• Quantitative real-time polymerase chain reaction for enteropathogenic Escherichia coli: a tool for investigation of asymptomatic versus symptomatic infections

      Barletta, Francesca; Ochoa, Theresa J.; Mercado, Erik H.; Ruiz, Joaquim; Ecker, Lucie; Lopez, Giovanni; Mispireta, Monica; Gil, Ana I.; Lanata, Claudio F.; Cleary, Thomas G. (Oxford University Press, 2015-05-30)
      BACKGROUND: Enteropathogenic Escherichia coli (EPEC) strains are pediatric pathogens commonly isolated from both healthy and sick children with diarrhea in areas of endemicity. The aim of this study was to compare the bacterial load of EPEC isolated from stool samples from children with and without diarrhea to determine whether bacterial load might be a useful tool for further study of this phenomenon. METHODS: EPEC was detected by polymerase chain reaction (PCR) of colonies isolated on MacConkey plates from 53 diarrheal and 90 healthy children aged <2 years. DNA was isolated from stool samples by cetyltrimethylammonium bromide extraction. To standardize quantification by quantitative real-time PCR (qRT-PCR), the correlation between fluorescence threshold cycle and copy number of the intimin gene of EPEC E2348/69 was determined. RESULTS: The detection limit of qRT-PCR was 5 bacteria/mg stool. The geometric mean load in diarrhea was 299 bacteria/mg (95% confidence interval [CI], 77-1164 bacteria/mg), compared with 29 bacteria/mg (95% CI, 10-87 bacteria/mg) in control subjects (P = .016). Bacterial load was significantly higher in children with diarrhea than in control subjects among children <12 months of age (178 vs 5 bacteria/mg; P = .006) and among children with EPEC as the sole pathogen (463 vs 24 bacteria/mg; P = .006). CONCLUSIONS: EPEC load measured by qRT-PCR is higher in diarrheal than in healthy children. qRT-PCR may be useful to study the relationship between disease and colonization in settings of endemicity.
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    • ¿Quién puede ejercer la docencia en nuestras facultades de medicina?

      Herrera-Añazco, Percy; Valenzuela-Rodriguez, German; silamud@gmail.com (Colegio Médico del Perú (CMP), 2017-01)
      El número de médicos en el Perú no garantiza una cobertura adecuada a toda la población (1). La posibilidad de cubrir ésta demanda con la formación de más médicos es bienvenida; sin embargo, se ha cuestionado si este aumento va de la mano con una supervisión de la calidad de su enseñanza (2).
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    • Quimioterapia y alternativas en el cáncer terminal: Desafío pendiente para el Perú

      Arsentales Montalva, Valeria; Tenorio Guadalupe, María; Yonz Buendía, Yessabell; Pimentel Alvarez, Patricia; Fiestas Saldarriaga, Fabián; vale_wini293@hotmail.com (Universidad Nacional Mayor de San Marcos (UNMSM), 2016-06-24)
      Cartas al editor
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    • Quiste de colédoco en una lactante de tres meses de edad: diagnóstico prenatal y manejo quirúrgico

      Corrochano Fatule, Mariana; Llanos Rodriguez, Rodolfo; Garcia, Alcides; rodllanos@yahoo.com (Asociación Interciencia, 2014-11-03)
      El quiste de colédoco es una patología poco común, diagnosticada generalmente después del nacimiento; pero en los últimos tiempos el diagnóstico prenatal ha tomado mayor importancia, pues permite una intervención precoz y brinda un mejor pronóstico a los pacientes. Se presenta el caso de una lactante que fue diagnosticada mediante ecografía obstétrica, a las 21 semanas de vida intrauterina; confirmándose luego el diagnóstico por medio de resonancia magnética. La paciente fue operada a los tres meses de vida, realizándosele una quistectomía, colecistectomía y derivación biliodigestiva en Y de Roux, con evolución posoperatoria favorable.
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    • Radiographic and Clinical Brain Infarcts in Cardiac and Diagnostic Procedures: A Systematic Review and Meta-Analysis.

