• Macrolide resistance mechanisms in Enterobacteriaceae: Focus on azithromycin

      Gomes, Cláudia; Martínez Puchol, Sandra; Palma, Noemí; Horna, Gertrudis; Ruiz-Roldán, Lidia; Pons, Maria J; Ruiz, Joaquim; joruiz.trabajo@gmail.com (Taylor & Francis, 2016-10-27)
      From its introduction in 1952 onwards, the clinical use of macrolides has been steadily increasing, both in human and veterinary medicine. Although initially designed to the treatment of Grampositive microorganisms, this antimicrobial family has also been used to treat specific Gram-negative bacteria. Some of them, as azithromycin, are considered in the armamentarium against Enterobacteriaceae infections. However, the facility that this bacterial genus has to gain or develop mechanisms of antibiotic resistance may compromise the future usefulness of these antibiotics to fight against Enterobacteriaceae infections. The present review is focused on the mechanisms of macrolide resistance, currently described in Enterobacteriaceae.
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    • Mala calidad de sueño en pacientes que reciben terapia anti-retroviral de gran actividad: ¿necesidad de evaluación en la práctica ambulatoria?

      Díaz-Llanes, Bruno E.; Tello-Velásquez, Jorge R.; Mezones-Holguín, Edward; Arévalo, Jorge; Rodríguez-Morales, Alfonso J. (Sociedad Chilena de Infectología, 2014-03-06)
      El manejo de un paciente infectado por el virus de inmunodefi ciencia humana (VIH) implica un enfoque multidisciplinario que incluya diversas esferas de la salud de la persona1. Sin embargo, en muchas oportunidades la evaluación se centra en marcadores meramente biológicos descuidando aspectos de índole psicológico y social que tendrían importante repercusión en la calidad de vida de estos pacientes. Dentro de ellos, las alteraciones del sueño (AS), son un factor a considerar, más aún cuando han demostrado tener un impacto negativo en la calidad de vida de las personas2, asimismo, un incremento de la probabilidad de desarrollo de diabetes mellitus, enfermedad cardiovascular y dolencias respiratorias.
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    • La mala calidad de sueño se asocia a una menor adherencia al tratamiento antirretroviral de gran actividad en pacientes peruanos con infección por VIH/SIDA

      Tello Velásquez, Jorge Renzo; Díaz Llanes, Bruno Eduardo; Mezones-Holguín, Edward; Rodríguez Morales, Alfonso J.; Huamaní, Charles; Hernández, Adrian V.; Arévalo Abanto, Jorge (Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2015-06-23)
      Con el objetivo de evaluar si existe asociación entre la mala calidad de sueño y la adherencia al tratamiento antirretroviral de gran actividad (TARGA) en personas con infección por VIH/ SIDA; llevamos a cabo un estudio analítico de corte transversal que incluyó 389 pacientes peruanos en TARGA. La mala calidad de sueño fue medida con la Escala de Calidad de Sueño de Pittsburgh y la adherencia con el CEAT-VIH. Realizamos un modelo lineal generalizado de familia Poisson, con errores estándar robustos para estimar razones de prevalencia y su IC95%. A nivel crudo la mala calidad de sueño leve, moderada y severa se asoció a la adherencia inadecuada. Al ajustar por las variables asociadas en el análisis bivariado o por las variables teóricamente asociadas a la adherencia, sólo la mala calidad de sueño moderada/severa se mantuvo asociada (RP = 1,34; IC95%: 1,17-1,54 y RP = 1,34; IC95%: 1,16-1,57; respectivamente). Se concluye que la mala calidad de sueño moderada/severa se asocia de manera independiente con la adherencia al TARGA. La evaluación de la calidad de sueño podría por ende ser útil en la valoración integral de los pacientes con VIH.
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    • Manejo empírico de las adicciones en el Perú.

      Nizama-Vía, Ayar; Nizama-Valladolid, Martín (Instituto Nacional de Salud (INS), 2014-03-21)
      Cartas al editor.
      Acceso abierto
    • Mapping of somatostatin-28 (1-12) in the alpaca (Lama pacos) brainstem.

