Tesis de Medicina para obtener el título profesional de Médico Cirujano

Recent Submissions

  • Immediate complications in post-mastectomy breast reconstruction: comparison between different surgical techniques in patients with breast cancer at the National Institute of Neoplastic Diseases in Lima, Peru 2014-2018

    Araujo Castillo, Roger Vladimir; López Viena, Karen Gabriela; Málaga Avendaño, Nicolás (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-03-18)
    Introduction: The number of breast reconstructions after breast cancer is increasing over the years. This study evaluates complications in the first 30 days after breast reconstruction post mastectomy in different surgical techniques for patients with non-metastatic breast cancer. Methods: Retrospective cohort including patients who underwent breast reconstruction post mastectomy at the National Institute of Neoplastic Diseases (INEN) 2014-2018. Outcomes were immediate complications (first 30 days after surgery). Cumulative incidences were obtained. Association with clinical and demographic factors was evaluated using adjusted relative risk (aRR) obtained via Poisson Regression with robust variances. Results: 2092 patients had mastectomy at INEN during the study period, but only 271 underwent breast reconstruction. From them, 148 had complete data and fulfilled the selection criteria. Median age was 45 years old, 62.16% had overweight/obesity, and 35.85% had clinical stage III. 28.38% had immediate autologous reconstruction, 33.11% immediate prosthetic reconstruction, and 38.51% delayed reconstruction of any type. 48.65% had some surgical complication in the first 30 days, being the most frequent dehiscence (20.27%) and superficial infection (18.92%). Overweight/Obesity (aRR 1.96; 1.24-3.10) and having immediate reconstruction (aRR 1.54; 1.04-2.27) were associated to complications. Prosthetic technique use was protective (aRR 0.59; 0.40-0.85), as well as Neoadjuvant Chemotherapy (aRR 0.65; 0.42-0.99). Conclusions: The prosthetic surgical technique had less early complication incidence than the autologous one. On the other hand, immediate surgery after mastectomy was more likely to present complications compared with delaying. Variables as obesity, neoadjuvant therapy and ECOG intervened in the incidence of complications.
    Acceso abierto
  • Efficacy and safety of clomiphene citrate therapy in patients with male idiopathic infertility: A systematic review

    Mezones-Holguin, Edward; Enriquez Gutierrez, Gianfranco Fabricio; Sosaya Muñoz, Fernando Antonio (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-05-22)
    Introduction: Male idiopathic infertility is a rising problem globally and a significant challenge in clinical practice. Clomiphene citrate emerges as a promising therapy. Our objective is to synthesize available primary evidence about the efficacy and safety of clomiphene citrate treatment for male idiopathic infertility. Materials and Methods: We carried out a Systematic Review. We performed the primary search in PubMed/MEDLINE, Embase, WoS, Medline, Scopus, Cochrane and Trip Database until December 2020 for RCTs evaluating the effect of clomiphene citrate therapy compared to placebo and other therapies on adult males from any age group with idiopathic infertility diagnosis according to WHO 2010 criteria and ICD-10. The outcomes we studied were divided between efficacy: pregnancy and spermogram changes; and security: adverse effects. We evaluated the risk of bias using the Cochrane® Risk of Bias tool. Results: From 1010 registries, we selected 11 RCTs. Sample sizes varied between 23 and 141 participants. Five studies compared clomiphene citrate versus placebo and the remaining six compared clomiphene versus other therapies. The clomiphene doses used in the intervention group were 25mg and 50mg. For the main outcome, pregnancy, nine studies presented results, only one had a positive effect with unclear results (Ghanem et al. RR 3,00; 95% CI; 1,09 –8,25; p<0,05). Seven trials reported a significant increase in sperm concentration, three reported increased motility and one in morphology. However, these changes did not reflect on the increase in pregnancies. Six studies reported adverse effects out of 291 patients that received clomiphene citrate. 12 participants (4.12%) reported adverse effects, including headache and visual symptoms, no serious adverse effects were presented. Conclusion: Due to the variability and heterogeneity of the studies, a qualitative synthesis could not be realized. Nevertheless, evidence suggests pregnancy would not be achieved and so, their use in male idiopathic infertility could not be recommended. Furthermore, better quality randomized controlled trials with a larger sample size are required to measure its effect more validly and reliably.
    Acceso abierto
  • Type 2 diabetes and anxiety symptoms: a cross-sectional study in Peru

