• Early Prevention and Screening of Cervical Cancer in a Developing Country

      Carvallo Michelena, Alvaro; Rojas Dominguez, Jorge Luis; Piscoya, Alejandro (Elsevier B.V., 2015-02-27)
      Acceso abierto
    • Ebola: A latent threat to Latin America. Are we ready?

      Rodríguez Morales, Alfonso J.; Henao, Daniel E.; Franco, Tulio B.; Mayta-Tristan, Percy; Alfaro Toloza, Patricio; Paniz Mondolfi, Alberto E.; arodriguezm@utp.edu.co; Cartas al editor (Elsevier B.V., 2014-11-12)
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    • Educar por competencias a los profesionales de la salud para transformar la salud

      Risco de Domínguez, Graciela (Instituto Nacional de Salud, 2015-02-28)
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    • Los efectos de la novación objetiva en un contrato continente de un convenio arbitral¿A prueba de balas?

      García Valdez, Leandro; lgarciavaldez@gmail.com (2017-01)
      La novación objetiva es uno de los medios por los que podemos extinguir una relación obligatoria, siendo casi redundante afirmar que donde opera la novación objetiva todo a su paso “desaparece”, por lo que, en principio, diríamos que un contrato novado es aquel en donde se busca ir más allá de una simple modificación, pues el efecto deseado sería en hacer un “borrón y cuenta nueva”. En ese sentido, teniendo como premisa el efecto extintivo absoluto de la novación objetiva, cabría preguntarnos: ¿qué ocurriría en el caso de un contrato que contiene un convenio arbitral? ¿Será que este último corre la suerte de las demás obligaciones y se extingue, o es acaso que podría tener un tratamiento excepcional y sobreviviría al efecto extintivo de la novación objetiva? Esta y otras interrogantes son las que pretendemos dilucidar en las líneas siguientes. El presente artículo ha sido dividido en tres partes. Por un lado, desarrollaremos algunas ideas básicas acerca de la novación objetiva y, por otro lado, acerca de la naturaleza del convenio arbitral; para, finalmente, explicar los efectos de la novación objetiva en un contrato con convenio arbitral.
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    • Effect of a salt-reduction strategy on blood pressure and acceptability among customers of a food concessionaire in Lima, Peru

      Reynoso-Marreros, Isabel A.; Piñarreta-Cornejo, Perlita K.; Mayta-Tristan, Percy; Bernabe-Ortiz, Antonio; antonio.bernabe@upch.pe (Blackwell Publishing Ltd, 2018)
      Aim: Limited information exists regarding the implementation of salt reduction strategies on collective food services, such as restaurants and food concessionaires. The present study aimed to assess the effect of a salt reduction strategy on blood pressure levels and food acceptability among customers of a food concessionaire. Methods: A quasi-experimental study with two phases was conducted. In the pre-intervention phase, the amount of salt used in food preparation was determined. In the intervention phase, a reduction of 20% in salt added to food preparations was implemented. Four hedonic tests and two blood pressure measurements were performed before and after the intervention implementation using standardised techniques. In addition, an evaluation of uneaten food was conducted daily on all customers' plates. Mixed linear regression models were generated to assess the effect of the intervention on blood pressure and acceptability. Results: A total of 71 workers were evaluated, mean age of 37.5 years, 57.8% females, who consumed the food of the concessionaire, on average, 4.4 (SD: 0.7) days per week. Systolic and diastolic blood pressure were reduced by 3.1 (P<0.001) and 2.9 (P<0.001) mmHg at the end of the study, respectively. The results of the hedonic tests and the uneaten food before and after the intervention did not vary significantly. Conclusions: The reduction of 20% of salt added to food from a concessionaire had a positive impact on the reduction of customers' blood pressure without reducing food acceptability. This strategy could be implemented in other contexts.
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    • Effect of Diastolic Dysfunction on Postoperative Outcomes after Cardiovascular Surgery: a Systematic Review and Meta-Analysis