      De Souza, Eliana; Sánchez, Manuel Lisardo; Díaz-Cabiale, Zaida; Narváez, José Ángel; Coveñas, Rafael; Aguilar-Luis, Miguel Angel (John Wiley & Sons, Inc., 2015-05)
      Using an indirect immunoperoxidase technique, we studied the distribution of cell bodies and fibers containing somatostatin-28 (1-12) in the alpaca brainstem. Immunoreactive fibers were widely distributed throughout the whole brainstem: 34 brainstem nuclei/regions showed a high or a moderate density of these fibers. Perikarya containing the peptide were widely distributed throughout the mesencephalon, pons and medulla oblongata. Cell bodies containing somatostatin-28 (1-12) were observed in the lateral and medial divisions of the marginal nucleus of the brachium conjunctivum, reticular formation (mesencephalon, pons and medulla oblongata), inferior colliculus, periaqueductal gray, superior colliculus, pericentral division of the dorsal tegmental nucleus, interpeduncular nucleus, nucleus of the trapezoid body, vestibular nucleus, motor dorsal nucleus of the vagus, nucleus of the solitary tract, nucleus praepositus hypoglossi, and in the substantia nigra. This widespread distribution indicates that somatostatin-28 (1-12) is involved in multiple physiological actions in the alpaca brainstem.
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    • Marcadores de obesidad asociados a albuminuria en un centro de atención primaria de Lima, Perú

      Quintanilla, Alberto E.; Taype-Rondan, Álvaro; Lazo-Porras, María; Herrera-Añazco, Percy; a_quintanillav@hotmail.com (Elsevier Doyma, 2017-06)
      Objective To evaluate the association between three obesity markers, body mass index (BMI), abdominal circumference (AC), waist to height ratio (WHtR), and albuminuria in adults seen in a primary health care center specialized in chronic diseases in Lima, Perú. Methods A cross-sectional, descriptive, retrospective study in adults who attended a primary health care center specialized in chronic diseases in 2011. Patients were divided into four categories: healthy subjects and patients with high blood pressure, with type 2 diabetes mellitus (T2DM), and with both diseases (HBP + T2DM). The main outcome was presence of albuminuria, defined as urine albumin levels higher than 30 mg/day. Exposure variables included the following obesity markers: body mass index (BMI), waist-to-height ratio (WHtR), and abdominal circumference (AC). Other covariates considered included sex and age. Crude and adjusted Poisson regressions were performed to estimate prevalence ratios (PRs) and their respective 95% confidence intervals (95% CIs). Areas under the curve were calculated for each indicator, stratified by sex. Results Data from 1,214 patients, 41% of them male, were analyzed, and albuminuria was found in 14.2%. Albuminuria was found to be associated to AC and WHtR, but not to BMI. All three parameters assessed had similar areas under the curve. The optimum cut-off points found for BMI and AC in females were higher than conventional (32.7 kg/m2 and 93 cm respectively), while the values in males were lower than conventional (27.9 kg/m2 and 100 cm respectively). For WHtR, however, the optimum cut-off point was higher in both sexes. The higher index in females was for BMI, followed by AC and WHtR. In males, the higher index was for WHtR, followed by AC and BMI. Conclusions AC and WHtR were found to be directly associated to albuminuria, while BMI was not associated to albuminuria. Areas under the curve were similar for all three markers. The optimum cut-off points for BMI and AC were higher than the conventional ones in females and lower in males.
    • Mastocitos y síndrome de intestino irritable, ¿falta de asociación o de potencia del estudio?

