• Undergraduate publication in Latin America: role of Medical Students' Scientific Societies

      Pereyra Elías, Reneé; Rodriguez Morales, Alfonso.; Mayta-Tristan, Percy; p.mayta@gmail.com (Medical Teacher is published in collaboration with the Association for Medical Education in Europe (AMEE Read More: http://informahealthcare.com/journal/mte, 2014-11-17)
      Cartas el editor
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    • Understanding drivers of domestic public expenditure on reproductive, maternal, neonatal and child health in Peru at district level: an ecological study

      Huicho, Luis; Hernandez, Patricia; Huayanay-Espinoza, Carlos A.; Segura, Eddy R.; Niño de Guzman, Jessica; Flores-Cordova, Gianfranco; Rivera-Ch, Maria; Friedman, Howard S.; Berman, Peter; lhuicho@gmail.com; patricia.hernandez.consultancy@gmail.com; carlos.huayanay@upch.pe; eddysegura@gmail.com; jninodeguzman@mef.gob.pe; g.flores.cordova@gmail.com; maria.rivera.c@upch.pe; friedman@unfpa.org; pberman@hsph.harvard.edu (BioMed Central Ltd., 2018-11)
      Background: Peru has increased substantially its domestic public expenditure in maternal and child health. Peruvian departments are heterogeneous in contextual and geographic factors, underlining the importance of disaggregated expenditure analysis up to the district level. We aimed to assess possible district level factors influencing public expenditure on reproductive, maternal, neonatal and child health (RMNCH) in Peru. Methods: We performed an ecological study in 24 departments, with specific RMNCH expenditure indicators as outcomes, and covariates of different hierarchical dimensions as predictors. To account for the influence of variables included in the different dimensions over time and across departments, we chose a stepwise multilevel mixed-effects regression model, with department-year as the unit of analysis. Results: Public expenditure increased in all departments, particularly for maternal-neonatal and child health activities, with a different pace across departments. The multilevel analysis did not reveal consistently influential factors, except for previous year expenditure on reproductive and maternal-neonatal health. Our findings may be explained by a combination of inertial expenditure, a results-based budgeting approach to increase expenditure efficiency and effectiveness, and by a mixed-effects decentralization process. Sample size, interactions and collinearity cannot be ruled out completely. Conclusions: Public district-level RMNCH expenditure has increased remarkably in Peru. Evidence on underlying factors influencing such trends warrants further research, most likely through a combination of quantitative and qualitative approaches.
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    • Unexplained changes on a psychiatric pregnancy study.

      Chang-Cabanillas, Sergio; Alarcón-Guevara, Samuel; Peñafiel-Sam, Joshua; Tejada, Romina A; schangc94@gmail.com (Springer International Publishing, 2017-08)
      Cartas al Editor
    • Unidentified dengue serotypes in DENV positive samples and detection of other pathogens responsible for an acute febrile illness outbreak 2016 in Cajamarca, Peru

      Del Valle-Mendoza, Juana; Vasquez-Achaya, Fernando; Aguilar-luis, Miguel Angel; Martins-Luna, Johanna; Bazán-Mayra, Jorge; Zavaleta-Gavidia, Victor; Silva-Caso, Wilmer; Carrillo-Ng, Hugo; Tarazona-Castro, Yordi; Aquino-Ortega, Ronald; Del Valle, Luis J. (BioMed Central Ltd., 2020-10-06)
      Objective: To describe the prevalence of dengue virus serotypes, as well as other viral and bacterial pathogens that cause acute febrile illness during an outbreak in Cajamarca in 2016. Results: Dengue virus (DENV) was the most frequent etiologic agent detected in 25.8% of samples (32/124), followed by Rickettsia spp. in 8.1% (10/124), Zika virus in 4.8% (6/124), Chikungunya virus 2.4% (3/124) and Bartonella bacilliformis 1.6% (2/124) cases. No positive cases were detected of Oropouche virus and Leptospira spp. DENV serotypes identification was only achieved in 23% of the total positive for DENV, two samples for DENV-2 and four samples for DENV-4. During the 2016 outbreak in Cajamarca-Peru, it was observed that in a large percentage of positive samples for DENV, the infecting serotype could not be determined by conventional detection assays. This represents a problem for the national surveillance system and for public health due to its epidemiological and clinical implications. Other viral and bacterial pathogens responsible for acute febrile syndrome were less frequently identified.
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    • Up to 206 Million People Reached and Over 5.4 Million Trained in Cardiopulmonary Resuscitation Worldwide: The 2019 International Liaison Committee on Resuscitation World Restart a Heart Initiative

