• 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.
      Acceso restringido temporalmente
    • Validación de una escala para evaluar contaminación de alimentos en el hogar, estudio en la zona rural de Perú

      Lozada Urbano, Michelle; Rivera, Roger; Miranda, Doris; Gallegos Vergara, Clara; Reyes Villegas, María Ysabel; Xirinachs Salazar, Yanira (iMedPub Journals, 2014-12-02)
      Objectives: To validate a scale to assess contamination of food at home and measure the validity and reliability. Methods: mothers or caregivers with children under 5 years were surveyed in San Juan de Lurigancho in Lima Peru. The scale was previously subject to a rating of expert judges. Factor analysis with principal components was performed; the internal consistency was measured with Kuder-Richardson Formula 20 (KR-20) and the validity of the test with the coefficient Kaiser-Meyer-Olkin (KMO) and the sphericity test Barlet. Results: The sample was 194 caregivers. Three components (Practices cleaning, storage practices and pollution of the child) with a total of 10 items were identified. The item Cleaning Practices had a KR-20 = 0.722 storage practices and food contamination 0.518 and 0.5 respectively. The validity of the test was KMO = 0.549 and 591,678. Barlet test, df = 136, (p <0.05). Conclusions: This scale can contribute to the planning of interventions in the aspect of pollution in the home and thus reduce episodes of infections in children.
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    • Validación de una escala para medir las Motivaciones para estudiar Medicina (MEM-12) en estudiantes Latinoamericanos

      Unknown author (iMedPub Journals, 2015-09-10)
      Introducción: Las motivaciones para estudiar la carrera de medicina podrían jugar un rol importante en el futuro desempeño de los profesionales. Objetivo: Validar una escala para evaluar las motivaciones para estudiar medicina en estudiantes de medicina latinoamericanos. Métodos: Estudio de corte transversal multicéntrico que incluyó a una muestra de estudiantes de 18 escuelas de medicina de ocho países hispanohablantes. A partir de un instrumento español y estudios cualitativos se generó una matriz inicial de 24 ítems con escala tipo-Likert, cuya compresión fue evaluada en un estudio piloto. Se efectuó un análisis factorial exploratorio (AFE), mediante el análisis de componentes principales con rotación oblicua oblimin y normalización de Kaiser, previa evaluación de la correlación ítem-test. La determinación estadística del número de dominios fue basada en el criterio de Kaiser, la pendiente de Catell y una varianza explicada mínima de 5%. La asignación de los ítems se basó en valores de carga superiores a 0,35. Se midió la consistencia interna con el alpha de Cronbach (α). Resultados: Se incluyó 435 participantes; 55% fueron varones y la media de la edad fue 21,7±2,7 años. Se excluyeron dos ítems debido a una baja correlación ítemtest. En el AFE, se identificaron cinco dominios iniciales; sin embargo, tres de ellos no contaban con una adecuada consistencia interna y su exclusión no afectaba a la consistencia interna global del cuestionario. Finalmente, fueron incluidos dos dominios de seis ítems cada uno: i) social/altruista (α=0,80) y ii) económico/ prestigio (α=0,71), presentaron los cuales explicaban en conjunto el 45,5% de la varianza y presentaron una adecuada consistencia interna global (α=0,74). Conclusiones: La escala generada (MEM-12) es válida y confiable, y está conformada por dos dominios, los cuales denotan aspectossociales y económicos. Se sugiere su uso en la valoración de las motivaciones en la elección de la carrera de medicina en Latinoamérica.
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    • Validity of the posttraumatic stress disorders (PTSD) checklist in pregnant women