      Mayta-Tristan, Percy (Sociedad de Gastroenterología del Perú (SGP), 2014-08-11)
      Cartas al editor
      Acceso abierto
    • Maternal depressive symptoms are not associated with child anaemia: A cross-sectional population study in Peru, 2015

      Alarcón-Guevara, Samuel; Peñafiel-Sam, Joshua; Chang-Cabanillas, Sergio; Pereyra-Elías, Reneé (Blackwell Publishing Ltd., 2021-03-01)
      Introduction: Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children. Methods: Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl. Results: Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother–child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3–30.2) and 6.9% (95% CI: 6.1–7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85–1.30). The sample did not have moderate or severe malnutrition. Conclusions: There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done.
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    • Maternal post-natal tobacco use and current parental tobacco use is associated with higher body mass index in children and adolescents: an international cross-sectional study.

      Braithwaite, Irene; Stewart, Alistair W; Hancox, Robert J; Beasley, Richard; Murphy, Rinki; Mitchell, Edwin A; Chiarella, Pascual; ISAAC Phase Three Study Group; irene.braithwaite@mrinz.ac.nz (BioMed Central Ltd., 2015-12-24)
      Background: We investigated whether maternal smoking in the first year of life or any current parental smoking is associated with childhood or adolescent body mass index (BMI). Methods: Secondary analysis of data from a multi-centre, multi-country, cross-sectional study (ISAAC Phase Three). Parents/guardians of children aged 6-7 years completed questionnaires about their children's current height and weight, whether their mother smoked in the first year of the child's life and current smoking habits of both parents. Adolescents aged 13-14 years completed questionnaires about their height, weight and current parental smoking habits. A general linear mixed model was used to determine the association between BMI and parental smoking. Results: 77,192 children (18 countries) and 194 727 adolescents (35 countries) were included. The BMI of children exposed to maternal smoking during their first year of life was 0.11 kg/m 2 greater than those who were not (P = 0.0033). The BMI of children of currently smoking parents was greater than those with non-smoking parents (maternal smoking: +0.08 kg/m 2 (P = 0.0131), paternal smoking: +0.10 kg/m 2 (P < 0.0001)). The BMI of female adolescents exposed to maternal or paternal smoking was 0.23 kg/m 2 and 0.09 kg/m 2 greater respectively than those who were not exposed (P < 0.0001). The BMI of male adolescents was greater with maternal smoking exposure, but not paternal smoking (0.19 kg/m 2 , P < 0.0001 and 0.03 kg/m 2 , P = 0.14 respectively). Conclusion: Parental smoking is associated with higher BMI values in children and adolescents. Whether this is due to a direct effect of parental smoking or to confounding cannot be established from this observational study.
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    • Mecanismos Alternativos para la solución de controversias en el contexto de los derechos en salud : experiencia Peruana desde el centro de conciliación y arbitraje de la Superintendencia Nacional de Salud

      Hidalgo Salas, Darwin; Ortiz Pérez,Claudia; Lobatón Flores,Juan; Huamaní Ñahuinlla, Percy; Mezones-Holguín, Edward; emezones@gmail.com (Instituto Nacional de Salud (INS), 2016-07)
      En Perú se reconoce constitucionalmente el derecho a la protección de la salud; asimismo, la ley establece que la población tiene derecho al acceso a servicios de salud, a la información, a la atención y recuperación de su salud, al consentimiento informado y a la protección de sus derechos en salud. No obstante, con la ejecución de acciones relacionadas a ello, pueden presentarse inconformidades que requieren ser solucionadas. En ese marco, los mecanismos alternativos de solución de controversias (MASC) -como la mediación, la conciliación y el arbitraje- son vías válidas y accesibles en el Sistema de Salud Peruano. Actualmente, el Centro de Conciliación y Arbitraje de la Superintendencia Nacional de Salud (CECONAR) lidera la puesta en marcha de los MASC a nivel nacional. En este artículo se ofrece una visión general de CECONAR con un recorrido por sus bases históricas y legales, para luego mostrar su accionar presente y, finalmente, discutir y delinear algunas perspectivas a futuro
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    • La Medicina Basada en la Evidencia: ¿mejoró la medicina que practicamos y enseñamos?