      Kaw, Roop; Hernandez, Adrian V.; Pasupuleti, Vinay; Deshpande, Abhishek; Nagarajan, Vijaiganesh; Bueno, Hector; Coleman, Craig I.; Ioannidis, John P.A.; Bhatt, Deepak L.; Blackstone, Eugene H. (Elsevier B.V., 2016-06)
      Objective The objective of this study was to investigate the effect of preoperative diastolic dysfunction on postoperative mortality and morbidity after cardiovascular surgery. Methods We systematically searched for articles that assessed the prognostic role of diastolic dysfunction on cardiovascular surgery in PubMed, Cochrane Library, Web of Science, Embase and Scopus until February 2016. Twelve studies (n=8224) met our inclusion criteria. Due to scarcity of outcome events, fixed-effects meta-analysis was performed using the Mantel-Haenszel method. Results Preoperative diagnosis of diastolic dysfunction was associated with higher postoperative mortality (OR 2.41, 95% CI 1.54-3.71; p<0.0001), major adverse cardiac events (MACE) (OR 2.07, 95% CI 1.55-2.78; p <=0.0001) and prolonged mechanical ventilation (OR 2.08, 95% CI 1.04-4.16; p=0.04) in comparison to patients without diastolic dysfunction among patients who underwent cardiovascular surgery. The odds of postoperative myocardial infarction (OR: 1.29, 95% CI 0.82, 2.05; p=0.28) and atrial fibrillation (OR: 2.67; 95% CI 0.49-14.43; p=0.25) did not significantly differ between the two groups. Severity of preoperative diastolic dysfunction was associated with increased postoperative mortality (OR 21.22, 95% CI 3.74 -120.33; p=0.0006) for Grade 3 diastolic dysfunction compared with patients with normal diastolic function. Inclusion of left ventricular ejection fraction (LVEF) <40% accompanying diastolic dysfunction, did not further impact postoperative mortality (p=0.27; I2 =18%) when compared with patients with normal LVEF and diastolic dysfunction. Conclusions Presence of preoperative diastolic dysfunction was associated with higher postoperative mortality and MACE, regardless of LVEF. Mortality was significantly higher in grade III diastolic dysfunction. Keywords Diastolic dysfunction; cardiovascular surgical procedures; mortality; meta-analysis
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    • Effect of exercise alone or combined with dietary supplements on anthropometric and physical performance measures in community-dwelling elderly people with sarcopenic obesity: A meta-analysis of randomized controlled trials

      Hita-Contreras, Fidel; Bueno-Notivol, Juan; Martínez-Amat, Antonio; Cruz-Díaz, David; Hernandez, Adrian V.; Pérez-López, Faustino R.; faustino.perez@unizar.es (Elsevier Ireland Ltd, 2018-10)
      Objective: To evaluate the effect of exercise (EXE) alone or exercise combined with dietary supplements (EXE-SUPPL) on body composition and physical performance in subjects 60 years and older with sarcopenic obesity. Methods: A systematic review was carried out of studies identified through five search engines up to April 15, 2018. We searched for randomized controlled trials (RCTs) evaluating EXE or EXE-SUPPL in elderly individuals with sarcopenic obesity for at least six weeks. Primary outcomes were percentage of body fat mass, appendicular skeletal muscle mass, and hand grip strength. Random effects meta-analyses with the inverse variance method were used to evaluate the effects of interventions on outcomes. Effects were expressed as mean differences (MD) and their 95% confidence intervals (CI). Risk of bias was assessed with the Cochrane tool. Results: Nine papers reporting seven RCTs (with a total of 558 participants) were included in the review. EXE alone and EXE-SUPPL increased grip strength (MD 1.30 kg; 95% CI 0.58–2.01), gait speed (MD 0.05 m/s; 95% CI 0.03–0.07) and appendicular skeletal muscle mass (MD 0.40 kg; 95% CI 0.18–0.63). EXE alone and EXE-SUPPL reduced waist circumference (MD −1,40 cm; 95% CI −1.99 to −0.81), total fat mass (MD −1,77 kg; 95% CI −2.49 to −1.04), and trunk fat mass (MD −0.82 kg; 95% CI −1.22 to −0.42). Conclusion: EXE alone and EXE-SUPPL improved muscle-related outcomes and reduced fat-related outcomes in subjects with sarcopenic obesity. There is a need for better-designed RCTs with systematic assessment of both different exercise regimes and dietary supplements in sarcopenic obese subjects.
    • Effect of exercise on sleep quality and insomnia in middle-aged women: A systematic review and meta-analysis of randomized controlled trials

