• Safety and efficacy of drug eluting stents vs bare metal stents in patients with atrial fibrillation: A systematic review and meta-analysis

      Sambola, Antonia; Rello, Pau; Soriano, Toni; Bhatt, Deepak L.; Pasupuleti, Vinay; Cannon, Christopher P.; Gibson, C. Michael; Dewilde, Willem J.M.; Lip, Gregory Y.H.; Peterson, Eric D.; Airaksinen, K. E.Juhani; Kiviniemi, Tuomas; Fauchier, Laurent; Räber, Lorenz; Ruiz-Nodar, Juan M.; Banach, Maciej; Bueno, Héctor; Hernandez, Adrian V. (Elsevier Ltd, 2020-11-01)
      Objective: A systematic review and meta-analysis was performed to evaluate the safety and efficacy of drug-eluting stents (DES) vs bare-metal stents (BMS) in atrial fibrillation (AF) patients. Methods: We systematically searched 5 engines until May 2019 for cohort studies and randomized controlled trials (RCTs). Primary outcomes were major bleeding and major adverse cardiac events (MACE) including cardiac death, myocardial infarction, target vessel revascularization (TVR) or stent thrombosis. Effects of inverse variance random meta-analyses were described with relative risks (RR) and their 95% confidence intervals (CI). We also stratified analyses by type (triple [TAT] vs dual [DAT]) and duration (short-vs long-term) of antithrombotic therapy. Results: Ten studies (3 RCTs; 7 cohorts) including 10,353 patients (DES: 59.6%) were identified. DES did not show higher risk of major bleeding than BMS (5.6% vs 6.9%, RR 1.07; 95%CI, 0.89–1.28, p = 0.47; I2 = 0%) or MACE (12% vs 13.6%; RR 0.96; 95%CI 0.81–1.13, p = 0.60; I2 = 44%). Although, DES almost decreased TVR risk (6.4% vs 8.4%, RR 0.78; 95%CI, 0.61–1.01, p = 0.06; I2 = 15%). Stratified analyses by type and duration of antithrombotic therapy showed no differences in major bleeding or MACE between both types of stents. In DES, long-term TAT showed higher major bleeding risk than long-term DAT (7.7% vs 4.7%, RR 1.48, 95%CI 1.08–2.03, p = 0.01; I2 = 12%). For both types of stents, MACE risk was similar between TAT and DAT. Conclusions: In patients with AF undergoing PCI, DES had similar rate of major bleeding and MACE than BMS. DAT seems to be a safer antithrombotic therapy compared with TAT.
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    • Safety and efficacy of PD-1/PD-L1 inhibitors in treatment naïve and chemotherapy refractory patients with Non-small cell lung cancer: a systematic review and meta-analysis

      Khunger, Monica; Jain, Prantesh; Rakshit, Sagar; Pasupuleti, Vinay; Hernandez, Adrian V.; Stevenson, James; Pennell, Nathan A.; Velcheti, Vamsidhar (Elsevier B.V., 2018-01)
      Introduction PD-1/PD-L1 inhibitors show significant clinical activity in non-small cell lung carcinoma (NSCLC). However, there is relative lack of data on comparative efficacy of these drugs in front-line setting versus chemotherapy-treated patients. We compared the efficacy and toxicity of these drugs in these two distinct groups of patients. Methods Electronic databases (PubMed-Medline, EMBASE, Scopus) and major conference proceedings were systematically searched for all phase I-III clinical trials in NSCLC using PD-1/PD-L1 inhibitors. Objective response rate (ORR) and progression free survival (PFS) data were collected and combined using DerSimonian and Laird random effects model meta-analysis. The I2 statistic was used to assess heterogeneity. Results Seventeen distinct trials (8 with treatment naïve patients [n = 937]; 14 with chemotherapy-treated patients [n = 3620]; 5 with separate treatment naïve and previously treated arms) were included. Treatment naïve patients had a statistically significant higher objective response rate (ORR 30.2% (95% CI 22.70-38.2) than previously chemotherapy treated patients (ORR 20.1% (95%CI 17.5-22.9; p=0.02). No significant differences in PFS were observed between the two groups. Treatment naive patients had statistically significant higher rates of all grade pneumonitis as compared to previously treated patients (4.9%, 95%CI 3.4-6.7 vs 3.0%, 95% CI 2.0-4.1, p=0.04); however, no significant differences in any other immune related adverse events were observed. Conclusions PD-1/PD-L1 inhibitor therapy for advanced NSCLC has a significantly higher objective response rate (ORR) and a higher rate of immune mediated pneumonitis when used in front-line setting as compared to chemotherapy treated patients.
    • Salud y calidad de vida en adultos mayores de un área rural y urbana del Perú