      Huicho, Luis; Carreazo, Nilton Yhuri; Gonzales, Carlos; lhuicho@gmail.com (Universidad Nacional Mayor de San Marcos (UNMSM), 2014-08-12)
      En los últimos años la práctica y la enseñanza médica han incorporado en forma progresiva y creciente el concepto de medicina basada en la evidencia (MBE). La misma se define como la utilización de la mejor evidencia proveniente de la investigación clínica para la toma de decisiones en el manejo del paciente individual. Esta propuesta de cambio en la manera de practicar y enseñar la medicina clínica es, en parte, consecuencia del vertiginoso avance de la investigación científica, particularmente en las últimas décadas, aunque el costo creciente involucrado en la atención de los pacientes ha jugado también un rol importante en su desarrollo y consolidación. La MBE implica la integración de la preparación y experiencia del médico con la mejor evidencia clínica externa accesible, proveniente de la investigación sistemática, proporcionando una visión más crítica en la toma de decisiones clínicas, para ofrecer atención de calidad óptima al paciente, evitando errores en cada una de las diferentes etapas del proceso de diagnóstico y tratamiento. En ausencia de información recolectada sistemáticamente, no es fácil llegar a una conclusión sobre los efectos de la MBE en la práctica y la enseñanza de la medicina en nuestro medio. Sin duda contamos hoy con mayor evidencia científica, incluyendo aquella relacionada a los problemas de salud infantil, y también se ha producido un avance vertiginoso en la tecnología que nos permite acceder a dicha información en tiempo real, a la cabecera del paciente. Sin embargo, si deseamos de veras lograr una mejor medicina, basada en la ciencia y en el respeto a la salud como un derecho que nos asiste a todos, hay necesidad de romper definitivamente con el paradigma predominante de una medicina jerárquica, poco dada a la discusión y a la justificación de las decisiones clínicas, de aprovechar la mejora sustancial ocurrida en el acceso a la evidencia disponible, y de mostrar mayor disposición a compartir amigable y respetuosamente dicha justificación con nuestros pacientes. Del mismo modo, hay la necesidad imperiosa de promover la investigación, la creatividad y el espíritu crítico en todos los niveles de la educación, para contribuir a la evidencia global que permita que la medicina clínica y la salud pública continúen avanzando.
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    • Medicina Tradicional versus Medicina Científica ¿En verdad somos tan diferentes en lo esencial?

      Pereyra Elías, Reneé; Fuentes Delgado, Duilio; renee.pereyra.elias@gmail.com (Colegio Médico del Perú, 2014-08-11)
      Cartas al editor
      Acceso abierto
    • Medición y magnitud del bullying en Perú

      Cobián Lezama, Carla; Nizama-Vía, Ayar; Ramos Aliaga, David; Mayta-Tristan, Percy (Instituto Nacional de Salud (INS), 2015-04-07)
      Cartas al editor
      Acceso abierto
    • Medidas de asociación en estudios transversales: a propósito del estudio “elevada frecuencia de dislipidemia en pacientes infectados por VIH en un hospital público peruano”

      Farfán-García, Reyna C.; Ulloque, Jorge L.; Araujo-Castillo, Roger V.; reyna.farfan16@gmail.com (Instituto Nacional de Salud, 2018)
      Carta al editor
      Acceso abierto
    • Melanoma anal amelanótico. Reporte de caso

      Núñez Garbín, Alexandra; Córdova Pantoja, Cesia; Patiño Ascona, Suzanne; Santillana Callirgos, Juan (Sociedad Colombiana de Gastroenterología, 2014-04-29)
      We present the case of a 60 year old patient suffering pain and the sensation of a foreign body in the anal region associated with traces of blood in stools. Digital rectal exam (DRE) revealed a hardened lesion located on the wall of the anal canal. Colonoscopy revealed a raised proliferating lesion with a blackish color which was about 2 inches in diameter. This was compatible with an anal canal malignancy. We proceeded to a biopsy and immunohistochemistry study which tested positive for S-100 and negative for HMB-45. A multislice helical chest, abdominal and pelvic CAT scan ruled out metastatic tumors and lymphadenopathy. The patient underwent local transanal excision of the partially pigmented tumor. Post- surgical histopathological results confi rmed the diagnosis of malignant anal amelanotic melanoma positive for S-100. The sample tested weakly positive for Melan-A and positive for KI-67. The favorable outcome of the procedure led to the patient’s discharge 3 days after surgery.
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    • Meningitis por Listeria monocytogenes en niñas inmunocompetentes: queso no pasteurizado como probable causa de infección

