia de síntomas depresivos. RESULTADOS: La prevalencia de sintomatología depresiva fue de 56,5% (intervalo de confianza 95%: 46,6-66,0%). El análisis bivariado mostró como significativa la asociación entre la presencia de síntomas depresivos con las variables: sexo, edad y complicaciones clínicas de la diabetes. En los análisis ajustados, la retinopatía diabética [RP: 1,3; intervalo de confianza 95%: 1,1-1,7], y la neuropatía diabética [RP: 1,4; intervalo de confianza 95%: 1,1-1,7] se asociaron a una mayor presencia de síntomas depresivos luego de considerar el sexo de los participantes. CONCLUSIONES: Observamos una elevada presencia de síntomas depresivos en la población de estudio, especialmente en los pacientes geriátricos o del sexo femenino. También en aquellos con complicaciones tardías de la diabetes mellitus tipo 2, y que probablemente representen la repercusión de la enfermedad en la calidad de vida del paciente. Un abordaje multidisciplinario, con enfoque físico y mental, debe ser considerado ya que podría beneficiar a la evolución de los pacientes con esta concomitancia en Perú.
      Acceso abierto
    • Desarrollo de guías de práctica clínica basadas en evidencia en Perú desde el sector público

      García-Mostajo, Jorge A.; Alva-Díaz, Carlos; Suárez, Víctor J.; Timaná, Raúl; Canelo-Aybar, Carlos; [email protected] (Colegio Médico del Perú (CMP), 2017-09)
      There has been a regulation for generating clinical practice guidelines in Peru since 2005 (NT N° 027-MINSA/DGSP-V.01), which was issued by the Ministry of Health. However, its use has had little emphasis in the methodological quality of such guidelines, and a narrative style was preferred. Some isolated efforts aiming to improve the quality of such guidelines have taken place, especially with respect to have such documents produced based on evidence. Now we have a new regulation (NT N° 302-2015/MINSA), which places more emphasis in this requirement; and some institutions are already working in such way, in order to comply with international standards and be able to generate a positive impact in our healthcare system through the adequate development of clinical practice guidelines in our country.
      Acceso abierto
    • Desarrollo de neumoconiosis y trabajo bajo la modalidad de tercerización en trabajadores peruanos del sector minero

      Cáceres-Mejía, Brenda; Mayta-Tristan, Percy; Pereyra Elías, Reneé; Collantes, Héctor; Cáceres Leturia, Walter (Instituto Nacional de Salud (INS), 2016-01-25)
      Objetivos. Evaluar la asociación entre el tiempo de trabajo tercerizado y el desarrollo de neumoconiosis en trabajadores mineros peruanos atendidos en el Centro Nacional de Salud Ocupacional y Protección al Ambiente para la Salud entre 2008 y 2011. Materiales y métodos. Estudio de casos y controles retrospectivo no pareado. Los casos incluyeron trabajadores diagnosticados de neumoconiosis, según criterios estandarizados. Trabajo tercerizado se definió como meses de trabajo en empresa no titular. Las empresas titulares están registradas en el Directorio Minero del Perú (Ministerio de Energía y Minas). Se realizó regresión logística múltiple con OR crudos y ajustados. Resultados. El estudio incluyó 391 casos y 1519 controles. En ambos grupos, la mayoría tenían estudios menores a secundaria completa y habían nacido y vivían en la sierra. Trabajar 10 o más años en una empresa tercerizadora se asoció significativamente con mayor frecuencia de neumoconiosis (OR 1,50; IC 95%:1,05-2,14; p=0,026). Los casos presentaron mayor probabilidad de no tener ningún tipo de estudio (OR: 3,07; IC 95%:1,55–6,08; p=0,001), residir en la sierra peruana (OR 1,40; IC 95%:1,10-1,78; p=0,007) y haber trabajado más de 20 años en subsuelo (OR 8,92; IC 95%: 4,53-18,25; p<0,001). Conclusiones. Se encontró asociación entre el desarrollo de neumoconiosis y el tiempo de trabajo tercerizado. No tener estudios, residir en la sierra peruana y el tiempo de trabajo en subsuelo fueron factores de riesgo.
      Acceso abierto
    • Desigualdades sociogeográficas en la mortalidad materna en Perú: 2001-2015