      Böttiger, Bernd W.; Lockey, Andrew; Aickin, Richard; Carmona, Maria; Cassan, Pascal; Castrén, Maaret; Chakra Rao, Ssc; De Caen, Allan; Escalante, Raffo; Georgiou, Marios; Hoover, Amber; Kern, Karl B.; Khan, Abdul Majeed S.; Levi, Cianna; Lim, Swee H.; Nadkarni, Vinay; Nakagawa, Naomi V.; Nation, Kevin; Neumar, Robert W.; Nolan, Jerry P.; Mellin-Olsen, Jannicke; Pagani, Jacopo; Sales, Monica; Semeraro, Federico; Stanton, David; Toporas, Cristina; van Grootven, Heleen; Wang, Tzong Luen; Wijesuriya, Nilmini; Wong, Gillian; Perkins, Gavin D. (NLM (Medline), 2020-08-04)
      Sudden out-of-hospital cardiac arrest is the third leading cause of death in industrialized nations. Many of these lives could be saved if bystander cardiopulmonary resuscitation rates were better. "All citizens of the world can save a life-CHECK-CALL-COMPRESS." With these words, the International Liaison Committee on Resuscitation launched the 2019 global "World Restart a Heart" initiative to increase public awareness and improve the rates of bystander cardiopulmonary resuscitation and overall survival for millions of victims of cardiac arrest globally. All participating organizations were asked to train and to report the numbers of people trained and reached. Overall, social media impact and awareness reached up to 206 million people, and >5.4 million people were trained in cardiopulmonary resuscitation worldwide in 2019. Tool kits and information packs were circulated to 194 countries worldwide. Our simple and unified global message, "CHECK-CALL-COMPRESS," will save hundreds of thousands of lives worldwide and will further enable many policy makers around the world to take immediate and sustainable action in this most important healthcare issue and initiative.
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    • Use of adaptive servo ventilation therapy as treatment of sleep-disordered breathing and heart failure: a systematic review and meta-analysis

      Hernandez, A.V. (Springer, 2020-03-01)
      Purpose: Adaptive servoventilation (ASV) has been reported to show improvement in patients with sleep-disordered breathing (SDB) and heart failure (HF); however, its role as a second-line or adjunctive treatment is not clear. We conducted a systematic review and meta-analysis of new existing data including cardiac mechanistic factor, geometry, and cardiac biomarkers. Methods: We systematically searched for randomized controlled trials (RCTs) and cohort studies that assessed the efficacy or effectiveness of ASV compared to conventional treatments for SDB and HF in five research databases from their inception to November 2018. Random-effects meta-analyses using the inverse variance method and stratified by study design were performed. Results: We included 15 RCTs (n = 859) and 5 cohorts (n = 162) that met our inclusion criteria. ASV significantly improved left ventricular ejection fraction (LVEF) in cohorts (MD 6.96%, 95% CI 2.58, 11.34, p = 0.002), but not in RCTs. Also, the ASV group had significantly lower apnea-hypopnea index (AHI) in both cohorts (MD − 26.02, 95% CI − 36.94, − 15.10, p < 0.00001) and RCTs (MD − 21.83, 95% CI − 28.17, − 15.49, p < 0.00001). ASV did not significantly decrease the E/e′ ratio in RCTs or in cohorts. Finally, ASV significantly decreased brain natriuretic peptide (BNP) in the cohorts (SMD − 121.99, CI 95% − 186.47, − 57.51, p = 0.0002) but not in RCTs. ASV did not have a significant effect on systolic blood pressure, diastolic blood pressure, and cardiac diameters. Conclusions: ASV therapy is associated with improvements of AHI in comparison to alternative treatments in patients with SDB and HF. ASV did not improve LVEF or E/e′ ratios in randomized trials; other intermediate outcomes did not improve significantly.
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    • The use of ustekinumab in refractory treatment of psoriatic arthritis

      Vega Villanueva, Karen; Cortez-Bazán, Nathaly; Alvarado-Molina, Angela (Brazilian Society of Rheumatology (BSR), 2014-03-26)
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    • Usefulness of cell-mediated immune function in risk stratification for patients with advanced heart failure