    Torres Slimming, Paola; Bernabé-Ortiz, Antonio; Arteaga Zarate, María de Guadalupe; Demarini Olivares, Gina Elizabeth (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-05-21)
    Objective: To determine the association between diabetes mellitus type 2 and anxiety symptoms using a population-based study from the semi urban population of Tumbes, Peru. Research design and methods: The present study was an observational, analytical cross-sectional one. Data from a population-based study conducted in Tumbes, Peru between 2016 and 2017 was analyzed. The variables studied were T2DM, defined using fasting glucose and anxiety symptoms, using the Goldberg scale. Results: Data from 1609 individuals was analyzed, with mean age 48.16 (SD:10.61) and 810 women (50.3%), where a total of 161 were classified as having T2DM (10.0%; CI 95%: 8.5%-11.4%) and 675 individuals had anxiety symptoms (41.95%; CI 95%:39.5%-44.3%). A statistically significant association was found between DM2 and anxiety symptoms (p <0.001). Furthermore, those patients aware of their diagnosis of diabetes over 5 years had a 56% (95% CI: 25% - 96%) higher prevalence of anxiety symptoms compared to participants without DM2. Conclusion: An association was found between DM2 and anxiety symptoms; there being a higher prevalence of anxiety symptoms in participants previously aware of having DM2. Periodic monitoring of anxiety symptoms is recommended in these patients.
    Acceso abierto
  • Coverage and factors associated with incomplete vaccination against diphtheria, tetanus and pertussis in infants aged 12 to 23 months: secondary analysis of the Demographic and Family Health Survey

    Guibovich Perez, Guillermo Eduardo; Piiroja Devrout, Ricardo Adrien (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-05-20)
    A cross-sectional study was conducted based on the secondary analysis of the Demographic and Family Health Survey (ENDES) 2019, with the objective of estimating the incomplete coverage of PTD and determining the factors associated with it in infants aged 12 to 23 months in Peru. Pearson's chi-square test was used for the bivariate analysis and the magnitude of the association was estimated using the crude (PRc) and adjusted (RPa) prevalence ratios. Incomplete DPT coverage was 12.4% (CI 11.88-14.79) for the entire population studied. Infants in the third order of birth or more (PRa: 1.37; CI 1.01-1.84) and infants born by non-institutionalized delivery were more likely than children whose delivery was institutionalized (PRa; 1.70; CI 1.15-2.54). The probability of having incomplete coverage decreased by having 6 or more prenatal check-ups (PRa; 0.58; CI 0.46-0.73), as well as living in rural areas compared to living in urban areas (PRa; 0.64; CI 0.48-0.85). Incomplete DPT vaccination in infants aged 12 to 23 months in Peru has a high level (> 10%), placing this population group at risk of suffering from these immunopreventable diseases and triggering outbreaks and epidemics in the community. The factors associated with incomplete vaccination are related to lower socioeconomic conditions and limited access to health services, which is why it is necessary to focus the interventions of the National Immunization Health Strategy to reverse this situation.
    Acceso abierto
  • Predicting mortality in patients diagnosed with pulmonary tuberculosis: a systematic review of prognostic models