      Valdivia Tapia, María del C.; Pinelo Chumbe, Elizabeth; Carreazo, Nilton Yhuri (Pontificia Universidad Católica de Chile, 2015-09-30)
      Listeria meningoencephalitis is a rare condition, occurring mainly in immunocompromised patients. We present two cases of Listeria monocytogenes meningoencephalitis in immunocompetent children, with successful treatment with betalactam/aminoglycoside combination. Unpasteurized cheese was postulated as the source of infection.
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    • Menopausal symptoms are associated with non-adherence to highly active antiretroviral therapy in human immunodeficiency virus-infected middle-aged women

      Cutimanco-Pacheco, V.; Arriola-Montenegro, J.; Mezones-Holguin, E.; Niño-Garcia, R.; Bonifacio-Morales, N.; Lucchetti-Rodríguez, A.; Ticona-Chávez, E.; Blümel, J. E.; Pérez-López, F. R.; Chedraui, P. (Taylor and Francis Ltd, 2020-05-03)
      Objective: This study aimed to evaluate the association between the intensity of menopausal symptoms and highly active antiretroviral therapy (HAART) adherence in middle-aged women with human immunodeficiency virus (HIV) infection. Methods: In this cross-sectional study, 313 Peruvian women with HIV infection (age 40-59 years) were surveyed and classified as adherent or non-adherent to HAART based on the Antiretroviral Treatment Adherence Evaluation Questionnaire. The intensity of menopausal symptoms was assessed with the Menopause Rating Scale, and categorized as none, mild, moderate, and/or severe. Age, sexual orientation, used HAART scheme, time since HIV diagnosis, menopausal status, risk of depression, and presence of comorbidities were also assessed. Poisson generalized linear models with robust variance were performed in order to estimate crude prevalence ratios (PRs) and adjusted PRs using statistical (a1PR) and epidemiological criteria (a2PR). Results: A total of 19.9%, 32.6%, and 15.0% of all women presented mild, moderate, and severe menopausal symptoms, respectively. Overall, 70.6% women were non-adherent to HAART. The probability of non-adherence was higher in women with mild, moderate, and severe symptoms as compared to asymptomatic women in the non-adjusted model (PR: 1.79, 95% confidence interval [CI]: 1.39–2.29; PR: 1.76, 95% CI: 1.38–2.23; and PR: 2.07, 95% CI: 1.64–2.61, respectively) and the adjusted model. Conclusion: The severity of menopausal symptoms was associated with HAART non-adherence in HIV-infected middle-aged women.
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    • Metabolomic markers of antepartum depression and suicidal ideation