      Nagarajan, Vijaiganesh; Hernandez, Adrian V.; Cauthen, Clay A.; Starling, Randall C.; Tang, W. H. Wilson; tangw@ccf.org (Mosby Inc., 2017-01)
      Although heightened inflammation and autoimmune responses have been well described in patients with heart failure, the role of cell-mediated immune function in the pathogenesis and progression of heart failure is unclear. The aim of our study is to evaluate the prognostic role of cell-mediated immune function in patients with advanced heart failure. Methods We studied patients with advanced heart failure referred for evaluation of candidacy for advanced heart failure therapies between 2007 and 2010. Cell-mediated immune response was categorized into 3 groups—low or poor immune response (≤225 ng/mL), moderate or normal immune response (226-524 ng/mL), and strong immune response (≥525 ng/mL)—using a phytohemagglutinin-stimulated T-cell response assay. Results Out of 368 patients, 41 patients (11.1%) had poor immune function, 258 patients (70.1%) had normal immune function, and 69 patients (18.7%) had strong immune function. The primary outcome of all-cause mortality or cardiac transplantation occurred in 63.4%, 45.3%, and 34.8% in the poor immunity, normal immunity, and strong immune function groups, respectively. In univariate analysis, cell-mediated immune function was strongly associated with the primary outcome (P =.014). Poor immune function portended worse prognosis (hazard ratio = 2.18, 95% CI 1.01-4.70, P =.047), and strong immune function was associated with better survival (hazard ratio = 0.67, 95% CI 0.43-1.04). However, when adjusted for multiple variables in multivariate analysis, immune function status lost its overall significance to predict primary outcome (P = 0.11), but the direction to an increased risk of primary outcome was maintained in the poor immune function group. Conclusions Poor cell-mediated immune function measured by a clinically available assay could be associated with more adverse long-term prognosis in patients with advanced heart failure. © 2016 Elsevier Inc.
    • Usefulness of Neutrophil-to-Lymphocyte Ratio in Risk Stratification of Patients With Advanced Heart Failure

      Benítes-Zapata, Vicente A.; Hernández, Adrian V.; Nagarajan, Vijaiganesh; Cauthen, Clay A.; Starling, Randall C.; Tang, W.H. Wilson (Elsevier B.V., 2015-01-09)
      Elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in patients with acute heart failure (HF) and neoplastic diseases. We investigated the association between NLR and mortality or cardiac transplantation in a retrospective cohort of 527 patients presented to the Cleveland Clinic for evaluation of advanced HF therapy options from 2007 to 2010. Patients were divided according to low, intermediate, and high tertiles of NLR and were followed longitudinally for time to all-cause mortality or heart transplantation (primary outcome). The median NLR was 3.9 (interquartile range 2.5 to 6.5). In univariate analysis, intermediate and highest tertiles of NLR had a higher risk than the lowest tertile for the primary outcome and all-causes mortality. Compared with the lowest tertile, there was no difference in the risk of heart transplantation for intermediate and high tertiles. In multivariate analysis, compared with the lowest tertile, the intermediate and high NLR tertiles remained significantly associated with the primary outcome (hazard ratio [HR] [ 1.61, 95% confidence interval [CI] 1.10 to 2.37 and HR [ 1.55, 95% CI 1.02 to 2.36, respectively) and all-cause mortality (HR [ 1.83, 95% CI 1.07 to 3.14 and HR [ 2.16, 95% CI 1.21 to 3.83, respectively). In conclusion, elevated NLR is associated with increased mortality or heart transplantation risk in patients with advanced HF.
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    • Using the Patient Health Questionnaire (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS) to assess suicidal ideation among pregnant women in Lima, Peru.

      Zhong, Qiu-Yue; Gelaye, Bizu; Sánchez, Sixto E; Simon, Gregory E; Henderson, David C; Barrios, Yasmin V; Sánchez, Pedro Mascaro; Williams, Michelle A; Rondón, Marta B.; qiz304@mail.harvard.edu (Pubmed Central (PMC), 2015-12)
      We sought to examine the concordance of two suicidal ideation items from the Patient Health Questionnaire-9 (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS), to evaluate the prevalence of suicidal ideation among pregnant women, and to assess the co-occurrence of suicidal ideation with antepartum depressive symptoms. A cross-sectional study was conducted among 1,517 pregnant women attending prenatal care clinics in Lima, Peru. Item 9 of the PHQ-9 assesses suicidal ideation over the last 14 days while item 10 of the EPDS assesses suicidal ideation in the past 7 days. The two suicidal ideation items have a high concordance rate (84.2 %) but a moderate agreement (the Cohen's kappa = 0.42). Based on the PHQ-9 and the EPDS, 15.8 and 8.8 % of participants screened positive for suicidal ideation, respectively. Assessed by the PHQ-9, 51 % of participants with suicidal ideation had probable depression. In prenatal care clinics, screening for suicidal ideation is needed for women with and without depressive symptoms. Future studies are needed to identify additional predictors of antepartum suicidality, determine the appropriate duration of reporting period for suicidal ideation screening, and assess the percentage of individuals with positive responses to the two suicidal ideation items at high risk of planning and attempting suicide.
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    • Uso de cuestionarios de calidad de vida para la evaluación de pacientes sometidos a cirugía de catarata

