• 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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