      Mitro, S.D. (Elsevier B.V., 2020-02-01)
      Background: Recent analyses have described metabolomic markers for depression and suicidal ideation in non-pregnant adults. We examined the metabolomic profile of antepartum depression and suicidal ideation during mid-pregnancy, a time of high susceptibility to mood disorders. Methods: We collected fasting blood from 100 pregnant Peruvian women and profiled 307 plasma metabolites using liquid chromatography-mass spectrometry. We used the Patient Health Questionnaire 9 to define antepartum depression (score ≥ 10) and suicidal ideation (having thoughts that you would be better off dead, or of hurting yourself). Logistic regression was used to calculate odds ratios (ORs). Results: Three triacylglycerol metabolites (C48:5 triacylglycerol [OR = =1.89; 95% confidence interval (CI): 1.14–3.14], C50:6 triacylglycerol [OR = =1.88; 95%CI: 1.13–3.14], C46:4 triacylglycerol [OR = =1.89; 95%CI: 1.11–3.21]) were associated with higher odds of antepartum depression and 4 metabolites (betaine [OR = =0.56; 95%CI:0.33–0.95], citrulline [OR = =0.58; 95%CI: 0.34–0.98], C5 carnitine [OR = =0.59; 95%CI: 0.36–0.99], C5:1 carnitine [OR = =0.59; 95%CI: 0.35–1.00]) with lower odds of antepartum depression. Twenty-six metabolites, including 5-hydroxytryptophan (OR = =0.52; 95%CI: 0.30–0.92), phenylalanine (OR = =0.41; 95%CI: 0.19–0.91), and betaine (OR = =0.53; 95%CI: 0.28–0.99) were associated with lower odds of suicidal ideation. Limitations: Our cross-sectional study could not determine whether metabolites prospectively predict outcomes. No metabolites remained significant after multiple testing correction; these novel findings should be replicated in a larger sample. Conclusions: Antepartum suicidal ideation metabolomic markers are similar to markers of depression among non-pregnant adults, and distinct from markers of antepartum depression. Findings suggest that mood disorder in pregnancy shares metabolomic similarities to mood disorder at other times and may further understanding of these conditions’ pathophysiology.
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    • Method of histopathology-ultrasound association as a pedagogical strategy for medical students in the identification of the halo sign

      Guillen Astete, Carlos Antonio; Salvador Saenz, Belén; Henriquez Camacho, César; Lores Seijas, Fernando (Elsevier Espana S.L.U, 2020-01-01)
      Introduction: There are no validated strategies in the teaching of ultrasound as a diagnostic tool in undergraduate medicine students. Given the role that ultrasound plays in the diagnostic capacity of any clinician is currently undeniable, a teaching method is proposed based on the demonstration of the association between the histopathology of a large vessel vasculitis and the characteristic ultrasound finding, known as the «halo sign». Methods: The teaching strategy was imparted by means of a 10-minute video presentation. Twenty-one final-year students from a single medical school participated in a concordance study and a validation test, identifying images corresponding to the halo sign in 120 different cases. The overall sensitivity, specificity and likelihood ratio of the students were also determined. Results: The overall concordance test had a kappa coefficient of 0.749 (SD: 0.11). The kappa concordance was 0.76 with dynamic images, and 0.84 with cross-sectional slices. The overall sensitivity was 89.7%, and the positive predictive value was 92.3%. The likelihood ratio achieved was 7.28. Conclusions: It has been shown that the application of this pedagogical method is useful in teaching the identification of an ultrasound sign to medical students. This study also suggests conditions that could be useful to improve between-observer agreement in both teaching scenarios and multiple observer scientific studies.
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    • Mieloma múltiple con osteoesclerosis difusa: reporte de caso

      Valdivieso Herrera, Marco Antonio Josué; Vargas Ruiz, Luis Oswaldo; Morales Luna, Domingo Antonio; Piscoya, Alejandro; del Carpio Jayo, Daniel Rubén; mvaldiviesoh@gmail.com (Elsevier B.V., 2016-06)
      The case is presented of a female patient with history of anaemia (haemoglobin 9 g/dL) of 4 years onset, who was referred to the Internal Medicine department complaining of fatigue, dyspnoea, and syncope. She also had a burning pain in the costal region radiating to dorsal and lumbar spine, and lower limbs, which persisted for more than 6 months. The laboratory results reported a haemoglobin value of 8.4 g / dL. There were also high levels of immunoglobulin A (2087). The serum protein electrophoresis revealed the presence of a monoclonal peak, with immunofixation showing the presence of Kappa type IgA. The histopathological examination of the bone marrow biopsy showed the presence of osteosclerosis and few plasma cells. Multiple myeloma was confirmed by CD 138 immunohistochemical staining. A review is presented on multiple myeloma, its clinical presentation, and differential diagnosis.
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