      Hernandez-Huayta, Jean; Chavez-Meneses, Sofía; Carreazo, Nilton Yhuri; jeanh1796@gmail.com (2016-12-13)
      urbana del Perú. Materiales y métodos. Estudio transversal en población adulta mayor de cuatro distritos rurales y uno urbano realizado entre octubre del año 2014 a enero de 2016. Se evaluó la asociación entre el área de residencia y cinco variables sociodemográficas mediante la prueba de chi cuadrado. Utilizando la prueba de suma de rangos de Wilcoxon y evaluando magnitud de efectos se midieron y compararon los puntajes por dimensiones obtenidos en los instrumentos WHOQOL-BREF y WHOQOL-OLD y el puntaje total de este último. Se realizó regresión lineal simple y múltiple para hallar los valores ajustados a las diferencias sociodemográficas. Resultados. Se encuestaron a 447 adultos mayores con una media de edad de 69 años (+ 6,46 años), 207 del área rural, los cuales, en su mayoría, trabajaban y tenían menos años de educación. La población adulta mayor del área rural tuvo mayor calidad de vida en las dimensiones “Física”, “Psicológico” y “Medioambiente” del WHOQoL-BREF y en “Habilidades sensoriales”, “Autonomía”, “Actividades del pasado, presente y futuro”, “Participación social” y en el puntaje total del WHOQoL-OLD; mientras que aquellos del área urbana sólo mostraron mayor calidad de vida en la dimensión “Intimidad”. Conclusiones. El área de residencia ejerce un efecto diferencial en las distintas dimensiones de la calidad de vida relacionada a salud de la población adulta mayor estudiada
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    • School Motivation Questionnaire for the Portuguese Population: Structure and Psychometric Studies.

      Gomes Cordeiro, Pedro Miguel; Couceiro Figueira, Ana Paula; Tomás da Silva, José; Matos, Lennia (Cambridge University Press, 2014-03-20)
      Se presenta la estructura y los estudios psicométricos del “Cuestionario de Motivación Escolar“. El CME es un cuestionario de auto informe con 101 ítems, organizados en dieciséis escalas que miden las orientaciones de las metas de los estudiantes, la percepción de las estructuras de las metas de clase, las percepciones del apoyo del profesor a la autonomía y el uso de estrategias de aprendizaje. Doce escalas son una adaptación del “Learning Climate Questionnaire”, “Perceptions of Instrumentality” y “Cuestionario a Estudiantes”. Cuatro escalas y cinco frases adicionales se crearon para este estudio. Los estudios psicométricos se basan en una muestra de conveniencia compuesta por estudiantes de los grados 9 y 12 (N = 485) de las escuelas portuguesas. La validez factorial y la construcción ha sido verificada a través de varios análisis factoriales exploratorios de los datos, y presenta una solución definitiva de seis factores, siendo Estrategias (F1), Metas extrínsecas de los docentes (F2), Metas extrínsecas de los estudiantes, reguladas externamente (F3), Metas intrínsecas de los docentes (F4), Metas extrínsecas de los estudiantes ,reguladas internamente (F5), y Metas intrínsecas de los estudiantes (F6). La solución de seis factores explica una variación significativa de los resultados de la escala (53,95%). Se encontraron buenos coeficientes de consistencia interna para todos los factores, nunca por debajo de (.858; F6). En suma, hay una fuerte evidencia para apoyar la multidimensionalidad del CME. Estos resultados son exploratorios y servirán como una base para estudios de validación posteriores.
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    • ¿Schwannoma gástrico de crecimientorápido o tumor del estromagastrointestinal?: presentación de casoclínico y revisión de la literatura

