• Fibromyalgia Among Patients With Chronic Migraine and Chronic Tension-Type Headache: A Multicenter Prospective Cross-Sectional Study: A Comment

      Leiva-Calderón, Alvaro; Mayorga-Moreno, Renzo J.; Escuela de Medicina; Universidad Peruana de Ciencias Aplicadas; Lima Peru; Escuela de Medicina; Universidad Peruana de Ciencias Aplicadas; Lima Peru (Wiley Publishing Asia Pty Ltd, 2018-02)
      Cartas al editor
    • First report of a primitive neuroectodermal tumor of the bladder in a newborn

      Orbegoso-Celis, L.; Bernuy-Guerrero, R.; Imán-Izquierdo, F.; Alfaro-Lujan, L.; Barreto Espinoza, L.; Silva-Caso, W. (Elsevier Inc., 2021-01-01)
      Primitive neuroectodermal tumor (PNET) is part of the Ewing sarcoma family of tumors. The present case reports a primitive neuroectodermal tumor (PNET) of rare location in the bladder in a newborn. It was evaluated with prenatal ultrasound and postnatal tomography that revealed a mass in the posterior wall of the bladder. The patient underwent partial cystectomy with subsequent analysis of the surgical piece removed, the histopathological study indicated a tumor of mesenchymal origin, and immunohistochemical staining confirmed the diagnosis of PNET of the bladder. Satisfactory result and short-term follow-up.
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    • First report of Myroides phaeus bacteraemia identified by Polymerase chain reaction and genetic sequencing

      Pérez-Lazo, G.; Morales-Moreno, A.; Soto-Febres, F.; Jove-Químper, H.; Morales-Castillo, L.; Palomares-Reyes, C.; Del Valle-Mendoza, J.; Aguilar-Luis, M.; Silva-Caso, W. (lsevier Ltd, 2020-01-01)
      We report the first case of Myroides phaeus isolated from blood, causing bacteremia in an immunocompromised patient using the automated MicroScan Walk Away 96 system, followed by bacterial identification by amplification-sequencing of the 16S rDNA. The sequences obtained were compared with the reference sequence of the BLAST ® platform - National Library of Medicine, USA, and the isolation was identified as Myroides phaeus strain with 99.67 % identity in Blast report. In the literature we did not find previous reported cases of infections by this bacterium, however its pathogenic role is still controversial; therefore, this isolation alerts us to carry out an exhaustive surveillance of other possible acquisition routes.
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    • Forest Plots: Linear or Logarithmic Scale?

      Cruz-Retamozo, Ximena; Prado-Ghezzi, Daniela; Pereyra-Elías, Reneé (Elsevier B.V., 2017-11)
      Cartas al Editor
    • Formación de especialistas en gastroenterología: nuevas oportunidades

      Piscoya, Alejandro (Sociedad de Gastroenterología del Perú (SGP), 2017-06)
      En los últimos años hemos tenido grandes cambios en la enseñanza de la Gastroenterología, desde la salida pasando por el sistema inglés en 1994 que inicialmente se dedicaba sólo al entrenamiento y que en los últimos años se ha convertido en un sistema nacional de entrenamiento y acreditación, el JAG (Joint Advisory Group on GI Endoscopy) (1) y su rama JETS (JAG Endoscopy Training System) (2), aparecieron en el 2012 el "Blue Book" europeo (3) y los estándares generales para la especialización en Estados Unidos, el nuevo sistema de acreditación (NAS), que generó "Milestones" basado en competencias del sistema nacional de acreditación (ACGME) (4) que a su vez se tradujeron en actividades profesionales confiables para cada especialidad, en el caso de Gastroenterología se creó el Oversight Working Network (OWN) que es un esfuerzo conjunto de cinco sociedades, AGA Institute, American Association for the Study of Liver Diseases (AASLD), American College of Gastroenterology (ACG), American Neurogastroenterology and Motility Society (ANMS) y American Society for Gastrointestinal Endoscopy (ASGE), con apoyo de North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) (5) cuyo White Paper fue publicado en 2014 (6).
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    • Formación del estudiante de medicina en salud pública y atención primaria de la salud, una experiencia en el Perú

      Champin, Denisse; Risco de Domínguez, Graciela (Instituto Nacional de Salud (INS), 2014-01-13)
      Cartas al editor
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    • Formación profesional por competencias en terapia física. Aplicación real en la Universidad Peruana de Ciencias Aplicadas.