      Luján Paredes, Silvio; Alburquerque, M.; Pizango, O.; si_lujan@yahoo.com (Elsevier B.V., 2014-11-03)
      Cartas al editor
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    • Uso de fuentes de información en médicos recién graduados de Lima

      R. Mejia, Christian; Caceres, Onice J.; Vera, Claudia A.; Nizama Vía, Ayar; Curioso, Walter H.; Mayta-Tristan, Percy (Instituto Nacional de Salud (INS), 2014-12-01)
      In order to determine the use of information sources by recently graduated physicians of Lima, Peru in 2011, a survey was conducted among graduated physicians at seven universities. They were asked about the use of search engines in the health area during their year of medical internship [last year of medical school]. Regular use was defined as the source being used once a week or daily. For 490 respondents, regularly used information sources were SciELO, accessed by 173 (36.4%); PubMed 165 (34.4%); HINARI 117 (25.5%); UpToDate 98 (22.3%); Cochrane Library 94 (20.6%); LILACS 91 (19.8%); a hospital institutional library 70 (15.0%); LIPECS 39 (8.7%); and Peru BVS 42 (9.3%). Only a minority regularly accessed information sources related to health. It is necessary to improve capacity in the efficient use of various resources of scientific information in a continuous way and that reaches students and health professionals.
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    • Uso de internet en pacientes diabéticos que buscan información sobre su enfermedad. Lima, Perú, 2014

      Cántaro, Katherine; Mayta-Tristan, Percy; pcnukcan@upc.edu.pe (Instituto Nacional de Salud (INS), 2016-03)
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    • Uso del team based learning para el aprendizaje de biología en estudiantes de medicina

      Denisse Champin; Huamán Mesías, Luis; Gavino Gutierrez, Arquímedes; denisse.champin@upc.edu.pe (Instituto Nacional de Salud (INS), 2014-09-29)
      Cartas al editor
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    • Uso do desfibrilador automático externo no ambiente pré-hospitalar peruano: melhorando a resposta a emergências na América Latina

      Lister, Pablo; Loret de Mola, Christian; Arroyo, Elena; Solórzano, José; Escalante Kanashiro, Raffo; Matos Iberico, Giuliana; raffo.escalante@gmail.com (Associação de Medicina Intensiva Brasileira - AMIB, 2014-08-12)
      Este relato de caso reporta o atendimento pré-hospitalar de um paciente com fatores de risco atendido pelo serviço pré-hospitalar ao ser acometido por uma parada cardíaca e apresentar fibrilação ventricular. O paciente foi atendido seguindo os padrões de suporte básico de vida e suporte cardiovascular avançado. Um desfibrilador automático externo (DAE) foi aplicado com resultados favoráveis e o paciente se recuperou do quadro de perigo de vida com sucesso. Este é o primeiro relato documentado com resultados favoráveis no Peru, na área de atendimento pré-hospitalar e enfatiza a necessidade de serem adotadas políticas de acesso público à desfibrilação precoce.
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    • Uso incorrecto de inhaladores de dosis medida en pacientes adultos de un hospital de Callao, Perú, 2014: estudio transversal

      Cayo Quiñe, Alexandra; Martínez-Vargas, Valeria; Bustamante-Voysest, Rossi (Medwave Estudios Limitada, 2015-10-14)
      INTRODUCCIÓN La terapia inhalatoria ha demostrado ser la más rápida y eficaz para el control del asma y la enfermedad pulmonar obstructiva crónica. El inhalador de dosis medida es el más usado por la población. El objetivo de este estudio es evidenciar la asociación entre la técnica inhalatoria incorrecta y la edad. MÉTODOS Estudio observacional, analítico, de corte transversal realizado en Perú durante 2014. Se incluyeron pacientes desde los 18 años que utilizaran inhalador de dosis medida. Se utilizó una lista de verificación de pasos establecidos por la Sociedad Española de Neumología y Cirugía Torácica y filmaciones para evaluar la técnica inhalatoria de los pacientes. Las variables principales fueron la edad y la mala técnica inhalatoria práctica. Para el análisis bivariado se utilizó la prueba Chi cuadrado y para el análisis multivariado regresión de Poisson con varianza robusta. RESULTADOS Se incluyeron 378 pacientes; 167 fueron mayores de 60 años. El estudio reveló que el 81,2% de la población presentó una incorrecta técnica inhalatoria. Se encontró asociación entre la edad y la técnica inhalatoria incorrecta (p=0,014) (PR 1,19 con IC 95% 1,03-1,37). El grupo etario con mayor frecuencia de técnica incorrecta fue el de adultos jóvenes (88%). CONCLUSIONES La frecuencia de uso incorrecto del inhalador en la población es alta y esta característica predomina en el grupo de adultos jóvenes. A pesar de no haber asociación entre la persona que enseña la técnica inhalatoria y el desempeño de la misma, se demostró que existe alta frecuencia de errores, incluso en aquellos pacientes instruidos por un médico especialista.
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    • Uterine or paracervical lidocaine application for pain control during intrauterine contraceptive device insertion: a meta-analysis of randomised controlled trials