      Pinedo Pichilingue, Aranza; Quijano Ono, Javier (Elsevier B.V., 2015-04-09)
      Cartas al editor
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    • La seguridad del paciente: un componente de las políticas de salud que hay que fortalecer en América Latina

      Mondragón Cardona, Álvaro; Rojas Mirquez, Johana Carolina; Gómez Ossa, Ricardo; Rodríguez Morales, Alfonso J.; Mezones-Holguín, Edward (Organización Panamericana de la Salud (OMS), 2014-03-06)
      La identificación de eventos adversos es un componente de alta relevancia en salud. En América Latina y el Caribe, tal medición no siempre es tenida en cuenta pese a la considerable frecuencia con que tales eventos son reportados — esto sin contar la proporción de casos que no se consignan en los registros. Se estima que 10 de cada 100 pacientes hospitalizados han presentado efectos adversos alguna vez durante la hospitalización y se espera que la tasa aumente a 20 si se duplica el número de días hospitalizados. En el Estudio Iberoamericano de Efectos Adversos (IBEAS), el primer trabajo a gran escala en la región sobre incidentes que causan daño en la asistencia sanitaria, realizado en 58 hospitales de cinco países, la prevalencia estimada de efectos adversos fue de 10%, hallándose además que más de 28% de los efectos adversos desencadenaron discapacidad y 6%, muerte (1, 2).
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    • Seguridad hepática de maraviroc en pacientes coinfectados con VIH y hepatitis C y/o B

      Requena-Herrera, María P.; Bedoya-Ismodes, Enrique O.; Soto, Alonso (Elsevier Doyma, 2017-12)
      Cartas al Editor
    • Sentando las bases para la indización: cambios en las instrucciones para los autores de Acta Médica Peruana

      Zolezzi, Alberto; Mayta-Tristan, Percy (Colegio Médico del Perú (CMP), 2016-03)
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    • Separation, Aspiration, and Fat Equalization: SAFE Liposuction Concepts for Comprehensive Body Contouring

      Centurion, Patricio; Savitzky, Maria Jose; pccenturion@gmail.com (Lippincott Williams and Wilkins, 2017-07)
      Carta al Editor
    • Sera of Peruvians with fever of unknown origins include viral nucleic acids from non-vertebrate hosts.

      Phan, Tung Gia; Del Valle Mendoza, Juana Mercedes; Sadeghi, Mohammadreza; Altan, Eda; Deng, Xutao; Delwart, Eric (Springer International Publishing, 2017-10-17)
      Serum samples collected from 88 Peruvians with unexplained fever were analyzed for viral sequences using metagenomics. Nucleic acids of anelloviruses, pegivirus A (GBV-C), HIV, Dengue virus, and Oropouche virus were detected. We also characterized from two sera the RNA genomes of new species of partitivirus and dicistrovirus belonging to viral families known to infect fungi or arthropod, respectively. Genomic DNA of a putative fungal cellular host could be PCR amplified from the partitivirus-containing serum sample. The detection in human serum of nucleic acids from viral families not known to infect vertebrates may indicate contamination during sample collection and aliquoting or human infection by their presumed cellular host, here a fungus. The role, if any, of the non-vertebrate infecting viruses detected in serum in inducing fever is unknown.
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    • Seronegative disseminated Bartonella spp. infection in an immunocompromised patient