      Rubio-Arias, Jacobo Á.; Marín-Cascales, Elena; Ramos-Campo, Domingo J.; Hernandez, Adrian V.; Pérez-López, Faustino R. (Elsevier Ireland Ltd, 2017-06)
      Objective We assessed the effects of programmed exercise (PE) on sleep quality and insomnia in middle-aged women (MAW). Methods Searches were conducted in five databases from inception through December 15, 2016 for randomized controlled trials (RCTs) evaluating the effects of PE versus a non-exercising control condition on sleep quality, sleep disturbance and/or insomnia in MAW. Interventions had to last at least 8 weeks. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and insomnia with the Insomnia Severity Index (ISI). Random effects models were used for meta-analyses. The effects on outcomes were expressed as mean differences (MDs) and their 95% confidence intervals (CI). Results Five publications reported data from four RCTs on PE effects during 12–16 weeks on sleep quality (n = 4 studies reporting PSQI results) and/or insomnia (n = 3 studies reporting ISI results), including 660 MAW. Low-moderate levels of exercise significantly lowered the PSQI score (MD = −1.34; 95% CI −2.67, 0.00; p = 0.05) compared with controls. In a subgroup analysis, moderate PE (aerobic exercise) had a positive effect on sleep quality (PSQI score MD = −1.85; 95% CI −3.62, −0.07; p = 0.04), while low levels of physical activity (yoga) did not have a significant effect (MD-0.46, 95% CI −1.79, 0.88, p = 0.50). In three studies (two studies of yoga, one study of aerobic exercise), there was a non-significant reduction in the severity of insomnia measured with the ISI score (MD −1.44, 95% CI −3.28, 0. 44, p = 0.13) compared with controls. Heterogeneity of effects among studies was moderate to high. Conclusion In middle-aged women, programmed exercise improved sleep quality but had no significant effect on the severity of insomnia.
    • Effect of low-sodium salt substitutes on blood pressure, detected hypertension, stroke and mortality

      Hernandez, Adrian V.; Emonds, Erin E.; Chen, Brett A.; Zavala-Loayza, Alfredo J.; Thota, Priyaleela; Pasupuleti, Vinay; Roman, Yuani M.; Bernabe-Ortiz, Antonio; Miranda, J. Jaime (BMJ Publishing Group, 2019-06-01)
      Objective A systematic review and meta-analysis was conducted to assess the efficacy of low-sodium salt substitutes (LSSS) as a potential intervention to reduce cardiovascular (CV) diseases. Methods Five engines and ClinicalTrials.gov were searched from inception to May 2018. Randomised controlled trials (RCTs) enrolling adult hypertensive or general populations that compared detected hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), overall mortality, stroke and other CV risk factors in those receiving LSSS versus regular salt were included. Effects were expressed as risk ratios or mean differences (MD) and their 95% CIs. Quality of evidence assessment followed GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. Results 21 RCTs (15 in hypertensive (n=2016), 2 in normotensive (n=163) and 4 in mixed populations (n=5224)) were evaluated. LSSS formulations were heterogeneous. Effects were similar across hypertensive, normotensive and mixed populations. LSSS decreased SBP (MD-7.81 mm Hg, 95% CI-9.47 to-6.15, p<0.00001) and DBP (MD-3.96 mm Hg, 95% CI-5.17 to-2.74, p<0.00001) compared with control. Significant increases in urinary potassium (MD 11.46 mmol/day, 95% CI 8.36 to 14.55, p<0.00001) and calcium excretion (MD 2.39 mmol/day, 95% CI 0.52 to 4.26, p=0.01) and decreases in urinary sodium excretion (MD-35.82 mmol/day, 95% CI-57.35 to-14.29, p=0.001) were observed. Differences in detected hypertension, overall mortality, total cholesterol, triglycerides, glucose or BMI were not significant. Quality of evidence was low to very low for most of outcomes. Conclusions LSSS significantly decreased SBP and DBP. There was no effect for detected hypertension, overall mortality and intermediate outcomes. Large, long-term RCTs are necessary to clarify salt substitute effects on clinical outcomes.
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    • Effect of programmed exercise on insulin sensitivity in postmenopausal women