    Escalante Kanashiro, Raffo Lucio Joaquín; Bert Dulanto, Aimée (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-05-14)
    OBJECTIVE. To synthesize the evidence regarding prognostic models to predict mortality in patients diagnosed with pulmonary tuberculosis. METHODOLOGY. The current study followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (The PRISMA Group, 2020) Statement. A literature search on prognostic models aimed to predict mortality in patients diagnosed with pulmonary tuberculosis was conducted by three revisers. We included prospective and retrospective studies where prognostic models predicting mortality were either developed or validated in patients diagnosed with pulmonary tuberculosis. Three reviewers independently assessed the quality of the included studies using the PROBAST tool. (¨Prediction model study Risk Of Bias Assessment Tool¨), which assesses both the risk of bias (RoB) and the applicability of each model. A descriptive analysis of each of the prediction models developed, their performance and the population characteristics of each article was conducted. RESULTS. Only 6 articles met the selection criteria. There was a total of 6 prognostic rules, one in each article. Most studies (5 out of 6) were retrospective cohorts, only 1 study was a prospective case-control study. When adding the population of all the studies, there were a total of 3,553 participants, with samples ranging from 103 participants to 1070 participants. All the studies had a high risk of bias according to the PROBAST tool in the overall assessment. The overall assessment showed that 3 studies had a low concern of applicability, 2 high concern and 1 unclear concern. Only 5 studies developed new prediction rules. In general, the presented models had a good discriminatory ability, with areas under the curve fluctuating between 0.65 up to 0.91. The predictive model with the highest discriminatory power was the one reported by Horita, et - al. with an AUC of 0.910 in the development cohort and 0.893 in the validation cohort. CONCLUSION. Considering that pulmonary tuberculosis is a highly prevalent disease in low-income countries, it would be very useful to have quality tools that allow healthcare personnel to be able to catalog patients with a higher risk of death so that they can receive priority medical attention.
    Acceso abierto
  • Access to health services and its association with chronic malnutrition in children under 5 years of age from low socioeconomic levels in Peru. A population-based analysis

    Maguiña Quispe, Jorge Luis; Gonzales Rojas, Carlos Alejandro; Romero Cerna, Mario Sergio (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-05-14)
    Introduction: Chronic malnutrition (Stunting) is one of the main problems in developing countries. On the other hand, the health of the mother and her timely access to a health service is a relevant aspect, but the relationship that the fact of being born in a non-institutional environment has on chronic malnutrition in children under 5 is not yet known. Objectives: Our analysis aims at evaluating the association between institutional delivery and chronic malnutrition in the first 5 years of life using the ENDES-2017 database in low and very low socioeconomic levels. Methods: Analytical cross-sectional observational study with data from the Demographic and Family Health Survey (ENDES). All the analyses were carried out considering the complex sample design (svy), considering that the database comes from a survey at the time of analysis. Chi square was used for bivariate analysis for categorical variables. Crude prevalence ratios (RPc) and adjusted (RPa) were obtained through the construction of generalized linear models, using the Poisson family and the log link function. A confidence level of 95% was considered, significant p <0.05. Results: A total of 11,734 records were analyzed. The prevalence of chronic malnutrition in children under 5 years of age was 20.50% and the prevalence of non-institutional delivery was 15.53%. 92.47% of the children who received their complete vaccinations up to one year of life had institutional delivery in urban areas, while only 85.71% in rural areas. The multivariate analysis shows that not having an institutional delivery increases the probability of developing chronic malnutrition by 1.42 times. The higher the mother’s educational level, the less likely the minor is to develop chronic malnutrition. The greater the number of children under 5 years of age, the greater the risk of developing chronic malnutrition (PR: 1.39 and 1.67). Conclusion: It cannot be concluded that there is an association between non-institutional childbirth and chronic malnutrition in children under 5 years of age from low and extremely low socioeconomic levels in Peru.
    Acceso abierto
  • Antibiotic prophylaxis for ventilator-associated pneumonia in pediatric patients with moderate to severe traumatic brain injury in a hospital in Lima, Peru