      Becerra Bravo, Giancarlo; Zuzunaga-Infantes, Flor (Fundación Educación Médica, 2014-03-20)
      Cartas al editor.
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    • Frequency and coinfection between genotypes of human papillomavirus in a population of asymptomatic women in northern Peru

      Ponce-Benavente, Luis; Rejas-Pinelo, Patricia; Palomares-Reyes, Carlos; Becerra-Goicochea, Lorena; Pinillos-Vilca, Luis; Silva-Caso, Wilmer; Costa, Luis E.; Weilg, Pablo; Alvitrez-Arana, Juan; Bazán-Mayra, Jorge; del Valle-Mendoza, Juana; Aguilar-Luis, Miguel Angel; juana.delvalle@upc.pe (BioMed Central Ltd., 2018-07)
      Objective: Describe the prevalence of HPV genotypes via PCR and DNA sequencing in 397 women who attended to the gynecological outpatient center in the Hospital Regional Docente de Cajamarca from March to September 2017. Results: A positive PCR result for HPV was observed in 121 cervical samples. A high-risk genotype was found in 63.6% (77/121) of patients, a probably oncogenic type in 23.1% (28/121) and a low-risk type in 7.4%. Among the high-risk genotypes, HPV-31 was the most common one present in 20% (21/77), followed by HPV-16 in 11.4% (12/77). Coinfections between two or more genotypes were observed in 12 cases.
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    • Fruits and vegetables consumption and depressive symptoms: A population-based study in Peru

      Wolniczak, Isabella; Cáceres-DelAguila, José A.; Maguiña, Jorge L.; Bernabe-Ortiz, Antonio; antonio.bernabe@upch.pe (Public Library of Science, 2017-10-12)
      Objectives: Among different factors, diet patterns seem to be related to depression. The aim of this study was to evaluate the association between the consumption of fruits and/or vegetables and depressive symptoms. Methodology/Principal findings: A secondary data analysis was conducted using information from a population-based survey from 25 regions from Peru. The outcome was the presence of depressive symptoms according to the Patient Health Questionnaire (cutoff 15 to define major depressive syndrome); whereas the exposure was the self-reported consumption of fruits and/or vegetables (in tertiles and using WHO recommendation 5 servings/day). The association of interest was evaluated using Poisson regression models controlling for the complex-sample survey design and potential confounders. Data from 25,901 participants were analyzed, mean age 44.2 (SD: 17.7) and 13,944 (54.0%) women. Only 910 (3.8%; 95%CI: 3.5%–4.2%) individuals reported consuming 5 servings of fruits and/or vegetables/day; whereas 819 (2.8%; 95%CI: 2.5%–3.1%) had depressive symptoms. Those in the lowest tertile of fruits and/or vegetables consumption had greater prevalence of depressive symptoms (PR = 1.88; 95% CI: 1.39–2.55) than those in the highest tertile. This association was stronger with fruits (PR = 1.92; 95%CI: 1.46–2.53) than vegetables (PR = 1.42; 95%CI: 1.05–1.93) alone. Conclusions: An inverse relationship between consumption of fruits and/or vegetables and depressive symptoms is reported. Less than 5% of subjects reported consuming the amount of fruits and vegetables recommended by the WHO. There is a need to implement strategies to promote better diet patterns with potential impact on mental health. © 2017 Wolniczak et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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    • Fulminant Puerperal Sepsis caused by Hemolytic Group A Streptococci and Toxic Shock Syndrome – A Case Report and Review of the Literature

      Bauerschmitz, G.; Hellriegel, M.; Strauchmann, J.; Schäper, J.; Emons, G.; Frauenklinik, UMG, Göttingen; Frauenklinik, UMG, Göttingen; Zentrum für Anästhesie, UMG, Göttingen; Zentrum für Anästhesie, UMG, Göttingen; Frauenklinik, UMG, Göttingen (2014-09-03)
      Summary Puerperal sepsis is a rare but serious and potentially lethal syndrome. It is imperative that severe postpartum malaise is taken seriously; early initiation of antibiotic therapy before sepsis becomes manifest can save lives.
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    • Gait speed and the appearance of neurocognitive disorders in older adults: Results of a Peruvian cohort