      Cho, Sung-Min; Deshpande, Abhishek; Pasupuleti, Vinay; Hernandez, Adrian V.; Uchino, Ken (American Heart Association, 2017-10)
      BACKGROUND AND PURPOSE: The incidence of periprocedural brain infarcts varies among cardiovascular procedures. In a systematic review, we compared the ratio of radiographic brain infarcts (RBI) to strokes and transient ischemic attacks across cardiac and vascular procedures. METHODS: We searched MEDLINE and 5 other databases for brain infarcts in aortic valve replacement, coronary artery bypass grafting, cardiac catheterization, and cerebral angiogram through September 2015. We followed the PRISMA (preferred reporting items for systematic reviews and meta-analyses) recommendations. We defined symptomatic rate ratio (RR) as ratio of stroke plus transient ischemic attack rate to RBI rate. RESULTS: Twenty-nine studies involving 2124 subjects met the inclusion criteria. In meta-analysis of aortic valve replacements with 494 people, 69.4% (95% confidence interval (CI), 57.6%-81.4%) had RBIs, whereas 3.6% (95% CI, 2.0%-5.2%) had clinical events (RR, 0.08; 95% CI, 0.05-0.12). Coronary artery bypass grafting among 204 patients had 27.4% (95% CI, 6.0%-48.8%) RBIs and 2.4% (95% CI, 0.3%-4.5%) clinical events (RR, 0.11; 95% CI, 0.05-0.26). Cardiac catheterization among 833 people had 8.0% (95% CI, 4.1%-12.0%) RBIs, and 0.6% (95% CI, 0.1%-1.1%) had clinical events (RR, 0.16; 95% CI, 0.08-0.31). Cerebral angiogram among 593 people had 12.8% (95% CI, 6.6-19.0) RBIs and 0.6% (95% CI, 0%-13%) clinical events (RR, 0.10; 95% CI, 0.04-0.27). The RR of all procedures was 0.10 (95% CI, 0.07-0.13) without differences in the RRs across procedures (P=0.29). CONCLUSIONS: One of 10 people with periprocedural RBIs during cardiac surgeries and invasive vascular diagnostic procedures resulted in strokes or transient ischemic attacks, which may serve as a potential surrogate marker of procedural proficiency and perhaps as a predictor of risk for periprocedural strokes.
    • Radiographic and symptomatic brain ischemia in CEA and CAS: A systematic review and meta-analysis

      Cho, Sung-Min; Deshpande, Abhishek; Pasupuleti, Vinay; Hernandez, Adrian V.; Uchino, Ken (American Academic of Neurology, 2017-10-11)
      OBJECTIVE: In a systematic review, we compared ratio of new periprocedural radiographic brain ischemia (RBI) to the number of strokes and TIAs among patients undergoing carotid endarterectomy (CEA) and carotid artery stenting (CAS). METHODS: We searched 5 databases for entries related to brain ischemia in CEA or CAS from inception through September 2015. We included articles with CEA or CAS and systematic performance of preprocedural and postprocedural brain MRI and reporting of RBI and stroke incidence. We calculated a symptomatic risk ratio of number of strokes and TIAs to RBI. Random effects models were used. RESULTS: Fifty-nine studies (5,431 participants) met the inclusion criteria. There were 22 cohorts in CEA, 34 in CAS with distal protection, 8 in CAS with proximal protection, 9 in CAS without protection, and 9 in CAS with unspecified devices. Overall, 30.7% (95% confidence interval [CI] 26.6%-34.7%) had RBI, while 3.2% (95% CI 2.6%-3.8%) had clinical strokes or TIAs, with a stroke and TIA to RBI weighted ratio of 0.18 (95% CI 0.15-0.22). CEA had lower incidence of RBI compared to CAS (13.0% vs 37.4%) and also lower number of strokes and TIAs (1.8% vs 4.1%). The stroke and TIA to RBI ratio did not differ across 5 different types of carotid interventions (p = 0.58). CONCLUSIONS: One in 5 persons with periprocedural radiographic brain ischemia during CEA and CAS had strokes and TIAs. The stable ratio of stroke and TIA to radiographic ischemia suggests that MRI ischemia could serve as a surrogate measure of periprocedural risk.
    • Re: "Mortality Attributed to COVID-19 in High-Altitude Populations" by Woolcott and Bergman