    Carreazo Pariasca, Nilton Yhuri; Chira Alarcon, Patricia Fiorela; Romaña Castillo, Natalia (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-04-30)
    Introduction: This study evaluates the use of antibiotic prophylaxis for prevention and development of ventilator associated pneumonia (VAP) in pediatric patients with moderate to severe traumatic brain injury (TBI) in order to promote best practices and use the appropriate resources. Methods: A retrospective cohort study of all pediatric patients, between 1 and 18 years, who were admitted and had moderate or severe TBI diagnosis at the Pediatric Emergency Hospital, Lima-Peru. Results: One hundred and forty-five patients with diagnosis of traumatic brain injury (TBI), who received mechanical ventilation for at least 48 hours, were evaluated. We obtained an incidence density of 44.60/1000 ventilator days. No relationship was found between antibiotic prophylaxis and the development of VAP. Likewise, it was found that performing oral hygiene with chlorhexidine reduces the risk of developing VAP by 45% (p = 0.03, CI 0.33-0.95).In addition, the presence of purulent secretions (IC 2.23-11.45), solid (, IC 1.67-11.34) or dense ( IC 2.91-16.75) has a 3, 5 and 6 times higher risk of ventilator-associated pneumonia, respectively. Conclusions: Antibiotic prophylaxis did not show to have a positive effect on the prevention of ventilator associated pneumonia; However, other measures such as oral hygiene with chlorhexidine were associated with reducing the risk of developing VAP. The proportion of patients who received antibiotic prophylaxis was 81 (55.6%) and the incidence density of VAP found in the study is within the standards found in the available literature. Furthermore, the type of discharge was identified as a predictor of increased risk of ventilator-associated pneumonia. Even more studies focused on this population are required.
    Acceso abierto
  • Comparison of knowledge, attitudes and practices on prevention and control measures in dengue infection between families with or without dengue cases after “El Niño Costero” phenomenon at the District of Palpa - Ica during January's 2019

    Sánchez Chiroque, Juan Francisco; Cruz Cutty, Lourdes Marylin; Baella Vigil, Gilda Viera Milagros (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2020-11-11)
    Introduction: Dengue is an endemic disease in Peru and is considered a public health problem. During and after the “El Niño Costero” phenomenon in 2017, the Department of Ica presented 4384 cases of dengue, the highest number of cases in this region. Methods: A cross-sectional analytical study was conducted and included all the families in the district of Palpa, Ica. The main exposure was the report of a previous dengue infection of any family member and we want to find an association with the level of knowledge, attitudes and practices about dengue. Results: We found that the participants who had been exposed to dengue had a 63% higher probability (PR: 1.63; 95% CI: 1.02 - 2.58) of having a high level of knowledge about dengue in comparison with the participants of families who did not have a history of dengue. For the levels of attitudes (PR: 0.90; IC 95%: 0.60 – 1.35) and practices (PR: 0.88; IC 95%: 0.51 – 1.51) no statistically significant differences were found. Conclusions: Our study found that previous exposure to dengue is associated with a high level of knowledge but, it is not associated with a high level of attitude or practices in families in the district of Palpa-Ica.
    Acceso abierto
  • Effectiveness of bariatric surgery in morbidly obese adults for cardiovascular outcomes: a systematic review

    Gutierrez Sierra, Manuel; Hernández Díaz, Adrián Vladimir; Tejada Caminiti, Romina Arely; Silva Licera, Humberto Rafael; Almeyda Yglesias, María Antoinette (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-05-04)
    Objectives: to determine the effectiveness of bariatric surgery to reduce the risk of cardiovascular events such as coronary heart disease, stroke, cardiovascular mortality, and total mortality in morbidly obese patients, compared with a non-surgical treatment and no intervention control group. Methods: a systematic review was carried out with cohort-type studies that evaluated, with a minimum follow-up of one year, morbidly obese adults who had undergone bariatric surgery compared to a control group of non-surgical treatment and without intervention in relation to the cardiovascular events such as coronary heart disease, stroke, cardiovascular mortality, and total mortality in morbidly obese patients. Results: 14 studies were selected that met our inclusion criteria. 44,912 patients who underwent bariatric surgery and 208,347 non-surgical controls were included. The high heterogeneity of the included studies did not allow the meta-analysis to be carried out. However, most of the individual results show decreased risk of the outcomes studied. A subgroup analysis was performed, where Bariatric Roux-en-Y surgery reduces the risk of coronary artery disease by approximately 60%. In morbidly obese diabetic patients, our calculations showed a risk reduction of 80% for cardiovascular mortality and 70% for total mortality. Finally, our calculations show a 58% decrease in cardiovascular mortality in studies with a follow-up of 2 or more years. Conclusions: Our study suggests that bariatric surgery is beneficial for morbidly obese adult patients at risk of presenting cardiovascular events.
    Acceso abierto
  • Relationship between adherence to an asthma management regimen and hospitalization in asthmatic children from a private clinic in Lima, Peru

