• 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.; [email protected] (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; [email protected] (Humana Press Inc., 2016-05-06)
      Reporte de casos
    • Recurrence of urinary tract infections due to escherichia coli and its association with antimicrobial resistance

      Ormeño, Maria Angeles; Ormeño, Maria José; Quispe, Antonio M.; Arias-Linares, Miguel Angel; Linares, Elba; Loza, Felix; Ruiz, Joaquim; Pons, Maria J. (Mary Ann Liebert Inc., 2022-02-01)
      We analyzed the association between antibiotic resistance and recurrent urinary tract infection (rUTI) by Escherichia coli. Susceptibility levels to 14 antimicrobial agents and the presence of extended-spectrum β-lactamases (ESBL) were established using MicroScan. Incidences of multidrug resistant (MDR), extensively drug resistant (XDR), and ESBL-producer isolates as well as rUTIs were estimated. The time to recurrence was established adjusted for number of antibiotic-resistant families and MDR as predictors of interest, respectively. Overall, 8,553 urinary tract infection (UTI) cases related to E. coli, including 963 rITU, were analyzed with levels of resistance >30% in all cases, except for amikacin, nitrofurantoin, and carbapenems. The incidence of rUTI was of 11.3%, being 46.5%, 24.3%, and 42.5% for MDR, XDR, and ESBLs, respectively. Bivariate analysis showed that rUTI was associated with age, gender, resistance to specific antimicrobials, MDR, and XDR. The number of antibiotic families tested as resistant, MDR, XDR, gender, and age were associated with time to recurrence when adjusted for number of antibiotic families, and MDR, gender, and age were related when adjusted for MDR. High rates of antibiotic resistance to the usual antibiotics was observed in E. coli causing UTI, with female sex, age, and antibiotic resistance being risk factors for the development of rUTI.
      Acceso restringido temporalmente
    • 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.
      Acceso abierto
    • Reforma del sector salud en el Perú: Derecho, gobernanza, cobertura universal y respuesta contra riesgos sanitarios

      Velásquez, Aníbal; Suarez, Dalia; Nepo-Linares, Edgardo; [email protected] (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.
      Acceso abierto
    • 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.
      Acceso abierto
    • 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.; [email protected] (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.
      Acceso abierto
    • 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; [email protected] (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
      Acceso abierto
    • Reply to “Conceptual interpretation and clinical applicability of A systematic review and meta-analysis about prognostic value of Apolipoproteins in COVID-19 patients”

      Ulloque-Badaracco, Juan R.; Hernandez-Bustamante, Enrique A.; Herrera-Añazco, Percy; Benites-Zapata, Vicente A. (Elsevier Inc., 2022-03-01)
      Carta al editor
      Acceso abierto
    • Requerimiento de micronutrientes y oligoelementos

      Ciudad Reynaud, Antonio; [email protected] (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.
      Acceso abierto
    • 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.
      Acceso abierto
    • Residentado Médico en el Perú: Una visión más allá de la demanda

      Herrera Añazco, Percy; [email protected] (Colegio Médico del Perú (CMP), 2014-08-12)
      Cartas al editor.
      Acceso abierto
    • Resilience mediates the relationship between household dysfunction in childhood and postpartum depression in adolescent mothers in Peru

      Carroll, Haley; Rondon, Marta B.; Sanchez, Sixto E.; Fricchione, Gregory L.; Williams, Michelle A.; Gelaye, Bizu (2021-01-01)
      Acceso abierto
    • Resistance to quinolones, cephalosporins and macrolides in Escherichia coli causing bacteraemia in Peruvian children

      Palma, Noemí; Pons, Maria J.; Gomes, Cláudia; Mateu, Judit; Riveros, Maribel; García, Wilfredo; Jacobs, Jan; García, Coralith; Ochoa, Theresa J.; Ruiz, Joaquim; [email protected] (Elsevier Ltd, 2017-12)
      Objectives To characterise the β-lactam, quinolone and macrolide resistance levels and mechanisms in 62 Escherichia coli isolates causing bacteraemia in Peruvian children. Methods Minimum inhibitory concentrations (MICs) of ciprofloxacin, nalidixic acid (NAL) and azithromycin were determined in the presence and absence of Phe-Arg-β-naphthylamide. Susceptibility to other 14 antimicrobial agents was also established. Extended-spectrum β-lactamases (ESBLs) were identified, and mutations in gyrA and parC as well as the presence of transferable mechanisms of quinolone resistance (TMQR) and macrolide resistance (TMMR) were determined. Results Fifty isolates (80.6%) were multidrug-resistant. High proportions of resistance to ampicillin (93.5%), NAL (66.1%) and trimethoprim/sulfamethoxazole (66.1%) were observed. No isolate showed resistance to carbapenems and only two isolates were resistant to nitrofurantoin. Twenty-seven isolates carried ESBL-encoding genes: 2 blaSHV-12; 13 blaCTX-M-15; 4 blaCTX-M-2; 6 blaCTX-M-65; and 2 non-identified ESBLs. Additionally, 27 blaTEM-1 and 9 blaOXA-1-like genes were detected. All quinolone-resistant isolates showed target mutations, whilst TMQR were present in four isolates. Efflux pumps played a role in constitutive NAL resistance. The association between quinolone resistance and ESBL production was significant (P = 0.0011). The mph(A) gene was the most frequent TMMR (16 isolates); msr(A) and erm(B) genes were also detected. Only one TMMR-carrying isolate [presenting mph(A) and erm(B) concomitantly] remained resistant to azithromycin when efflux pumps were inhibited. Conclusions A variety of ESBL-encoding genes and widespread of blaCTX-M-15 in Lima has been shown. The role of efflux pumps in azithromycin resistance needs to be further evaluated, as well as effective control of the use of antimicrobial agents. © 2017 International Society for Chemotherapy of Infection and Cancer