      Casalino Rojo, Eduardo; Ochoa Amenabar, Edurne; Mújica, Oscar J.; Munayco, César V.; [email protected] (Instituto Nacional de Salud, 2018)
      Acceso abierto
    • Detection of Bordetella pertussis using a PCR test in infants younger 3 than one year old hospitalized with whooping cough in five 4 Peruvian hospitals

      Castillo, María Esther; Bada, Carlos; Del Aguila, Olguita; Petrozzi Helasvuo, Verónica; Casabona Ore, Verónica; Reyes, Isabel; Del Valle Mendoza, Juana Mercedes (International Society for Infectious Diseases (Int J Infect Dis), 2015-11-24)
      Acceso abierto
    • Detection of dengue virus serotype 3 in Cajamarca, Peru: Molecular diagnosis and clinical characteristics

      Aguilar-Luis, Miguel; Carrillo-Ng, Hugo; Kym, Sungmin; Silva-Caso, Wilmer; Verne, Eduardo; Del Valle, Luis; Bazn-Mayra, Jorge; Zavaleta-Gavidia, Victor; Cornejo-Pacherres, Daniel; Tarazona-Castro, Yordi; Aquino-Ortega, Ronald; Cornejo-Tapia, Angela; Valle-Mendoza, Juana (Wolters Kluwer Medknow Publications, 2021-10-01)
      Objective: To describe and molecularly characterize an outbreak of dengue virus (DENV) infection in Cajamarca, an Andean region in Peru. Methods: A total of 359 serum samples from patients with acute febrile illness were assessed for the presence of DENV via RT-PCR, ELISA NS1, IgM and IgG in Cajamarca, Peru from January 2017 to June 2017. The evaluation of the different diagnostic tests and their applicability was performed. Results: Dengue virus was detected in 24.7% of samples by RTPCR. Meanwhile, serological analysis detected 30.3% positive cases via ELISA NS1 antigen, 16.7% via ELISA IgG and 9.7% via ELISA IgM. Most of the cases corresponded to DENV-3 (77.5%). The use of RT-PCR performed better in primary infections (P<0.01), while detection of ELISA IgM performed better in secondary infections (P<0.01). The combination of NS1 and IgM performed better than the other assays in detecting primary (92.5%) and secondary infections (96.6%). The most frequent symptoms associated with fever were headaches, myalgias, and arthralgias across all groups. Conclusions: We report an important outbreak of dengue infection caused by DENV-3 in Cajamarca, Peru. Our findings encourage the use of NS1 antigen and IgM co-detection. These findings demonstrate an increasing expansion of DENV-3 in Peru and highlight the importance of molecular diagnosis and serotype characterization among the clinically defined dengue cases to strengthen the Peruvian epidemiological surveillance.
      Acceso abierto
    • Detection of SARS-CoV-2 antibodies in febrile patients from an endemic region of dengue and chikungunya in Peru