    Maguiña Quispe, Jorge Luis; Chiarella Ortigosa, Pascual Renato; Guerreros Benavides, Alfredo; Diaz Flores, Rommel; Rojas Luna, David Ismael (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2019-03-21)
    INTRODUCTION: Asthma is a chronic inflammatory disease that affects about 300 million people, where a significant proportion is the paediatric population. There are currently no studies in Peru where regimens seeking adherence to asthma control are related to a decrease in hospitalization. OBJECTIVES: Determine the relationship between adherence to an asthma management regimen and the incidence of hospitalization in asthmatic children aged 5 to 12 years in a private clinic in Lima, Peru. METHODS: Retrospective cohort study conducted at all headquarters of the private clinic. 388 patients between 5 and 12 years of age were included, of them 76 abandoned the asthma management regimen voluntarily during the study period. Therefore, 312 patients with asthma diagnosis who entered the asthma management regimen were obtained as a sample between 2012 and 2013. The exposure variable was adherence to the asthma management regimen, defined as attached to the patient who at least attends a medical visit every 2 months or 6 visits per year. The result variable (hospitalization) refers to the patient belonging to the regimen and entered at least 1 day in the hospitalized area in the period 2013-2018. Other variables we analyzed were sex, parent education, housing area, treatment, BMI (z-score) and asthma classification (GINA 2016). RESULTS: A total of 312 records of asthma patients were analyzed, where, 273 (87.50%) patients were properly attached to the asthma management regimen; and only 42 (13.46%) 39 (12.50%) were hospitalized patients were not attached to the asthma management regimen; 16 (41.03%) were hospitalized. In the bivariate and multivariate analysis, an association was found between hospitalization and adherence to the asthma management regimen (RR, 0.22, CI95%, 0.12 -0.43). CONCLUSIONS: Good adherence to medical visits from the asthma management regimen would be a protective factor to prevent hospitalization in paediatric patients aged 5 to 12 years.
    Acceso abierto
  • Efficacy of alcohol gel versus alcoholic wipes on hands to reduce bacterial contamination of mobile devices of sixth-year medical students at a Peruvian University in 2019

    Alvarado Cutipa-Flores, Germán; Poletti Ferrara, Giovanni; Poletti Jabbour, Giordana Francesca; Elejalde Farfán, Natalia Andrea (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-03-15)
    CONTEXT: Nowadays, cellphones are susceptible to bacterial contamination and, therefore, they are potential reservoirs for disease transmission. The main aim of this study is to evaluate the efficacy of the use of alcoholic agents, in different presentations, for the decontamination of the hands and/or cell phones, therefore, to prevent the contamination of mobile devices. OBJECTIVES: To evaluate the efficacy of the anti-bacterial hand gel versus antibacterial wipes in the decontamination of the hands, to reduce the bacterial contamination of the cellphones of med students. PARTICIPANTS: 60 cellphones of med students in their 6th year at a Peruvian university, 2019 INTERVENTION: An experimental study and cultures of gram-negatives and positive bacteria were carried out before and after a 48-hour intervention. The participants were told to use two different agents with alcohol as they were divided in four groups (n=15 each group). The sample was taken with swabs and enriched transport tubes. The analysis was made by intention to treat. RESULTS: Basal contamination of 53.33%. Bacteria isolated in basal culture: Staphylococcus coagulase negative (36%), Staphylococcus aureus (5%), Pseudomonas stutzeri (3.33%), Bacillus spp (3.33%), Candida sp, Pseudomonas aeruginosa, Bordetella hinzii, Acinetobacter baumanii and Klebsiella Pneumoniae (1.67%). Lower final contamination proportion was found in the phones of the groups that were told to use an alcoholic agent (27-53%), compared to the control group (67%), however p value was not significant. No difference was reported when we compared specific bacteria, except for Enterobacter cloacae (p=0,05) CONCLUSIONS: In the present exploratory study, there was no difference found between the intervention groups, except for Enterobacter cloacae. More studies are required.
    Acceso abierto
  • Relationship between the presence of metabolic syndrome and electrocardiographic abnormalities in HIV patients with HAART in a level III hospital, Lima - Peru