      Zubieta-Calleja, Gustavo; Merino-Luna, Alfredo; Zubieta-Deurioste, Natalia; Armijo-Subieta, N. Freddy; Soliz, Jorge; Arias-Reyes, Christian; Escalante-Kanashiro, Raffo; Carmona-Suazo, Jose Antonio; López-Bascope, Alberto; Calle-Aracena, Jose Manuel; Epstein, Murray; Maravi, Enrique (Mary Ann Liebert Inc., 2021-03-01)
      Carta al editor
      Acceso abierto
    • Re: Maud Rijnders, Ronald de Wit, Joost L. Boormans, Martijn P.J. Lolkema, Astrid A.M. van der Veldt. Systematic Review of Immune Checkpoint Inhibition in Urological Cancers. Eur Urol. 2017;72:411–23

      Martinez Merizalde Balarezo, Nelson; Monroe Rivera, Mark; Tejada, Romina A.; nelson.mmb1402@gmail.com (Elsevier B.V., 2018-03)
      “Cartas al editor”
      Acceso restringido temporalmente
    • Re: “Racial Differences in 20-Year Cardiovascular Mortality Risk Among Childhood and Young Adult Cancer Survivors” by Berkman et al. (J Adolesc Young Adult Oncol. 2017;6(3):414–21)

      Valiente, Daniela Fernanda; Coico, Rodrigo Alexander; Araujo-Castillo, Roger Vladimir; Department of Research, School of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.; Department of Research, School of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.; Department of Research, School of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima, Peru. (Mary Ann Liebert Inc., 2018-02)
      Carta al editor
    • Rectal Metastases from Breast Cancer. A Case Report

      Guzmán-Calderón, Edson; edson_guzman@hotmail.com (Humana Press Inc., 2016-05-06)
      Reporte de casos
    • Reducing salt in bread: a quasi-experimental feasibility study in a bakery in Lima, Peru

      Saavedra Garcia, Lorena; Sosa Zevallos, Vanessa; Diez Canseco, Francisco (The Nutrition Society, 2015-05-22)
      Objectives: To explore salt content in bread and to evaluate the feasibility of reducing salt contained in ‘pan francés’ bread. Design: The study had two phases. Phase 1, an exploratory phase, involved the estimation of salt contained in bread as well as a triangle taste test to establish the amount of salt to be reduced in ‘pan francés’ bread without detection by consumers. In Phase 2, a quasi-experimental, pre–post intervention study assessed the effects of the introduction of low-salt bread on bakery sales. Setting: A municipal bakery in Miraflores, Lima, Peru. Subjects: Sixty-five clients of the bakery in Phase 1 of the study; sales to usual costumers in Phase 2. Results: On average, there was 1·25 g of salt per 100 g of bread. Sixty-five consumers were enrolled in the triangle taste test: fifty-four (83·1 %) females, mean age 58·9 (SD 13·7) years. Based on taste, bread samples prepared with salt reductions of 10 % (P = 0·82) and 20 % (P =0·37) were not discernible from regular bread. The introduction of bread with 20 % of salt reduction, which contained 1 g of salt per 100 g of bread, did not change sales of ‘pan francés’ (P=0·70) or other types of bread (P =0·36). Results were consistent when using different statistical techniques. Conclusions: The introduction of bread with a 20 % reduction in salt is feasible without affecting taste or bakery sales. Results suggest that these interventions are easily implementable, with the potential to contribute to larger sodium reduction strategies impacting the population’s cardiovascular health.
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    • Reforma del sector salud en el Perú: Derecho, gobernanza, cobertura universal y respuesta contra riesgos sanitarios