      Tarazona-Castro, Yordi; Troyes-Rivera, Lucinda; Martins-Luna, Johanna; Cabellos-Altamirano, Felipe; Aguilar-Luis, Miguel Angel; Carrillo-Ng, Hugo; Del Valle, Luis J.; Kym, Sungmin; Miranda-Maravi, Sebastian; Silva-Caso, Wilmer; Levy-Blitchtein, Saul; del Valle-Mendoza, Juana (Public Library of Science, 2022-04-01)
      Introduction The rapid expansion of the novel SARS-CoV-2 virus has raised serious public health concerns due to the possibility of misdiagnosis in regions where arboviral diseases are endemic. We performed the first study in northern Peru to describe the detection of SARSCoV-2 IgM antibodies in febrile patients with a suspected diagnosis of dengue and chikungunya fever. Materials and methods A consecutive cross-sectional study was performed in febrile patients attending primary healthcare centers from April 2020 through March 2021. Patients enrolled underwent serum sample collection for the molecular and serological detection of DENV and CHIKV. Also, serological detection of IgM antibodies against SARS-CoV-2 was performed. Results 464 patients were included during the study period, of which (40.51%) were positive for one pathogen, meanwhile (6.90%) presented co-infections between 2 or more pathogens. The majority of patients with monoinfections were positive for SARS-CoV-2 IgM with (73.40%), followed by DENV 18.09% and CHIKV (8.51%). The most frequent co-infection was DENV + SARS-CoV-2 with (65.63%), followed by DENV + CHIKV and DENV + CHIKV + SARSCoV-2, both with (12.50%). The presence of polyarthralgias in hands (43.75%, p<0.01) and feet (31.25%, p = 0.05) were more frequently reported in patients with CHIKV monoinfection. Also, conjunctivitis was more common in patients positive for SARS-CoV-2 IgM (11.45%, p<0.01). The rest of the symptoms were similar among all the study groups. Conclusion SARS-CoV-2 IgM antibodies were frequently detected in acute sera from febrile patients with a clinical suspicion of arboviral disease. The presence of polyarthralgias in hands and feet may be suggestive of CHIKV infection. These results reaffirm the need to consider SARS-CoV-2 infection as a main differential diagnosis of acute febrile illness in arboviruses endemic areas, as well as to consider co-infections between these pathogens. Copyright:
      Acceso abierto
    • Detection of Zika virus infection among asymptomatic pregnant women in the North of Peru

      Weilg, Claudia; Troyes, Lucinda; Villegas, Zoila; Silva-Caso, Wilmer; Mazulis, Fernando; Febres, Ammy; Troyes, Mario; Aguilar-Luis, Miguel Angel; del Valle-Mendoza, Juana; [email protected] (BioMed Central Ltd., 2018-05-18)
      Objective: To report an outbreak of ZIKV infection among asymptomatic pregnant women during 2016 in the city of Jaen, Cajamarca. Results: Zika virus RNA was detected in 3.2% (n = 36) of cases by RT-PCR. The mean age of patients positive for ZIKV infection was 29.6 years. 7 patients (19.4%) infected with ZIKV were in their first-trimester of gestation, 13 (36.1%) were in their second-trimester, and 16 (44%) were in their third-trimester. All of the infected pregnant women were asymptomatic. ZIKV infection remains a major public health issue that calls for constant epidemiological surveillance. It can cause the congenital Zika virus syndrome in the newborns of infected mothers. The lack of molecular diagnostic methods in isolated localities and the similarity of symptoms to other arboviral infections, lead to an under-diagnosis of this disease in endemic areas.
      Acceso abierto
    • Development and analysis of furazolidone-resistant Escherichia coli mutants