      Weilg,Claudia; Del Aguila ,Olguita; Mazulis,Fernando; Caso Wilmer,Silvia; Alva Urcia, Carlos Alberto; Cerpa Polar,Rosario; Mattos Villena ,Erick; Del Valle Mendoza ,Juana (Elsevier B.V., 2016-11)
      An 11 year old, hispanic girl with a history of B-cell acute lymphoblastic leukemia was admitted to the hospital for symptoms compatible with Bartonella henselae infection. The first molecularly diagnosed case of disseminated Bartonella henselae infection was reported in an immunocompromised patient in Lima, Peru. The analysis was confirmed by Polymerase Chain Reaction and automated sequencing of a liver biopsy sample, even though the serologic tests were negative. In conclusion, Bartonella spp. infection should have a particular diagnostic consideration in immunocompromised patients with fever of unknown origin and further investigation regarding the patient's past exposures with cats should also be elicited.
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    • Seropositividad a Helicobacter pylori y su relación con náusea y vómitos durante las primeras 20 semanas del embarazo

      Castillo Contreras, Ofelia; Maguiña Quispe, Jorge; Medina Morales, Bryan; Malaverry Lozano, Héctor (Sociedad Argentina de Gastroenterologia, 2017-12)
      There are studies that found a higher prevalence of antibodies against Helicobacter pylori (Hp) in patients with hyperemesis gravidarum, compared to asymptomatic pregnant women. Objective. To determine the relationship between seropositivity to Hp and the presence of nausea and vomiting during the first 20 weeks of gestation in pregnant women of a hospital network, from March to December 2015. Material and methods. Unmatched case-control studies in pregnant women until 20 weeks of gestation. The Rhodes’ index for nausea and vomiting classified pregnant women in cases (9-40 points) and controls (8 points). Hp seropositivity was defined as IgG ≥ 1.1 U/mL. The association between Hp and nausea and vomiting of pregnancy was determined by logistic regression analysis controlling for age, parity, gestational age and socioeconomic status. Results. A total of 108 patients were included, 21 controls and 87 cases. There were no significant differences in age (p = 0.916), parity (p = 0.18) and socioeconomic status (p = 0.36). Hp seropositivity in cases was 78.2% (68/87) and controls 61.9% (13/21). In the logistic regression analysis, cases had higher risk of Hp seropositivity than controls (OR = 3.05; 95% CI: 0.92-10.1; p = 0.068), but was not significant. Conclusions. Patients with nausea and vomiting in the first 20 weeks of gestation had a higher risk of having been exposed to Hp, although this relationship was not significant due to the small sample size.
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    • Serum brain-derived neurotrophic factor (BDNF) concentrations in pregnant women with post-traumatic stress disorder and comorbid depression

      Yang, Na; Gelaye, Bizu; Rondón, Marta B.; Sanchez, Sixto E.; Williams, Michelle A.; Zhong, Qiu-Yue; bgelaye@hsph.harvard.edu (Springer International Publishing, 2016-05-19)
      There is accumulating evidence for the role of brain-derived neurotrophic factor (BDNF) in the pathophysiology of depression. However, the role of BDNF in the pathophysiology of post-traumatic stress disorder (PTSD) remains controversial, and no study has assessed BDNF concentrations among pregnant women with PTSD. We examined early-pregnancy BDNF concentrations among women with PTSD with and without depression. A total of 2928 women attending prenatal care clinics in Lima, Peru, were recruited. Antepartum PTSD and depression were evaluated using PTSD Checklist—Civilian Version (PCL-C) and Patient Health Questionnaire-9 (PHQ-9) scales, respectively. BDNF concentrations were measured in a subset of the cohort (N = 944) using a competitive enzyme-linked immunosorbent assay (ELISA). Logistic regression procedures were used to estimate odds ratios (OR) and 95 % confidence intervals (95 % CI). Antepartum PTSD (37.4 %) and depression (27.6 %) were prevalent in this cohort of low-income pregnant Peruvian women. Approximately 19.9 % of participants had comorbid PTSD-depression. Median serum BDNF concentrations were lower among women with comorbid PTSD-depression as compared with women without either condition (median [interquartile range], 20.44 [16.97–24.30] vs. 21.35 [17.33–26.01] ng/ml; P = 0.06). Compared to the referent group (those without PTSD and depression), women with comorbid PTSD-depression were 1.52-fold more likely to have low (<25.38 ng/ml) BDNF concentrations (OR = 1.52; 95 % CI 1.00–2.31). We observed no evidence of reduced BDNF concentrations among women with isolated PTSD. BDNF concentrations in early pregnancy were only minimally and non-significantly reduced among women with antepartum PTSD. Reductions in BDNF concentrations were more pronounced among women with comorbid PTSD-depression.
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    • Serums y la migración de médicos: A propósito de una cohorte de médicos de Lima