      Gelaye, Bizu; Zheng, Yinnan; Medina-Mora, Maria Elena; Rondón, Marta B.; Sánchez, Sixto E.; Williams, Michelle A.; bgelaye@hsph.harvard.edu (Biomed Central Ltd, 2017-05-12)
      Abstract BACKGROUND: The PTSD Checklist-civilian (PCL-C) is one of the most commonly used self-report measures of PTSD symptoms, however, little is known about its validity when used in pregnancy. This study aims to evaluate the reliability and validity of the PCL-C as a screen for detecting PTSD symptoms among pregnant women. METHODS: A total of 3372 pregnant women who attended their first prenatal care visit in Lima, Peru participated in the study. We assessed the reliability of the PCL-C items using Cronbach's alpha. Criterion validity and performance characteristics of PCL-C were assessed against an independent, blinded Clinician-Administered PTSD Scale (CAPS) interview using measures of sensitivity, specificity and receiver operating characteristics (ROC) curves. We tested construct validity using exploratory and confirmatory factor analytic approaches. RESULTS: The reliability of the PCL-C was excellent (Cronbach's alpha =0.90). ROC analysis showed that a cut-off score of 26 offered optimal discriminatory power, with a sensitivity of 0.86 (95% CI: 0.78-0.92) and a specificity of 0.63 (95% CI: 0.62-0.65). The area under the ROC curve was 0.75 (95% CI: 0.71-0.78). A three-factor solution was extracted using exploratory factor analysis and was further complemented with three other models using confirmatory factor analysis (CFA). In a CFA, a three-factor model based on DSM-IV symptom structure had reasonable fit statistics with comparative fit index of 0.86 and root mean square error of approximation of 0.09. CONCLUSION: The Spanish-language version of the PCL-C may be used as a screening tool for pregnant women. The PCL-C has good reliability, criterion validity and factorial validity. The optimal cut-off score obtained by maximizing the sensitivity and specificity should be considered cautiously; women who screened positive may require further investigation to confirm PTSD diagnosis.
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    • Variación de la función visual y calidad de vida luego de cirugía de catarata por facoemulsificación con implante de lente intraocular

      Luján Paredes, Silvio; Pizango Malqui, Orion; Alburquerque Duglio, Miguel; Valenzuela Tito, Maruja; Mayta-Tristan, Percy; si_lujan@yahoo.com (Elsevier B.V., 2014-11-03)
      Objetivo Determinar la variación de la función visual y la calidad de vida en pacientes con cataratas antes y después de la facoemulsificación con colocación de LIO. Métodos Estudio longitudinal en pacientes mayores de 50 años, intervenidos de catarata con la cirugía de facoemulsificación con colocación de LIO. Se evaluó la variación de la función visual con el VFQ-25 y la calidad de vida con el QOL.Q antes de la intervención quirúrgica y luego de 3 meses. Resultados La edad media de los pacientes fue de 74 ± 7.4 años (55%), de los cuales 37.5% tuvieron una cirugía previa de cataratas. Se evidenció una variación favorable de la función visual en las subescalas de Salud general (p < 0.001), Visión general (p < 0.001), Visión de cerca (p < 0.001), Visión de lejos (p < 0.001), Limitaciones (p = 0.001) y Visión periférica (p < 0.001). La calidad de vida medida con el QOL.Q también presentó un cambio favorable, evidenciándose una diferencia significativa en la subescala de Satisfacción (p = 0.0001). La medida de la agudeza visual presentó un aumento favorable de la prequirúrgica a la posquirúrgica de 0.29 a 0.43 (p < 0.001). Conclusión Los pacientes presentaron respuesta favorable a la intervención tanto a nivel clínico, observando un incremento de la agudeza visual, como en la función visual y la calidad vida.
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    • Variación del estado nutricional durante el tratamiento antituberculoso en beneficiarios del programa PANTBC.

      Aparco, Juan Pablo; Huamán-Espino, Lucio; Segura, Eddy R. (Instituto Nacional de Salud (INS), 2014-03-20)
      Objectives. Analyze the nutritional changes among current and old beneficiaries of the Food and Nutrition Program for Outpatients with Tuberculosis and their Family (PANTBC, Spanish acronym). Materials and methods. A secondary analysis was conducted based on the anthropometric measurements with the body mass index (BMI) in current and old beneficiaries of the PANTBC program. The measurements were taken at the baseline, second and fifth or sixth month, and the distribution of the nutritional status was analyzed at baseline as compared to the endpoint (McNemar-Bowker test). Results. Information about 409 current beneficiaries and 110 old beneficiaries were included. A progressive decline in low weight as well as an increase in overweight were observed in both current and old beneficiaries (IMC<18.5). The results of the third measurement showed that 57.7% of current beneficiaries who started with low weight ended up with normal weight, while 20.7% of those who started with normal weight ended up with overweight. The analysis of the nutritional status at baseline compared to the endpoint showed changes in distribution (p<0.05). Conclusions. Across the PANTBC program, there is a variation of beneficiaries’ nutritional status, showing a tendency to go from a lower level to a higher level of BMI.
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    • Variations in cervico-vaginal microbiota among HPV-positive and HPV-negative asymptomatic women in Peru