    Maguiña Quispe, Jorge Luis; Taza Caroy, Jaime Enzo; Vilchez Muñoz, Renzo Alberto (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-02-28)
    Introduction: Antiretroviral Therapy (ARVT) has been related to some elements of Metabolic Syndrome (MS). Likewise, there exists a high prevalence of alterations on the electrocardiogram (ECG) in people with HIV. Objective: Evaluate the association between MS and alterations in the ECG in HIV patients who received ARVT. Methodology: A consecutive non-randomized cross-sectional study was developed in which patients from the Infectious Disease Service of the Arzobispo Loayza National Hospital were evaluated from January 2019 to April 2020. Survey data, clinical history, clinical examination and a 12-lead ECG were performed to each participant. Alterations in the ECG were classified with the Minnesota code. For SM, NCEP-ATP III 2005 criteria was used. Results: 63 patients were included, the mean age was 38,78 years (SD: 9,23). 25 participants presented electrocardiographic alteration, being 24 minor alterations and 5 major alterations. 27 from the 63 patients (42,9%) had MS. Association was found between MS and ECG alterations in the adjusted model by sex, age, smoking, time with HIV, time with ARVT and use of another medication, with a relative prevalence (RP) value of 2,17 (IC=95% 1,21-3,90) (p=0,009). Conclusion: Although association between the presence of MS and ECG alterations in the HIV population was found, due to the low power of the study, it is recommended to manage the results with caution.
    Acceso abierto
  • Mortalidad en pacientes con Sarcoma de Kaposi que recibieron tratamiento oncológico junto al Tratamiento Antirretroviral en tres hospitales públicos de Lima, Perú, 2008-2018

    Lucchetti Rodríguez, Aldo Javier; Astocondor Salazar, Lilian Marita; Resurreccion Delgado, Cristhian Pedro; Quispe Pineda, Diana Lizett; Rivera Castillo, Mirtha Patricia (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-03-18)
    Introducción: El Sarcoma de Kaposi (SK) es una enfermedad neoplásica por Herpesvirus 8 en sinergia con el VIH. En la actualidad, no existe tratamiento con evidencia científica que respalde su efectividad y disminución de mortalidad. Objetivo: Evaluar si el uso del tratamiento oncológico disminuye la mortalidad a tres años de inicio de TARV de los pacientes con VIH y SK. Materiales y métodos: Un estudio transversal analítico se realizó en tres hospitales nacionales entre el 2008 y 2018. Los pacientes con SK se dividieron entre aquellos que recibieron TARV y aquellos que recibieron TARV con tratamiento oncológico. La historia clínica y la ficha TARV fueron revisadas. Resultados: La media poblacional fue de 45,02 años para los pacientes de bajo riesgo (DE:12,56). En el análisis bivariado se encontró asociación significativa entre mortalidad y abandono del TARV (p=0,046). No se identificó asociación significativa de la mortalidad al momento de elegir tratamiento oncológico más TARV o TARV solo como tratamiento inicial (PR: 0,92; IC 95% 0,326;2,575). En el modelo ajustado no se observa asociación significativa entre las variables Evento de Muerte y Tratamiento. Conclusiones: El tratamiento oncológico no disminuye la mortalidad a tres años de inicio de TARV de los pacientes con VIH y SK. Existe aumento de mortalidad en pacientes con VIH y SK que abandonan TARV. El Estadiaje de SK, Rango de CD4 Inicial, Orientación Sexual, entre otros, no resultaron influyentes en la mortalidad. Fallecieron 27,9 % de pacientes con VIH y SK durante el periodo de estudio. Existen diversos factores aumentan la incidencia de VIH y SK.
    Acceso abierto
  • Factores asociados a la falla de la terapia con Estibogluconato de sodio en pacientes diagnosticados de Leishmaniasis cutánea en Hospital Arzobispo Loayza de Perú entre los años 2006- 2018