      Bueno-Notivol, Juan; Calvo-Latorre, Julia; Alonso-Ventura, Vanesa; Pasupuleti, Vinay; Hernandez, Adrian V.; Pérez-López, Faustino R. (Lippincott Williams and Wilkins, 2017-06)
      OBJECTIVE:: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effect of programmed exercise for at least 12 weeks, in postmenopausal women on insulin sensitivity-related outcomes (ISROs), including fasting insulin, C-peptide, insulin growth factor (IGF-1) and IGF-binding protein (IGFBP-3), Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), and anthropometric variables. METHODS:: Searches were conducted in PubMed-Medline, Embase, Scopus, Web of Science, and Cochrane Library from inception through May 3, 2016, for studies published in all languages. Extracted data included characteristics of the study design, study participants, intervention, and outcome measures. Types of exercise were classified into “mid-term exercise intervention” (MTEI, 3-4 months exercise duration) and a “long-term exercise intervention” (LTEI, 6-12 months exercise duration). Risk of bias in RCTs was evaluated with the Cochrane tool. We used random-effects models for meta-analyses. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS:: Seven RCTS (n?=?580) evaluating the effects of programmed exercise on ISROs were included. In three RCTs, MTEI significantly lowered insulin levels (mean difference [MD] −6.50?pmol/L, 95% confidence interval [CI] −11.19, −1.82, P?=?0.006) and HOMA-IR values (MD −0.18, 95% CI −0.34, −0.03, P?=?0.02) when compared with controls. LTEI had no significant effect on insulin levels (P?=?0.19) or HOMA-IR values (P?=?0.68) in four and three RCTs, respectively. There were no significant differences between exercise intervention versus controls in circulating IGF-1, glucose, triglycerides with both MTEI and LTEI, and in IGFBP-3 with LTEI. There were significant reductions in body mass index (BMI, kg/m) (MD −1.48, 95% CI −2.48, −0.48, P?=?0.004) and in body fat percentage (MD −2.99, 95% CI −4.85, −1.14, P?=?0.01) after MTEI; and in waist circumference after both MTEI (MD −1.87, 95% CI −3.02, −0.72, P?=?0.001) and LTEI (MD −3.74, 95% CI −6.68, −0.79). Heterogeneity of effects among studies was moderate to low. CONCLUSION:: Exercising for 3 to 4 months significantly lowered insulin levels and HOMA-IR values, BMI waist circumference, and percentage body fat mass; exercising for 6 to 12 months lowered waist circumference in postmenopausal women.
    • Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials

      Perez López, Faustino R.; Pasupuleti, Vinay; Mezones-Holguín, Edward; Thota, Priyaleela; Deshpande, Abhishek; Hernández, Adrian V.; Benítes-Zapata, Vicente A. (Elsevier B.V., 2015-03-30)
      Objective: To assess the effects of vitamin D supplementation during pregnancy on obstetric outcomes and birth variables. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting: Not applicable. Patient(s): Pregnant women and neonates. Intervention(s): PubMed and 5 other research databases were searched through March 2014 for RCTs evaluating vitamin D supplementation calcium/vitamins/ferrous sulfate vs. a control (placebo or active) during pregnancy. Main Outcome Measure(s): Measures were: circulating 25-hydroxyvitamin D [25(OH)D] levels, preeclampsia, gestational diabetes mellitus (GDM), small for gestational age (SGA), low birth weight, preterm birth, birth weight, birth length, cesarean section. Mantel-Haenszel fixed-effects models were used, owing to expected scarcity of outcomes. Effects were reported as relative risks and their 95% confidence intervals (CIs). Result(s): Thirteen RCTs (n ¼ 2,299) were selected. Circulating 25(OH)D levels were significantly higher at term, compared with the control group (mean difference: 66.5 nmol/L, 95% CI 66.2–66.7). Birth weight and birth length were significantly greater for neonates in the vitamin D group; mean difference: 107.6 g (95% CI 59.9–155.3 g) and 0.3 cm (95% CI 0.10–0.41 cm), respectively. Incidence of preeclampsia, GDM, SGA, low birth weight, preterm birth, and cesarean section were not influenced by vitamin D supplementation. Across RCTs, the doses and types of vitamin D supplements, gestational age at first administration, and outcomes were heterogeneous. Conclusion(s): Vitamin D supplementation during pregnancy was associated with increased circulating 25(OH)D levels, birth weight, and birth length, and was not associated with other maternal and neonatal outcomes. Larger, better-designed RCTs evaluating clinically relevant outcomes are necessary to reach a definitive conclusion. (Fertil Steril 2015;-:-–-. 2015 by American Society for Reproductive Medicine.)
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    • Effectiveness and cost-effectiveness of double reading in digital mammography screening: A systematic review and meta-analysis