      Parodi, José F; Nieto-Gutierrez, Wendy; Tellez, Walter A; Ventocilla-Gonzales, Iris; Runzer-Colmenares, Fernando M; Taype-Rondan, Alvaro (Elsevier España, 2017-09-07)
      Introducción La prevención y el manejo de los trastornos neurocognitivos (TNC) en adultos mayores puede mejorar si se identifica tempranamente sus factores de riesgo, como la velocidad de marcha. El objetivo del estudio es evaluar la asociación entre velocidad de la marcha y el desarrollo de TNC en una población de adultos mayores del Perú. Material y métodos Cohorte realizada en adultos mayores que acudieron al servicio de geriatría del Centro Médico Naval (Callao, Perú). Se registró la velocidad de la marcha de los participantes durante la evaluación basal, sometiéndoles a seguimiento anualmente hasta 60 meses, con un promedio de 21 meses. El desarrollo de TNC fue definido como la ocurrencia de una puntuación≤24 puntos en el Mini Mental State Examination (test de cribado) durante el seguimiento. Se hallaron hazard ratio (HR) y sus intervalos de confianza al 95% (IC 95%) usando regresiones de Cox. Resultados Se incluyeron 657 adultos mayores, con edad promedio de 73,4±9,2 (DE) años, de los cuales el 47,0% fueron varones. El 47,8% reportaron una velocidad de marcha <0,8 m/s, y el 20,1% desarrollaron TNC durante el seguimiento. Se encontró que los adultos mayores con una velocidad de marcha <0,8 m/s en la evaluación basal tuvieron más probabilidades de desarrollar TNC que aquellos con una velocidad de marcha ≥0,8 m/s (HR ajustada=1,41; IC 95%=1,34-1,47). Conclusión Encontramos asociación entre la velocidad de marcha disminuida y el desarrollo de TNC, lo cual sugeriría que la velocidad de marcha podría ser útil para identificar pacientes en riesgo para tal trastorno. Abstract Introduction The prevention and management of neurocognitive disorders (NCD) among older adults can be improved by early identification of risk factors such as walking speed. The objective of the study is to assess the association between gait speed and NCD onset in a population of Peruvian older adults. Material and methods Cohort conducted in older adults who attended the geriatrics service of Naval Medical Center (Callao, Peru). During the baseline assessment, participants’ gait speed was recorded. Subsequently, participants were followed-up annually for 5 years, with a mean of 21 months. NCD onset was defined as the occurrence of a score ≤24 points on the Mini Mental State Examination (screening test) during follow-up. The hazard ratios (HR) and their 95% confidence intervals (95% CI) were calculated using Cox regression. Results The study included 657 participants, with a mean age of 73.4±9.2 (SD) years, of whom 47.0% were male, 47.8% had a gait speed <0.8 m/s, and 20.1% developed NCD during the follow up. It was found that older adults who had gait speed <0.8 m/s at baseline were more likely to develop NCD than those who had a gait speed ≥0.8 m/s (adjusted HR=1.41, 95% CI=1.34-1.47). Conclusion A longitudinal association was found between decreased gait speed and NCD onset, suggesting that gait speed could be useful to identify patients at risk of NCD onset.
    • Gender Associated with the Intention to Choose a Medical Specialty in Medical Students: A Cross-Sectional Study in 11 Countries in Latin America

      Ng-Sueng, Luis Fernando; Vargas Matos, Iván; Mayta-Tristan, Percy; Pereyra Elías, Reneé; Montenegro Idrogo, Juan José; Inga Berrospi, Fiorella; Ancalli, Felix; Bonilla Escobar, Francisco; Diaz Velez, Cristian; Gutierrez Quezada, Erick; Gomez Alhach, Jennifer; Muñoz Medina, Carlos E.; Sanchez Pozo, Adriana; Vidal, Milisen; percy.mayta@upc.edu.pe (2016-08-12)
      The selection of a medical specialty has been associated with multiple factors, such as personal preferences, academic exposure, motivational factors and sociodemographic factors, such as gender. The number of women in the medical field has increased in recent years. In Latin America, we have not found any studies that explore this relationship.Secondary analysis of the Collaborative Working Group for the Research of Human Resources for Health (Red-LIRHUS) data; a multi-country project of students in their first year and fifth year of study, from 63 medical schools in 11 Latin American countries. All students who referred intention to choose a certain medical specialty were considered as participants.There is an association between the female gender and the intention to choose Obstetrics/ Gynecology, Pediatrics, Pediatric Surgery, Dermatology, and Oncology. We recommend conducting studies that consider other factors that can influence the choice of a medical specialty.
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    • Genetic diversity of locus of enterocyte effacement genes of enteropathogenic Escherichia coli isolated from Peruvian children.