      Carrillo-Ng, Hugo; Becerra-Goicochea, Lorena; Tarazona-Castro, Yordi; Pinillos-Vilca, Luis; Del Valle, Luis J.; Aguilar-Luis, Miguel Angel; Tinco-Valdez, Carmen; Silva-Caso, Wilmer; Martins-Luna, Johanna; Peña-Tuesta, Isaac; Aquino-Ortega, Ronald; del Valle-Mendoza, Juana (BioMed Central Ltd., 2021-12-01)
      Objective: To characterize the cervicovaginal microbiota of HPV-positive and HPV-negative asymptomatic Peruvian women, by identifying the presence of 13 representative bacteria genus. Results: A total of 100 HPV-positive and 100 HPV-negative women were matched by age for comparison of microbiota. The following bacteria were more frequently identified in HPV-positive patients compared to HPV-negative: Eubacterium (68 vs 32%), Actinobacteria (46 vs 33%), Fusobacterium (11 vs 6%) and Bacteroides (20 vs 13%). A comparison between high-risk and low-risk genotypes was performed and differences were found in the detection of Actinobacteria (50 vs 33.33%), Bifidobacterium (50 vs 20.83%) and Enterococcus (50 vs 29.17%).
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    • Vasoactive agents for the management of acute variceal bleeding: A systematic review and meta-analysis

      Huaringa-Marcelo, Jorge; Huaman, Mariella R.; Brañez-Condorena, Ana; Villacorta-Landeo, Pamela; Pinto-Ruiz, Diego F.; Urday-Ipanaqué, Diana; García-Gomero, David; Montes-Teves, Pedro; Miranda, Adelina Lozano (Romanian Society of Gastroenterology, 2021-01-01)
      Background & Aims: Vasoactive agents with endoscopic therapy are used to treat acute variceal bleeding (AVB). There are two main groups of vasoactive agents: terlipressin and vasopressin (T-V), and octreotide and somatostatin (O-S). However, the benefit/harm balance is unclear. Our aim was to assess the efficacy and safety of T-V versus O-S for the management of AVB. Methods: We performed a systematic search for randomized controlled trials (RCTs) in PubMed, Scopus, and CENTRAL. Our main outcomes were mortality and adverse events. Secondary outcomes were bleeding control, rebleeding, blood transfusion, hospital stay. We evaluated the certainty of evidence using GRADE methodology. Results: We included 21 RCTs. The risk of mortality (RR: 1.01; 95%CI: 0.83-1.22), bleeding control (RR: 0.96; 95%CI: 0.91-1.02; I2=53%), early rebleeding (RR: 0.91; 95%CI: 0.66-1.24: I2=0%), late rebleeding (RR: 0.94; 95 CI: 0.56-1.60; I2=0%), blood transfusion (MD: 0.04; 95%CI:-0.31-0.39; I2=68%) and hospital stay (MD:-1.06; 95%CI:-2.80-0.69; I2=0%) were similar between T-V and O-S groups. Only 15 studies reported adverse events, which were significantly higher in the T-V compared to the O-S group (RR 2.39; 95%CI: 1.58-3.63; I2=57%). The certainty of evidence was moderate for the main outcomes, and low or very low for others. Conclusions: In cirrhotic patients with AVB, those treated with T-V had similar mortality risk compared to O-S. However, the use of T-V showed an increased risk of adverse events compared to O-S.
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    • Videojuego Pueblo Pitanga en la lucha contra el dengue en Costa Rica

      Zamora, Antón; Galán Rodas, Edén; Ramírez, Eduardo; Rodríguez Morales, Alfonso J.; Mayta-Tristan, Percy (Instituto Nacional de Salud (INS), 2015-06-22)
      Cartas al editor
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    • Vigilancia epidemiológica de la Pertussis: la experiencia Argentina y su importancia para el resto de países de la región

      Bendezú Medina, Sandy; Pavic Espinoza, Ivana; Solari, Lely (Sociedad Argentina de Pediatría (SAP), 2015-01-26)
      Cartas al editor
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    • Violencia contra médicos: un problema por considerar en la investigación de recursos humanos en salud.