      Mejía, Christian R.; Quiñones Laveriano, Dante M. (2015-07-31)
      Sr. Editor. En el último número de su revista se menciona que uno de los problemas del Servicio Rural y Urbano-Marginal en Salud (SERUMS), además de su inconstitucionalidad, es que no contribuye a la retención del personal de salud (1). Nosotros hicimos una cohorte conformada por 166 médicos egresados de las facultades de medicina de Lima Metropolitana, a los que les preguntamos su intención de trabajo en provincias antes y después de la realización del SERUMS.
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    • Servicio social en medicina en Latinoamérica: cobertura sin retención

      Flores Anaya, Lizeth; León Lozada, Cinthia; Mayta-Tristan, Percy; lizethmfa1991@hotmail.com (Instituto Nacional de Salud Pública, 2016-02)
      Cartas al editor
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    • Sexual Partnership-Level Correlates of Intimate Partner Violence Among Men Who Have Sex with Men and Transgender Women in Lima, Peru

      Passaro, R. Colby; Segura, Eddy R.; Gonzales-Saavedra, Williams; Lake, Jordan E.; Perez-Brumer, Amaya; Shoptaw, Steven; Dilley, James; Cabello, Robinson; Clark, Jesse L. (Springer, 2020-01-01)
      To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV prevention, MSM/TW completed a sociobehavioral survey addressing demographic characteristics, sexual risk behaviors, and substance use, and were tested for rectal gonorrhea and chlamydia, syphilis, and HIV. Generalized estimating equations estimated individual- and partner-level correlates of IPV. Of 576 participants (median age, 27 years), 7.9% (36/456) of MSM and 15.0% (18/120) of TW reported IPV with ≥ 1 of their last three partners. MSM/TW reporting IPV were more likely to meet criteria for an alcohol use disorder (74.1%) than participants reporting no IPV (56.7%; p <.01). Physical violence (4.5% MSM; 9.2% TW) was associated with stable partnerships (aPR 3.79, 95% CI 1.79–8.04), partner concurrency (4.42, 1.19–16.40), and participant alcohol (4.71, 1.82–12.17) or drug use (5.38, 2.22–13.02) prior to sex. Psychological violence (4.5% MSM; 5.0% TW) was associated with stable partnerships (2.84, 1.01–7.99). Sexual IPV was reported by 1.1% of MSM and 5.0% of TW. Physical, psychological, and sexual IPV were reported in sexual partnerships of Peruvian MSM and TW, particularly with stable partners and in conjunction with substance use.
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    • Short-scar facelift without temporal flap: a 10-year experience.