      Contreras, C. A.; Ochoa, T. J.; Ruiz, J.; Lacher, D. W.; Durand, D.; DebRoy, C.; Lanata, C. F.; Cleary, T. G. (Society for General Microbiology, 2014-03-19)
      The aim of this study was to determine the frequency and allele associations of locus of enterocyte effacement encoded esp and tir genes among 181 enteropathogenic Escherichia coli (EPEC) strains (90 diarrhoea-associated and 91 controls) isolated from Peruvian children under 18 months of age. We analysed espA, espB, espD and tir alleles by PCR-RFLP. EPEC strains were isolated with higher frequency from healthy controls (91/424, 21.7 %) than from diarrhoeal samples (90/936, 9.6 %) (P,0.001); 28.9% of diarrhoeal and 17.6% of control samples were typical EPEC (tEPEC). The distribution of espA alleles (alpha, beta, beta2 and gamma) and espD alleles (alpha, beta, gamma and a new variant, espD-N1) between tEPEC and atypical EPEC (aEPEC) was significantly different (P,0.05). espD-alpha was more common among acute episodes (P,0.05). espB typing resulted in five alleles (alpha, beta, gamma and two new suballeles, espB-alpha2 and espB-alpha3), while tir-beta and tir-gamma2 were the most common intimin receptor subtypes. Seventy-two combinations of espA, espB, espD and tir alleles were found; the most prevalent combination was espA-beta, espB-beta, espD-beta, tir-beta (34/181 strains), which was more frequent among tEPEC strains (P,0.05). Our findings indicate that there is a high degree of heterogeneity among EPEC strains isolated from Peruvian children and that aEPEC and tEPEC variants cluster.
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    • Genotypic and Phenotypic Characterization of Enterotoxigenic Escherichia coli Strains Isolated from Peruvian Children

      Rivera, F. P.; Ochoa, T. J.; Maves, R. C.; Bernal, M.; Medina, A. M.; Meza, R.; Barletta, F.; Mercado, E.; Ecker, L.; Gil, A. I.; Hall, E. R.; Huicho, L.; Lanata, C. F. (American Society for Microbiology, 2014-03-19)
      Enterotoxigenic Escherichia coli (ETEC) is a major cause of childhood diarrhea. The present study sought to determine the prevalence and distribution of toxin types, colonization factors (CFs), and antimicrobial susceptibility of ETEC strains isolated from Peruvian children. We analyzed ETEC strains isolated from Peruvian children between 2 and 24 months of age in a passive surveillance study. Five E. coli colonies per patient were studied by multiplex real-time PCR to identify ETEC virulence factors. ETEC-associated toxins were confirmed using a GM1-based enzyme-linked immunosorbent assay. Confirmed strains were tested for CFs by dot blot assay using 21 monoclonal antibodies. We analyzed 1,129 samples from children with diarrhea and 744 control children and found ETEC in 5.3% and 4.3%, respectively. ETEC was more frequently isolated from children >12 months of age than from children <12 months of age (P < 0.001). Fifty-two percent of ETEC isolates from children with diarrhea and 72% of isolates from controls were heat-labile enterotoxin (LT) positive and heat-stable enterotoxin (ST) negative; 25% and 19%, respectively, were LT negative and ST positive; and 23% and 9%, respectively, were LT positive and ST positive. CFs were identified in 64% of diarrheal samples and 37% of control samples (P < 0.05). The most common CFs were CS6 (14% and 7%, respectively), CS12 (12% and 4%, respectively), and CS1 (9% and 4%, respectively). ST-producing ETEC strains caused more severe diarrhea than non-ST-producing ETEC strains. The strains were most frequently resistant to ampicillin (71%) and co-trimoxazole (61%). ETEC was thus found to be more prevalent in older infants. LT was the most common toxin type; 64% of strains had an identified CF. These data are relevant in estimating the burden of disease due to ETEC and the potential coverage of children in Peru by investigational vaccines.
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    • Global Causes of Diarrheal Disease Mortality in Children <5 Years of Age: A Systematic Review.