      Martínez Puchol, Sandra; Gómes, Cláudia; Pons, Maria J.; Ruíz Roldan, Lidia; Torrents De La Peña, Alba; Ochoa, Theresa J.; Ruíz, Joaquim (John Wiley & Sons, Inc., 2015-06-15)
      Furazolidone-resistant mutants were obtained from four clinical isolates of diarrhoeagenic Escherichia coli. The stability of the resistance and the frequency of mutation were established. The minimal inhibitory concentration of furazolidone, nitrofurantoin, nalidixic acid, ampicillin, chloramphenicol and tetracycline was established both in the presence and absence of the efflux pump inhibitor Phe-Arg-β-Naphtylamyde. The presence of mutations in the nitroreductase genes nfsA and nfsB was analysed by PCR; sequencing and their enzymatic activity was assessed by a spectrophotometric assay. Alterations in outer membrane proteins were studied by SDS-PAGE. The frequency of mutation ranged from <9.6 × 10-10 to 9.59 × 10-7 . Neither an effect on efflux pumps inhibited by Phe-Arg-β-Naphtylamyde nor cross-resistance with the antibiotics studied was observed. Nineteen mutants (52.94%) presented mutations in the nitroreductase-encoding genes: 17 in the nfsA gene (15 mutants with an internal stop codon, 2 with amino acid changes), 2 in the nfsB (all amino acid changes). Alterations in the outer membrane proteins OmpA and OmpW were also observed. Although more studies are necessary to find other resistance mechanisms, present data showed the low potential of selecting furazolidone-resistant mutants, together with the lack of cross-resistance with unrelated antimicrobial agents.
      Acceso abierto
    • Development of a 16S rRNA PCR-RFLP Assay for Bartonella Identification: Applicability in the Identification of Species Involved in Human Infections

      Del Valle, Luis J.; Jaramillo, Michael L.; Talledo, Miguel; Pons, Maria J.; Flores, Lidia; Quispe, Ruth L.; Ramírez, Pablo; García de la Guarda, Ruth; Alvarado, Débora; Espinoza-Culupú, Abraham; Del Valle Mendoza, Juana; Vargas, Martha; Ruíz, Joaquim (Horizon Research Publishing, 2014-07-02)
      Abstract We designed a 16S rRNA gene PCR-RFLP scheme to identify all currently described Bartonella spp. The 16S rRNA genes of all Bartonella spp. were in-silico analyzed in order to design a RFLP technique able to discriminate among different species. The restriction enzymes selected were MaeIII, MseI, Sau96I, BsaAI, DrdI, FokI, BssHII, BstUI, AluI, TspDTI and HphI which, according to a decision-making tree, facilitated the differentiation of all the currently described species of Bartonella.The technique was experimentally tested in different species of Bartonella, including human pathogenic B. bacilliformis and B. henselae with a 100% of concordance with the in-silico predicted patterns.This novel RFLP assay could be used to identify both human and non-human pathogenic Bartonella in diagnostic, phylogenetic and epidemiologic studies.
      Acceso abierto
    • 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.
      Acceso abierto
    • Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru

      Solari, L; Van der Stuyft, P; Soto, Alonso; [email protected] (Blackwell Publishing Ltd, 2018-04)
      Objectives: Diagnosis of tuberculous meningitis (TM) is a challenge in countries with a high burden of the disease and constrained resources and clinical prediction rules (CPRs) could be of assistance. We aimed at developing a CPR for diagnosis of TM in a Latin American setting with high tuberculosis incidence and a concentrated HIV epidemic. Methods: We enrolled adult patients with clinical suspicion of TM attending two hospitals in Lima, Peru. We obtained information on potential anamnestic, clinical and laboratory predictive findings that are easy to collect and promptly available. We independently diagnosed TM according to a composite reference standard that included a series of microbiological tests. We performed bivariate analysis and constructed a logistic regression model to select the predictive findings associated with TM. With the selected predictors included in the model, we developed a score-based CPR. We assessed its internal validity and diagnostic performance. Results: Of 155 analysed patients, 59 (38%) had TM. The CPR we derived includes three predictors: cough for 14 days or more, 10–500 cells in CSF and adenosine deaminase ≥ 6 U/l in CSF. It classifies patients into high-, moderate- or low-score groups and has an overall area under the ROC curve of 0.87. 59% of patients were assigned to either the high- or the low-score group, permitting prompt decision-making. In patients in the high-score group, it attains a positive likelihood ratio for TM of 10.6 and in patients with low scores, a negative likelihood ratio of 0.10. Bootstrap analysis indicated high internal validity. Conclusion: This CPR could support decision-making in patients with clinical suspicion of TM. External validation and further assessment of its clinical impact are necessary before application in other settings.
      Acceso restringido temporalmente