      Velásquez, Aníbal; Suarez, Dalia; Nepo-Linares, Edgardo; galonepo@gmail.com (Instituto Nacional de Salud (INS), 2016-09)
      In 2013, Peru initiated a reform process under the premise of recognizing the nature of health as a right that must be protected by the state. This reform aimed to improve health conditions through the elimination or reduction of restrictions preventing the full exercise of this right, and the consequent approach aimed to protect both individual and public health and rights within a framework characterized by strengthened stewardship and governance, which would allow system conduction and effective responses to risks and emergencies. The reform led to an increase in population health insurance coverage from 64% to 73%, with universalization occurring through the SIS affiliation of every newborn with no other protection mechanism. Health financing increased by 75% from 2011, and the SIS budget tripled from 570 to 1,700 million soles. From 2012 to May 2016, 168 health facilities have become operational, 51 establishments are nearing completion, and 265 new projects are currently under technical file and work continuity with an implemented investment of more than 7 billion soles. Additionally, this reform led to the approval of the Ministry of Health intervention for health emergencies and strengthened the health authority of the ministry to implement responses in case of risks or service discontinuity resulting from a lack of regional or local government compliance with public health functions.
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    • Refractory Thrombocytopenia Responds to Octreotide Treatment in a Case of Evans Syndrome with Gastric Neuroendocrine Tumor

      Chung Delgado, Kocfa; Revilla Montag, Alejandro; Guillén Bravo, Sonia; Ríos Díaz, Hugo; Alva Muñoz, José C. (Hindawi Publishing Corporation, 2014-03-12)
      A 37-year-old woman with history of Evans Syndrome with poor response to high-dose corticoid treatment presented to the emergency department with gastrointestinal and vaginal bleeding. The patient was later diagnosed with severe thrombocytopenia and a stage G1, well-differentiated gastric neuroendocrine tumor, confirmed by a biopsy. A total gastrectomy was performed to eradicate the tumor. After being treated with a total splenectomy for her Evans Syndrome with no clinical or laboratory improvement, she began regular treatment with octreotide on the basis of a possible hepatic metastasis. Days after the initiation of the octreotide, an increase in the platelet count was evidenced by laboratory findings, from 2,000 platelets/mm3 to 109,000 platelets/mm3 . Weeks later, the hepatic metastasis is discarded by a negative octreotide-body scan, and the octreotide treatment was interrupted. Immediately after the drug interruption, a progressive and evident descent in the platelet count was evidenced (4000 platelets/mm3 ). The present case report highlights the possible association between octreotide treatment and a severe thrombocytopenia resistant to conventional treatment.
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    • Regarding: Should we operate for an intra-abdominal emergency in the setting of disseminated cancer?

      Gonzales, Juan A.; Urrunaga, Paula V.; Jauregui, Alfredo M.; Hernandez, Adrian V.; abrahamgonzales@hotmail.com (Elsevier B.V., 2016-03)
      Cartas al editor
      Acceso restringido temporalmente
    • Relationship between stunting in children 6 to 36 months of age and maternal employment status in Peru: A sub-analysis of the Peruvian Demographic and Health Survey

      Chávez-Zárate, Airin; Maguiña, Jorge L.; Quichiz-Lara, Antoinette Danciana; Zapata-Fajardo, Patricia Edith; Mayta-Tristán, Percy (Public Library of Science, 2019-04-01)
      Objectives This study aimed to determine the relationship between stunting in children 6 to 36 months old and maternal employment status in Peru. Methods A secondary data analysis was conducted using information from the Demographic and Health Survey (DHS) in Peru. We used a representative sample of 4637 mother-child binomials to determine the association between stunting in children 6 to 36 months of age and the employment status of their mothers. Results The prevalence of stunting among children was 15.9% (95% CI: 13.9–16.7). The prevalence of working mothers was 63.7%. No association was found between maternal employment status and the presence of stunting in children [prevalence ratio (PR) = 1.04; 95% confidence interval (95% CI): 0.9 to 1.2; p = 0.627). However, on multivariate analysis we found that the prevalence of stunting was significantly higher among children of mothers performing unpaid work (12.4%) (PR = 1.38; 95% CI: 1.2–1.6; p < 0.001) compared with those of paid working mothers. Conclusion No significant association was found between maternal employment status and the presence of stunting in children 6 to 36 months of age. However, children of mothers doing unpaid work are at higher risk of stunting. These findings support the implementation of educational programs and labour policies to reduce the prevalence of stunting among children.
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    • Religious affiliation and the intention to choose psychiatry as a specialty among physicians in training from 11 Latin American countries