      Posso, Margarita; Puig, Teresa; Carles, Misericòrdia; Rué, Montserrat; Canelo-Aybar, Carlos; Bonfill, Xavier; ccanelo@santpau.cat (Elsevier Ireland Ltd, 2017-11)
      Purpose Double reading is the strategy of choice for mammogram interpretation in screening programmes. It remains, however, unknown whether double reading is still the strategy of choice in the context of digital mammography. Our aim was to determine the effectiveness and cost-effectiveness of double reading versus single reading of digital mammograms in screening programmes. Methods We performed a systematic review by searching the PubMed, Embase, and Cochrane Library databases up to April 2017. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklist to assess the methodological quality of the diagnostic studies and economic evaluations, respectively. A proportion's meta-analysis approach, 95% Confidence Intervals (95% CI) and test of heterogeneity (P values) were used for pooled results. Costs are expressed US$ PPP (United States Dollar purchasing power parities). The PROSPERO ID of this Systematic Review's protocol is CRD42014013804. Results Of 1473 potentially relevant hits, four high-quality studies were included. The pooled cancer detection rate of double reading was 6.01 per 1000 screens (CI: 4.47‰–7.77‰), and it was 5.65 per 1000 screens (CI: 3.95‰–7.65‰) for single reading (P = 0.76). The pooled proportion of false-positives of double reading was 47.03 per 1000 screens (CI: 39.13‰–55.62‰) and it was 40.60 per 1000 screens (CI: 38.58‰–42.67‰) for single reading (P = 0.12). One study reported, for double reading, an ICER (Incremental Cost-Effectiveness Ratio) of 16,684 Euros (24,717 US$ PPP; 2015 value) per detected cancer. Single reading + CAD (computer-aided-detection) was cost-effective in Japan. Conclusion The evidence of benefit for double reading compared to single reading for digital mammography interpretation is scarce. Double reading seems to increase operational costs, have a not significantly higher false-positive rate, and a similar cancer detection rate. © 2017 Elsevier B.V.
    • Effects of intermittent versus continuous dieting on weight and body composition in obese and overweight people: a systematic review and meta-analysis of randomized controlled trials

      Roman, Yuani M.; Dominguez, Mariah C.; Easow, Tommy M.; Pasupuleti, Vinay; White, C. Michael; Hernandez, Adrian V.; adrian.hernandez-diaz@uconn.edu (Nature Publishing Group, 2018)
      Background: Intermittent dieting may be an alternative to continuous dieting for weight reduction. Objective: To evaluate the effect of intermittent dieting versus continuous dieting on weight and body composition in overweight or obese adults. Design: A systematic review and meta-analysis of randomized controlled trials (RCTs). Five databases were searched until February 2018 for RCTs comparing intermittent versus continuous dieting. Intermittent dieting consisted of two types: regular intermittent was caloric restriction interspersed with days of weight maintenance or ad libitum eating; intensified intermittent was caloric restriction interspersed with days of even lower caloric restriction. Continuous was continual caloric restriction. Primary outcomes were weight, body fat, lean mass, waist circumference, hip circumference, and energy expenditure. Data were pooled by the inverse variance method using random-effects models and expressed as mean differences (MD) and their 95% confidence intervals (CI). Results: Nine trials met the inclusion criteria (n = 782), six comparing regular intermittent vs continuous (n = 553), and three comparing intensified intermittent vs continuous (n = 229). Populations were heterogeneous: obese only in five studies, and overweight or obese (mixed) in four studies. Lean mass was significantly lower in regular intermittent vs continuous (MD −0.86 kg; 95% CI −1.62 to −0.10; p = 0.03). No differences were found for the remaining outcomes for both comparisons (regular intermittent or intensified intermittent vs continuous). There was low heterogeneity of effects across trials. Subgroup effects by time to follow-up, gender, per-protocol versus intention-to-treat, enforced exercise, and diabetes were similar to main analyses. Conclusions: This systematic review in obese and overweight individuals showed that regular intermittent dieting decreased lean mass compared to continuous dieting. There were no differences in effects for either intermittent vs continuous interventions across all other outcomes. In contrast to previous systematic reviews, this study suggested that lean mass is better preserved in continuous dieting compared to regular intermittent dieting.
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    • Effects of preeclampsia and eclampsia on maternal metabolic and biochemical outcomes in later life: a systematic review and meta-analysis