      Claudio F. Lanata; Christa L. Fischer-Walker; Ana C. Olascoaga; Carla X. Torres; Martin J. Aryee; Robert E. Black (Public Library of Science (PLoS), 2014-03-19)
      Estimation of pathogen-specific causes of child diarrhea deaths is needed to guide vaccine development and other prevention strategies. We did a systematic review of articles published between 1990 and 2011 reporting at least one of 13 pathogens in children ,5 years of age hospitalized with diarrhea. We included 2011 rotavirus data from the Rotavirus Surveillance Network coordinated by WHO. We excluded studies conducted during diarrhea outbreaks that did not discriminate between inpatient and outpatient cases, reporting nosocomial infections, those conducted in special populations, not done with adequate methods, and rotavirus studies in countries where the rotavirus vaccine was used. Age-adjusted median proportions for each pathogen were calculated and applied to 712 000 deaths due to diarrhea in children under 5 years for 2011, assuming that those observed among children hospitalized for diarrhea represent those causing child diarrhea deaths. 163 articles and WHO studies done in 31 countries were selected representing 286 inpatient studies. Studies seeking only one pathogen found higher proportions for some pathogens than studies seeking multiple pathogens (e.g. 39% rotavirus in 180 single-pathogen studies vs. 20% in 24 studies with 5–13 pathogens, p,0?0001). The percentage of episodes for which no pathogen could be identified was estimated to be 34%; the total of all age-adjusted percentages for pathogens and no-pathogen cases was 138%. Adjusting all proportions, including unknowns, to add to 100%, we estimated that rotavirus caused 197 000 [Uncertainty range (UR) 110 000–295 000], enteropathogenic E. coli 79 000 (UR 31 000–146 000), calicivirus 71 000 (UR 39 000–113 000), and enterotoxigenic E. coli 42 000 (UR 20 000–76 000) deaths. Rotavirus, calicivirus, enteropathogenic and enterotoxigenic E. coli cause more than half of all diarrheal deaths in children ,5 years in the world.
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    • Global kidney disease

      Herrera Añazco, Percy; Mezones-Holguín, Edward; Hernández, Adrian V. (Elsevier B.V., 2014-07-03)
      We read with interest the Lancet Series on Global Kidney Disease. Valerie Luyckx and colleagues describe the economics and medical management of chronic kidney disease in sub-Saharan Africa.1 We note clear similarities with patients in Peru. Indeed, in Peru, the Ministry of Health (MINSA)—which covers 70% of the population—does not have a comprehensive programme for the management of patients with chronic kidney disease, including renal replacement therapies. However, the Social Security System (Essalud)—which covers 20% of the population—has a chronic kidney disease programme.
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    • Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three.

      Odhiambo, Joseph A; Williams, Hywel C; Clayton, Tadd O; Robertson, Colin F; Asher, M Innes; Chiarella, Pascual; ISAAC Phase Three Study Group.; t.clayton@auckland.ac.nz (Mosby Inc., 2009-12-01)
      Background: In 1999, The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One reported the prevalence of eczema symptoms in 715,033 children from 154 centers in 56 countries by using standardized epidemiologic tools. Objective: To update the world map of eczema prevalence after 5 to 10 years (ISAAC Phase Three) and include additional data from over 100 new centers. Methods: Cross-sectional surveys using the ISAAC questionnaire on eczema symptoms were completed by adolescents 13 to 14 years old and by parents of children 6 to 7 years old. Current eczema was defined as an itchy flexural rash in the past 12 months and was considered severe eczema if associated with 1 or more nights per week of sleep disturbance. Results: For the age group 6 to 7 years, data on 385,853 participants from 143 centers in 60 countries showed that the prevalence of current eczema ranged from 0.9% in India to 22.5% in Ecuador, with new data showing high values in Asia and Latin America. For the age group 13 to 14 years, data on 663,256 participants from 230 centers in 96 countries showed prevalence values ranging from 0.2% in China to 24.6% in Columbia with the highest values in Africa and Latin America. Current eczema was lower for boys than girls (odds ratio, 0.94 and 0.72 at ages 6 to 7 years and 13 to 14 years, respectively). Conclusion:ISAAC Phase Three provides comprehensive global data on the prevalence of eczema symptoms that is essential for public health planning. New data reveal that eczema is a disease of developing as well as developed countries.
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    • Gravedad de la gastroenteritis causada por Vibrio parahaemolyticus del grupo pandémic o en el Perú