      Perez-Lopez, Faustino R.; Martinez-Dominguez, Samuel J.; Perez-Roncero, Gonzalo R.; Hernandez, Adrian V.; faustino.perez@unizar.es (Taylor and Francis Ltd, 2018-05-04)
      Objective: Systematic review and meta-analysis to assess the effects of uterine or paracervical lidocaine application on pain control during IUD insertion. Methods: PubMed and five other electronic research databases were searched through 15 November 2017 for RCTs comparing lidocaine treatment vs. a control (placebo or no-intervention) to prevent pain during IUD insertion. Searched terms included ‘IUD insertion’, ‘lidocaine’ and ‘randomised controlled trial’. RCTs evaluating lidocaine treatment before IUD insertion without restriction of language, age and IUD type. Pain measured by visual pain scales at tenaculum placement, IUD insertion and immediate post-IUD insertion. Results of random effects meta-analyses were reported as mean differences (MDs) of visual pain scale (VPS) scores and their 95% confidence intervals (CIs). Results: Eleven RCTs (n = 1458 women) reporting paracervical lidocaine block or uterine mucosa lidocaine application before IUD insertion. Lidocaine produced lower VPS scores during tenaculum placement (MD −0.99, 95% CI: −1.73 to −0.26), IUD insertion (MD −1.26, 95% CI: −2.23 to −0.29) and immediate post-IUD insertion period (MD −1.25, 95% CI: −2.17 to −0.33). Conclusion: Lidocaine treatment was associated with modest reduction of pain during tenaculum placement and after IUD insertion.
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    • Utility of presepsin (sCD14-ST) as a diagnostic and prognostic marker of sepsis in the emergency department

      Carpio, Ricardo; Zapata, Juan; Spanuth, Eberhard; Hess, Georg (Elsevier B.V., 2015-09-08)
      Presepsin (PSEP) is released during infectious diseases and can be detected in the blood. PSEP has shown promising results as sepsis marker. We examined the diagnostic and prognostic validity of PSEP in patients suspicious of sepsis on admission in the emergency department (ED). Methods One hundred twenty three patients with signs of SIRS and/or sepsis and 123 healthy individuals were enrolled. PSEP was determined on admission, after 8, 24 and 72 h. Results Mean PSEP concentrations of the control group and the patient group were 130 and 1945 pg/ml. PSEP differed between SIRS, sepsis, severe sepsis and septic shock and showed strong association with 30-day mortality ranging from 10.3% in the 1st to 32.1% in the 4th quartile. The ROC curve analyses revealed an AUC value of 0.743. Combined assessment of PSEP and MEDS score increased the AUC up to 0.878 demonstrating the close relationship with outcome. Based on the PSEP values in the different severity degrees, decision thresholds for risk stratification were established. The course of PSEP during the first 72 h was associated with effectiveness of treatment and outcome. Conclusions PSEP allowed outcome prediction already on admission to a similar degree as the clinical scores MEDS and APACHE II. Combination of PSEP with MEDS score improved the discriminatory power for outcome prediction.
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    • Úlcera cecal única como presentación de enfermedad de Crohn

      Guzman Calderon, Edson; Montes Teves, Pedro (Sociedad de Gastroenterología del Perú (SGP), 2014-08-04)
      Crohn s Disease, is a rare inflammatory bowel disease in Perú. Incidence rates vary from 1,6 – 14,6 / 100 000 and prevalence rate is 140 / 100000 in the western hemisphere. We report a case of 52 y.o male patient from Callao Peru, with a colonoscopy image of a solitary cecal ulcer and without other gastrointestinal findings and a histology suggestive of Crohn s Disease with a ASCA positive and p –ANCA negative.
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    • Vaccination coverage and preventable diseases in Peru: Reflections on the first diphtheria case in two decades during the midst of COVID-19 pandemic

      Mezones-Holguin, Edward; Al-kassab-Córdova, Ali; Maguiña, Jorge L.; Rodriguez-Morales, Alfonso J. (Elsevier Inc., 2021-03-01)
      Carta al editor.
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