      Alonso-Ventura, Vanesa; Li, Yangzhou; Pasupuleti, Vinay; Roman, Yuani M.; Hernandez, Adrian V.; Pérez-López, Faustino R. (W.B. Saunders, 2020-01-01)
      Objective: To evaluate the association between preeclampsia (PE) and eclampsia (E) on subsequent metabolic and biochemical outcomes. Methods: Systematic review and meta-analysis of observational studies. We searched five engines until November 2018 for studies evaluating the effects of PE/E on metabolic and biochemical outcomes after delivery. PE was defined as presence of hypertension and proteinuria at >20 weeks of pregnancy; controls did not have PE/E. Primary outcomes were blood pressure (BP), body mass index (BMI), metabolic syndrome (MetS), blood lipids and glucose levels. Random effects models were used for meta-analyses, and effects reported as risk difference (RD) or mean difference (MD) and their 95% confidence interval (CI). Subgroup analyses by time of follow up, publication year, and confounder adjustment were performed. Results: We evaluated 41 cohorts including 3300 PE/E and 13,967 normotensive controls. Women were followed up from 3 months after delivery up to 32 years postpartum. In comparison to controls, PE/E significantly increased systolic BP (MD = 8.3 mmHg, 95%CI 6.8 to 9.7), diastolic BP (MD = 6.8 mmHg, 95%CI 5.6 to 8.0), BMI (MD = 2.0 kg/m2; 95%CI 1.6 to 2.4), waist (MD = 4.3 cm, 95%CI 3.1 to 5.5), waist-to-hip ratio (MD = 0.02, 95%CI 0.01 to 0.03), weight (MD = 5.1 kg, 95%CI 2.2 to 7.9), total cholesterol (MD = 4.6 mg/dL, CI 1.5 to 7.7), LDL (MD = 4.6 mg/dL; 95%CI 0.2 to 8.9), triglycerides (MD = 7.7 mg/dL, 95%CI 3.6 to 11.7), glucose (MD = 2.6 mg/dL, 95%CI 1.2 to 4.0), insulin (MD = 19.1 pmol/L, 95%CI 11.9 to 26.2), HOMA-IR index (MD = 0.7, 95%CI 0.2 to 1.2), C reactive protein (MD = 0.05 mg/dL, 95%CI 0.01 to 0.09), and the risks of hypertension (RD = 0.24, 95%CI 0.15 to 0.33) and MetS (RD = 0.11, 95%CI 0.08 to 0.15). Also, PE/E reduced HDL levels (MD = –2.15 mg/dL, 95%CI –3.46 to −0.85). Heterogeneity of effects was high for most outcomes. Risk of bias was moderate across studies. Subgroup analyses showed similar effects as main analyses. Conclusion: Women who had PE/E have worse metabolic and biochemical profile than those without PE/E in an intermediate to long term follow up period. ©
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    • Efficacy and harms of remdesivir for the treatment of COVID-19: A systematic review and meta-analysis