      Gil, Ana I.; Lanata, Claudio F.; Miranda, Hernán; Prada, Ana; Seas, Carlos; Hall, Eric R.; Meza, Rina; Barreno, Carmen M.; Maúrtua, Dora; G. Balakrish Nair; agil@iin.sld.pe (Instituto Nacional de Salud (INS), 2014-08-11)
      Objective. To determine the epidemiological and clinic characteristics of gastroenteritis caused by Vibrio parahaemolyticus strains of the pandemic group in Peru. Material and methods. Clinical and laboratory records were searched in 100 cases of gastroenteritis caused by V parahaemolyticus, either of the pandemic or non pandemic group. Clinical and epidemiological data were collected and statistical analysis was done to evaluate if the severity of illness was associated with the pandemic group. Results. Epidemiological data were collected in 85% of cases, and clinical data were only available in 37% of cases, mainly on those hospitalized. Cases associated with the pandemic strains had a higher probability of liquid stools (96.3% vs. 62.5%, p<0.05), moderate or severe dehydration (100% vs. 60%, p<0.05), and hospital care (98% vs. 42.9%, p<0.0001). Cases aged thirty or older were associated with the pandemic strains (63% vs. 39.5%, p<0.05). Conclusions. Vibrio parahaemolyticus of the pandemic group causes more severe gastrointestinal disease than none pandemic strains, with higher probability of requiring hospital care. Based on this report, it is advisable to include the identification of V. parahaemolyticus in the etiological diagnosis of agents causing severe gastroenteritis in the Peruvian health system.
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    • Guía para diagnóstico y tratamiento de la Enfermedad de Gaucher

      Colquicocha Murillo, Maria; Cucho Jurado, Janetliz; Eyzaguirre Zapata, Renee Mercedes; Manassero Morales, Gioconda; Moreno Larrea, Mariela del Carmen; Salas Arbizu, Katia Liliana; Torres Argandoña, Aimee Margarita; Vargas Castro, Jesús Olga (Universidad Peruana Cayetano Heredia. Facultad de Medicina "Alberto Hurtado", 2015-07-06)
      La enfermedad de Gaucher (EG), debe su nombre por haber sido descrita por Phillipe Gaucher en 1882. Es la enfermedad más frecuente del grupo de las enfermedades de depósito lisosomal comprendidas dentro de los errores innatos del metabolismo (1). La enfermedad de Gaucher se debe a mutaciones en el gen responsable de la síntesis de la enzima lisosomal b-glucocerebrosidasa ácida, también llamada ß-Glucosidasa ácida, (o ß-GA), cuyos locus se ubica en 1q21, es decir en la banda uno de la región 2 del brazo largo del cromosoma 1. El patrón de herencia es autosómico recesivo, es decir que la mutación en éste gen debe darse en estado de homocigocia (2).
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    • Guías de práctica clínica en el Perú: evaluación de su calidad usando el instrumento AGREE II

      Canelo-Aybar, Carlos; Balbin, Graciela; Perez-Gomez, Ángela; Florez, Iván D. (2016-12-13)
      Con el fin de evaluar la calidad metodológica de las guías de práctica clínica (GPC) desarrolladas por el Ministerio de Salud (MINSA) de Perú, se evaluaron 17 GPC del MINSA publicadas entre 2009-2014, por tres expertos metodológicos, de forma independiente, usando el instrumento AGREE II. La puntuación de los dominios del AGREE II fue baja y muy baja en todas las GPC: alcance y propósito (mediana, 44%), claridad de la presentación (mediana, 47%), participación de decisores (mediana, 8%), rigor metodológico (mediana 5%), aplicabilidad (mediana, 5%), e independencia editorial (mediana, 8%). Se concluye que la calidad metodológica de las GPC del MINSA es baja. Como consecuencia, no es posible recomendar su uso. Urge la incorporación de metodología estandarizada para el desarrollo de GPC de calidad en el Perú.
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