      Tuya-Figueroa, Ximena; Mezones-Holguín, Edward (Instituto Nacional de Salud (INS), 2014-03-21)
      Cartas al editor.
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    • Violencia laboral externa tipo amenaza contra médicos en servicios hospitalarios de Lima Metropolitana, Perú 2014

      Tuya-Figueroa, Ximena; Mezones-Holguín, Edward; Monge, Eduardo; Arones, Ricardo; Mier, Milagros; Saravia, Mercedes; Torres, José; Mayta-Tristan, Percy; emezones@gmail.com (Instituto Nacional de Salud (INS), 2016-12)
      Objetivos. Estimar la frecuencia y los factores asociados a la violencia laboral externa tipo amenaza (VLETA) contra médicos en servicios de salud hospitalarios de Lima Metropolitana, Perú. Materiales y Métodos. Se desarrolló un estudio transversal analítico que incluyó médicos del Ministerio de Salud (MINSA), la Seguridad Social (EsSalud) y el subsector privado. Se midió la frecuencia de VLETA durante toda la práctica profesional, en los últimos doce meses y en el último mes. Se midieron variables relacionadas al médico, al agresor y al servicio de salud. Se estimaron razones de prevalencia (RPs) cruda y ajustada mediante un modelo lineal generalizado familia Poisson con bootstrap no paramétrico. Resultados. Participaron 406 médicos. El 31,5% fueron víctimas de VLETA al menos una vez durante su práctica profesional; 19,9% en los últimos doces meses y 7,6% en el último mes. La probabilidad de ser amenazado en los últimos doce meses aumentó si el médico era varón (RPa:1,7;IC95%:1,1-2,8), egresado de una universidad peruana fuera de Lima Metropolitana (RPa:1,5; IC95%:1,1-2,4), laboraba en MINSA (RPa:7,9;IC95%:2,24-50,73) o en EsSalud (RPa:8,68; IC95%:2,26-56,17), y atendía en emergencia (RPa:1,9;IC95%:1,2-3,6) o en sala de operaciones (RPa:1,6 IC95%:1,1-2,3). La edad, los años de práctica profesional o ser médico residente no se asociaron a VLETA. Conclusiones. En los hospitales estudiados, una alta proporción de médicos ha sido víctima de VLETA. Laborar en servicios públicos aumenta dicha probabilidad. Se sugiere implementar estrategias de prevención primaria, identificación y soporte en los establecimientos hospitalarios.
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    • Von Hippel-Lindau disease with extramedullary and pancreatic involvement

      Pantigozo-Rimachi, Andrea; Murillo-Díaz, Giuliana; Carreazo, Nilton Yhuri; Cucho Dávila, Victor Manuel (Elsevier B.V., 2020-01-01)
      We report a patient with Von Hippel-Lindau disease who presented with an intradural extramedullary hemangioblastoma as a primary manifestation.
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    • Vulnerabilidad sísmica hospitalaria: experiencias del Hospital Regional de Ica a cuatro años del desastre.

      Pereyra Elías, Reneé; Elías-Barrera, Carmen Cecilia; Morales-Soto, Nelson (Instituto Nacional de Salud (INS), 2014-03-21)
      En este editorial se describe, inicialmente, un panorama general de los diversos aspectos que han llevado a un incremento en el gasto en salud en los países, con la consiguiente necesidad de priorización en la asignación presupuestaria a nivel sanitario. Igualmente, se presenta a las Evaluaciones Económicas en Salud (EES) como herramientas útiles en los procesos de toma de decisiones, haciendo hincapié en las principales dificultades que existen para lograr el desarrollo y aceptación de dichas evaluaciones. Al mismo tiempo, se da una mirada rápida a los modelos y opciones que proponen algunos paradigmas de la economía de la salud. De la misma forma, se puntualizan ciertas características actuales del sistema de salud peruano, así como acciones y sugerencias para implementar el uso de las EES en el sector. En último lugar, se presenta de modo sucinto el contenido del presente número.
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    • Wealth index and risk of childhood overweight and obesity: evidence from four prospective cohorts in Peru and Vietnam.

      Carrillo Larco, Rodrigo M.; Miranda, J Jaime; Bernabe-Ortiz, Antonio; jaime.miranda@upch.pe (Springer International Publishing, 2015-11-24)
      OBJECTIVES: To estimate the incidence and risk of childhood overweight and obesity according to socioeconomic status in Peruvian and Vietnamese school-aged children. METHODS: Longitudinal data from the Young Lives study were analyzed. Exposure was wealth index in tertiles. Outcome was overweight and obesity. Cumulative incidence per 100 children-years, relative risks (RR), and 95 % confidence intervals (95 % CI) were calculated. A hierarchical approach, including child- and family-related variables, was followed to construct multivariable models. RESULTS: The cumulative incidence of overweight and obesity was 4.8 (95 % CI 4.1-5.5) and 1.7 (95 % CI 1.3-2.2) in the younger and older Peruvian cohort, respectively; and in Vietnam 1.5 (95 % CI 1.2-1.8) and 0.3 (95 % CI 0.2-0.5), respectively. The incidence of overweight and obesity was higher at the top wealth index tertile in all samples. In the older cohorts, comparing highest versus bottom wealth index tertile, RR of overweight and obesity was four to nine times higher: 4.25 in Peru (95 % CI 2.21-8.18) and 9.11 in Vietnam (95 % CI 1.07-77.42). CONCLUSIONS: The results provide important information for childhood obesity prevention in countries moving ahead with economic, epidemiological and nutritional transitions.
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    • Weighing the evidence for suicide prevention