      Piscoya, Alejandro; Ng-Sueng, Luis F.; del Riego, Angela Parra; Cerna-Viacava, Renato; Pasupuleti, Vinay; Roman, Yuani M.; Thota, Priyaleela; White, C. Michael; Hernandez, Adrian V. (Public Library of Science, 2020-12-01)
      Background Efficacy and safety of treatments for hospitalized COVID-19 are uncertain. We systematically reviewed efficacy and safety of remdesivir for the treatment of COVID-19. Methods Studies evaluating remdesivir in adults with hospitalized COVID-19 were searched in several engines until August 21, 2020. Primary outcomes included all-cause mortality, clinical improvement or recovery, need for invasive ventilation, and serious adverse events (SAEs). Inverse variance random effects meta-analyses were performed. Results We included four randomized controlled trials (RCTs) (n = 2296) [two vs. placebo (n = 1299) and two comparing 5-day vs. 10-day regimens (n = 997)], and two case series (n = 88). Studies used intravenous remdesivir 200mg the first day and 100mg for four or nine more days. One RCT (n = 236) was stopped early due to AEs; the other three RCTs reported outcomes between 11 and 15 days. Time to recovery was decreased by 4 days with remdesivir vs. placebo in one RCT (n = 1063), and by 0.8 days with 5-days vs. 10-days of therapy in another RCT (n = 397). Clinical improvement was better for 5-days regimen vs. standard of care in one RCT (n = 600). Remdesivir did not decrease all-cause mortality (RR 0.71, 95% CI 0.39 to 1.28, I2 = 43%) and need for invasive ventilation (RR 0.57, 95%CI 0.23 to 1.42, I2 = 60%) vs. placebo at 14 days but had fewer SAEs; 5-day decreased need for invasive ventilation and SAEs vs. 10-day in one RCT (n = 397). No differences in all-cause mortality or SAEs were seen among 5-day, 10-day and standard of care. There were some concerns of bias to high risk of bias in RCTs. Heterogeneity between studies could be due to different severities of disease, days of therapy before outcome determination, and how ordinal data was analyzed. Conclusions There is paucity of adequately powered and fully reported RCTs evaluating effects of remdesivir in hospitalized COVID-19 patients. Until stronger evidence emerges, we cannot conclude that remdesivir is efficacious for treating COVID-19.
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    • Eficacia de probióticos para la disminución de los efectos adversos del tratamiento y la erradicación de Helicobacter pylori

      Lo, Jessica; Ramos, Juselly; jurv1114@hotmail.com (Sociedad de Gastroenterología del Perú, 2014-09-23)
      Carta el editor
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    • Eficacia y complicaciones de la técnica de doble guía durante la canulación de la vía biliar principal

      Guzmán-Calderón, Edson; Vera, Augusto; Díaz, Ramiro; Alva, Edgar; Arcana, Ronald; edson_guzman@hotmail.com (Sociedad de Gastroenterología del Perú (SGP), 2017-09)
      Objective: To determine the efficacy and safety of double guidewire technique in patients with difficult biliary cannulation during ERCP. Materials and methods: We conducted a retrospective cohort study of all ERCPs performed between January 2015 and July 2016. DGT was performed in patients for whom biliary cannulation was difficult and guidewire insertion into the pancreatic duct (PD) was inadvertently achieved while attempting the standard WGC technique. Results: 24 patients were enrolled with ERCP and DGT; 17 were female (70.8%) and 7 male (29.2%). The average age was 65.21±16.49 years. The most frequent indication was choledocholithiasis (62.5%), then cholangiocarcinoma (12.5%). Post ERCP diagnosis was choledocholithiasis (45.8%), and papillary fibrosis (29.2%). The success of DGT was 87.5%. Three cases of failure cannulation with the DGT were reported, two patients had pancreatitis post ERCP (8.3%), there were no cases of perforations. Conclusions: TDG, is an effective alternative to difficult biliary cannulation during ERCP with conventional methods; with a high success rate and low rate of post ERCP pancreatitis, similarly to reported in other countries.
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    • Electrohydraulic lithotripsy for the treatment of stone impacted in a lumen-apposing metal stent in a patient with endoscopic cholecystoduodenostomy

      Guzmán-Calderón, Edson; Martínez-Moreno, Belén; Casellas, Juan A.; Aparicio, José Ramó (2021-01-01)
      Resumen no disponible.
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    • Embarazo adolescente como factor de riesgo para complicaciones obstétricas y perinatales en un hospital de Lima, Perú