      Calizaya-Gallegos, Carlo; Mayta-Tristan, Percy; Pereyra-Elías, Reneé; José Montenegro-Idrogo, Juan; Avila-Figueroa, Johana; Benítez-Ortega, Ingrid; Cabrera-Enriquez, John; Calixto, Omar-Javier; Pablo Cardozo-López, Juan; Grandez-Urbina, José Antonio; Moreno-Loaiza, Oscar; Rodriguez, Manuel A.; Sepúlveda-Morales, Roxana; Sierra-Avendaño, Jairo A.; Carreño, Fabian; Vásquez-García, Gelsing Richard; Vasquez-Sullca, Roy R.; Yescas, Gilberto; pmayta@cientifica.edu.pe (SAGE Publications Ltd, 2018)
      The worldwide scarcity of psychiatrists makes the identification of the factors associated with the intention to choose this specialty an important issue. This study aims to evaluate the association between religious affiliation and the intention to choose psychiatry as a specialty among medical students from 11 Latin American countries. We conducted a cross-sectional, multi-country study that included first- and fifth-year students of 63 medical schools in 11 Latin-American countries between 2011 and 2012. The main outcome and measures were the intention to pursue psychiatry as a specialty over other specialties (yes/no) and religious affiliation (without: atheist/agnostic; with: any religion). A total of 8308 participants were included; 53.6% were women, and the average age was 20.4 (SD = 2.9) years. About 36% were fifth-year students, and 11.8% were not affiliated with any religion. Only 2.6% had the intention to choose psychiatry; the highest proportion of students with the intention to choose psychiatry was among students in Chile (8.1%) and the lowest among students in Mexico (1.1%). After adjusting for demographic, family, academic as well as personal and professional projection variable, we found that those who had no religious affiliation were more likely to report the intention to become a psychiatrist [OR: 2.92 (95%CI: 2.14-4.00)]. There is a strong positive association between not having a religious affiliation and the intention to become a psychiatrist. The possible factors that influence this phenomenon must be evaluated in greater depth, ideally through longitudinal research.
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    • Rendimiento físico en adultos mayores de una comunidad rural altoandina peruana

      Estela Ayamamani, David Gerardo; Espinoza Figueroa, Jossué; Columbus Morales, Mauricio; Runzer Colmenares, Fernando (Instituto Nacional de Salud (INS), 2014-03-19)
      Cartas al editor
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    • Requerimiento de micronutrientes y oligoelementos

      Ciudad Reynaud, Antonio; antonio.ciudad@golfmedic.com.pe (Sociedad Peruana de Obstetricia y Ginecología - SPOG, 2014-08-04)
      A brief evidence-based account on the importance of micronutrients and oligoelements in the diet during pregnancy and post-partum is done. An integral approach on nutrition must be given to women during reproductive life as well as before pregnancy. Micronutrient deficiencies have been associated with fetal structural defects risks. Micronutrient supplementation during pregnancy has shown to be effective in the prevention of different health problems including low birth weight, small for gestational age, and birth defects including neural, cardiovascular, cleft palate and abnormalities of the urinary tract. There is no evidence of protection against genetic problems type Down syndrome, or in reduction of perinatal mortality.
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    • El requisito obligatorio del servicio social en salud del Perú: discriminatorio e inconstitucional

      Mayta-Tristan, Percy; Poterico, Julio A.; Galán Rodas, Edén; Raa Ortiz, Daniel (Instituto Nacional de Salud (INS), 2014-12-02)
      The rural and urban-edge health service (SERUMS) is an activity that only health professionals perform for the Peruvian government, as it is a mandatory requirement to qualify for a second specialty or to work in public hospitals and public health care facilities, and obtain government scholarships for future training. The few legal changes in the rules of this social program and the focus of “service” restricted to health professionals lead to a perception of this policy as discriminatory and unconstitutional because it violates the right to education and work. There is no scientific evidence that supports the usefulness and effectiveness of this program in terms of quality of service and health indicator improvement, as well as in adequate distribution and retention of health professionals. We suggest to abolish the compulsory requirement and to reformulate a political strategy to help attract and retain health professionals in vulnerable areas of Peru.
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    • Residentado Médico en el Perú: Una visión más allá de la demanda

      Herrera Añazco, Percy; silamud@gmail.com (Colegio Médico del Perú (CMP), 2014-08-12)
      Cartas al editor.
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