      Centurión, Patricio; Romero, Carolina; Olivencia, Claudia; Garcia, Ronald Gamarra; Pardo, Paul Kaufmann; pccenturion@gmail.com (Springer International Publishing, 2014-08)
      BACKGROUND: The understanding of facial anatomy and its changes through aging has led to the development of several different facelift techniques that focus on being less invasive and traumatic and, at the same time, providing natural long-lasting results. In this article we describe step by step our facelift technique as it has been done over the past 10 years by the senior author. METHODS: This is a retrospective, descriptive, transversal study in which all patients who underwent a rhytidectomy using our technique from January 2002 to September 2012 were included. All patients were operated on under local anesthesia and superficial conscious sedation. All surgeries were performed by the same surgeon. A complete step-by-step description of the surgical technique can be found in the main article. RESULTS: Between January 2002 and September 2012, a total of 113 patients underwent facelift surgery. Of these, 88.9 % were women and 11.1 % were men. The mean age was 55.3 (± 8.66) years. Primary surgeries represented 80.3 % (n = 94), secondary 18.8 % (n = 22), and tertiary 0.85 % (n = 1). Only one major complication, representing 0.8 %, consisting of a right-sided temporal paresis with 2 months complete recovery was seen. The minor complications rate was 23.1 %. The most common minor complication was hypertrophic/keloid scars which made up 77.8 % of all minor complications. CONCLUSIONS: The technique described provides good and long-lasting aesthetic results with shorter scars, smaller areas of dissection (without temporal and postauricular flaps), and a shorter recovery period. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
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    • A silent public health threat: emergence of Mayaro virus and co-infection with Dengue in Peru

      Aguilar-Luis, Miguel Angel; del Valle-Mendoza, Juana; Sandoval, Isabel; Silva-Caso, Wilmer; Mazulis, Fernando; Carrillo-Ng, Hugo; Tarazona-Castro, Yordi; Martins-Luna, Johanna; Aquino-Ortega, Ronald; Peña-Tuesta, Isaac; Cornejo-Tapia, Angela; Del Valle, Luis J. (BioMed Central Ltd., 2021-12-01)
      Objective: To describe frequency and clinical characteristics of MAYV infection in Piura, as well as the association of this pathogen with DENV. Results: A total of 86/496 (17.3%) cases of MAYV were detected, of which 54 were MAYV mono-infection and 32 were co-infection with DENV, accounting for 10.9% and 6.4%, respectively. When evaluating monoinfection by MAYV the main groups were 18–39 and 40–59 years old, with 25.9% and 20.4% respectively. Co-infections were more common in the age group 18–39 and those > 60 years old, with 34.4% and 21.9%, respectively. The most frequent clinical presentation were headaches (94.4%, 51/54) followed by arthralgias (77.8%, 42/54). During the 8-month study period the most cases were identified in the months of May (29.1%) and June (50.0%).
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    • Situación epidemiológica de la pancreatitis aguda en Latinoamérica y alcances sobre el diagnóstico

      Valdivieso Herrera, Marco Antonio Josué; Vargas Ruiz, Luis Oswaldo; Arana Chiang, Alejandra Rosa; Piscoya, Alejandro (Sociedad Argentina de Gastoenterología, 2016-05)
      Cartas al editor
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    • Situs inversus totalis

      Navarro, Veronica; Oshiro, Harumi; Peña, Bruce; Moquillaza Pineda, Fernando (Sociedad de Gastroenterología del Perú, 2014-07-03)
      Situs inversus totalis (SIT) is a rare disease in which there is transposition of thoracic and abdominal organs. The symptoms of appendicitis in SIT are often confused with other intraperitoneal processes such as diverticulitis. We report the case of a 65-year-old, attended by emergency epigastric pain of 20 hours of the onset after a few hours left iliac fosse migrates associated with hyporexia. Diverticulitis is diagnosed in the first instance, and after the respective imaging tests is discarded for being relevant findings with situs inversus totalis and left poses appendicitis. Therefore, the realization of an adequate medical history and physical examination supported by imaging tests are important to keep in mind, appendicitis as part of the differential diagnosis, in order to avoid errors in diagnosis and treatment..
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