      Okumura, Javier A.; Maticorena, Diego A.; Tejeda, José E.; Mayta-Tristan, Percy (Instituto Materno Infantil de Pernambuco, 2015-02-17)
      Objetivos: analizar el riesgo de complicaciones obstétricas y perinatales en adolescentes embarazadas en un hospital de Lima, Perú. Métodos: estudio de cohorte retrospectiva de 67.693 gestantes atendidas en el período 2000-2010. Se evaluó complicaciones obstétricas y perinatales. Las adolescentes se clasificaron en tardías (15-19 años) y tempranas (< 15 años) y se compararon con las adultas (20-35 años). Se calculó OR ajustados por educación, estado civil, control prenatal, gestaciones previas, paridad e IMC pregestacional. Resultados: se encontró mayor riesgo de cesárea (OR=1,28; IC95%=1,07-1,53) e infección puerperal (OR=1,72; IC95%=1,17-2,53) en las adolescentes menores de 15 años, así como mayor riesgo (OR=1,34; IC95%=1,29-1,40)de episiotomía en las adolescentes tardías. Asimismo, se identificó un menor riesgo del embarazo adolescente para preeclampsia (OR=0,90; IC95%=0,85-0,97), hemorragia de la 2da mitad del embarazo (OR=0,80; IC95%=0,71-0,92), ruptura prematura de membranas (OR=0,83; IC95%=0,79-0,87), amenaza de parto pretérmino (OR=0,87; IC95%=0,80-0,94) y desgarro vaginal (OR= 0,86; IC95%=0,79-0,93). Conclusión: el embarazo se comporta como factor de riesgo para ciertas complicaciones obstétricas en la población adolescente, especialmente en las adolescentes tempranas. Existen además otros factores, que sumados a la edad materna, constituyen la necesidad de formar equipos multidis-ciplinarios para reducir complicaciones obstétricas en esta población.
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    • Emergence and spread of carbapenem-resistant Acinetobacter baumannii international clones II and III in Lima, Peru

      Levy-Blitchtein, Saúl; Roca, Ignasi; Plasencia-Rebata, Stefany; Vicente-Taboada, William; Velásquez-Pomar, Jorge; Muñoz, Laura; Moreno-Morales, Javier; Pons, Maria J.; del Valle-Mendoza, Juana; Vila, Jordi; Ignasi.roca@isglobal.org (Nature Publishing Group, 2018-12-01)
      Carbapenem-resistant Acinetobacter baumannii is the top-ranked pathogen in the World Health Organization priority list of antibiotic-resistant bacteria. It emerged as a global pathogen due to the successful expansion of a few epidemic lineages, or international clones (ICs), producing acquired class D carbapenemases (OXA-type). During the past decade, however, reports regarding IC-I isolates in Latin America are scarce and are non-existent for IC-II and IC-III isolates. This study evaluates the molecular mechanisms of carbapenem resistance and the epidemiology of 80 non-duplicate clinical samples of A. baumannii collected from February 2014 through April 2016 at two tertiary care hospitals in Lima. Almost all isolates were carbapenem-resistant (97.5%), and susceptibility only remained high for colistin (95%). Pulsed-field gel electrophoresis showed two main clusters spread between both hospitals: cluster D containing 51 isolates (63.8%) associated with sequence type 2 (ST2) and carrying OXA-72, and cluster F containing 13 isolates (16.3%) associated with ST79 and also carrying OXA-72. ST2 and ST79 were endemic in at least one of the hospitals. ST1 and ST3 OXA-23-producing isolates were also identified. They accounted for sporadic hospital isolates. Interestingly, two isolates carried the novel OXA-253 variant of OXA-143 together with an upstream novel insertion sequence (ISAba47). While the predominant A. baumannii lineages in Latin America are linked to ST79, ST25, ST15, and ST1 producing OXA-23 enzymes, we report the emergence of highly resistant ST2 (IC-II) isolates in Peru producing OXA-72 and the first identification of ST3 isolates (IC-III) in Latin America, both considered a serious threat to public health worldwide.
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