      Flores Cornejo, Fiorela; Kamego Tome, Mayumi; Zapata Pachas, Mariana A.; Alvarado, German F. (Associac¸a˜ o Brasileira de Psiquiatria, 2015-10-14)
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    • Weight variation over time and its relevance among multidrug-resistant tuberculosis patients

      Chung Delgado, Kocfa; Revilla Montag, Alejandro; Guillén Bravo, Sonia; Bernabe-Ortiz, Antonio (Elsevier B.V., 2014-09-15)
      Objectives: We aimed to assess the variation in patient body weight over time according to the treatment outcome among multidrug-resistant tuberculosis (MDR-TB) cases. Methods: This was a retrospective cohort study. The data of patients commencing MDR-TB therapy were analyzed. Data were collected from different public TB treatment facilities located in peri-urban areas to the south of Lima, Peru. The outcome was patient body weight (kilograms) from treatment commencement, measured monthly. A random effects model was fitted using robust standard errors to calculate 95% confidence intervals. Results: Of a total of 1242 TB cases, 243 (19.6%) were MDR-TB. Only 201 cases were included in the analysis; 127 (63.2%) were males and the mean patient age was 33.6 (standard deviation 16.2) years. Weight changes over time among the patients who were cured differed from changes in those who died during therapy (p < 0.001). Weight curve divergence was important at the end of the third, fourth, and fifth treatment months: on average, the weight difference was 2.18 kg (p < 0.001), 3.27 kg (p = 0.007), and 3.58 kg (p = 0.03), respectively, when cured patients were compared to those who died. Conclusions: Our results show that weight variation during treatment can be a useful surrogate for the treatment outcome, specifically death during therapy. MDR-TB patients with weight loss should be followed more closely, as they are at greater risk of death.
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    • Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One.

      Asher, M Innes; Stewart, Alistair W; Mallol, Javier; Montefort, Stephen; Lai, Christopher K W; Aït-Khaled, Nadia; Odhiambo, Joseph; Chiarella, Pascual; The ISAAC Phase One Study Group; mi.asher@auckland.ac.nz (2010-01-21)
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    • Whole genome analysis of extensively drug resistant Mycobacterium tuberculosis strains in Peru

      Santos-Lazaro, David; Gavilan, Ronnie G.; Solari, Lely; Vigo, Aiko N.; Puyen, Zully M. (Nature Research, 2021-12-01)
      Peru has the highest burden of multidrug-resistant tuberculosis in the Americas region. Since 1999, the annual number of extensively drug-resistant tuberculosis (XDR-TB) Peruvian cases has been increasing, becoming a public health challenge. The objective of this study was to perform genomic characterization of Mycobacterium tuberculosis strains obtained from Peruvian patients with XDR-TB diagnosed from 2011 to 2015 in Peru. Whole genome sequencing (WGS) was performed on 68 XDR-TB strains from different regions of Peru. 58 (85.3%) strains came from the most populated districts of Lima and Callao. Concerning the lineages, 62 (91.2%) strains belonged to the Euro-American Lineage, while the remaining 6 (8.8%) strains belonged to the East-Asian Lineage. Most strains (90%) had high-confidence resistance mutations according to pre-established WHO-confident grading system. Discordant results between microbiological and molecular methodologies were caused by mutations outside the hotspot regions analysed by commercial molecular assays (rpoB I491F and inhA S94A). Cluster analysis using a cut-off ≤ 10 SNPs revealed that only 23 (34%) strains evidenced recent transmission links. This study highlights the relevance and utility of WGS as a high-resolution approach to predict drug resistance, analyse transmission of strains between groups, and determine evolutionary patterns of circulating XDR-TB strains in the country.
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    • Zika virus is arriving at the American continent

      Levy Blitchtein, Saul; Del Valle Mendoza, Juana Mercedes; jdelvall@upc.edu.pe (Elsevier B.V., 2016-08)
      Cartas al editor
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