    Lucchetti Rodríguez, Aldo Javier; Mancha Feria, Carlos Ronaldo; Carrera Casas, Renato Eduardo (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-03-18)
    Antecedentes: La leishmaniasis es considerada una enfermedad endémica en nuestro país; sin embargo, su estudio en nuestro medio aún es incipiente. Objetivos: Determinar los diferentes factores asociados a la falla del tratamiento con estibogluconato de sodio en pacientes diagnosticados de leishmaniasis cutánea que fueron tratados en el Hospital Nacional “Arzobispo Loayza” (HNAL) en Lima, Perú, durante los años 2006-2018. Materiales y métodos: Se realizó un estudio retrospectivo de casos y control anidado a una cohorte de 100 pacientes con diagnóstico de leishmaniasis cutánea que tuvieron tratamiento con estibogluconato de sodio en el HNAL. Los 28 casos fueron los pacientes que fallaron al tratamiento y los 72 controles fueron los pacientes que tuvieron una buena respuesta clínica. Se comparó ambos grupos y se empleó la regresión logística para obtener los Odds ratio e intervalos de confianza al 95%. Resultados: La proporción de falla al tratamiento en el HNAL entre los años 2006 y 2018 fue de 28%. Los pacientes que fallaron al tratamiento tuvieron mayor probabilidad de proceder de la costa en comparación con los pacientes que no fallaron al tratamiento (OR 6,8 IC 95% 1,75 - 26,3 p<0,05). Asimismo, los pacientes que fallaron al tratamiento tuvieron mayor probabilidad de haber presentado una lesión única en comparación de los pacientes que no fallaron al tratamiento (OR 4,0 IC 95% 1,11 - 15,0 p= 0,03). Conclusión: Este estudio encontró que la proporción de fracaso del tratamiento fue ligeramente superior a estudios previos. Asimismo, los pacientes que fallaron al tratamiento tuvieron mayor probabilidad de proceder de la costa y haber presentado una lesión única. Se recomienda realizar estudios multicéntricos donde se pueda evaluar esta asociación.
    Acceso abierto
  • Eficacia y seguridad de los estilbenos en el manejo de la sintomatología climatérica en mujeres de edad mediana: Una revisión sistemática

    Mezones-Holguin, Edward; Villanueva Alvarado, Aryana Leonor; Trabucco Puicón, Claudia Estefany (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-02-13)
    Objetivo: Sintetizar la evidencia primaria con respecto a la eficacia y seguridad de los estilbenos en el tratamiento de la sintomatología climatérica en las mujeres de edad mediana. Métodos: Llevamos a cabo una revisión sistemática de la literatura según las recomendaciones del Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Realizamos la búsqueda primaria en Pubmed-Medline, Embase, Scopus, Web of Science, WOS-Medline, LILACS, CINAHL, PsycINFO, SciELO, CENTRAL y en registros internacionales de ensayos clínicos, sobre la eficacia y seguridad de los estilbenos en sintomatología climatérica. Consultamos fuentes de literatura gris, hasta diciembre del 2018, sin restricción de idioma. Usamos la herramienta de la Colaboración Cochrane para la evaluación de riesgo de sesgo de los estudios incluidos. Resultados: Obtuvimos 2752 registros en la búsqueda primaria, a partir de los cuales seleccionamos cuatro ensayos clínicos controlados aleatorizados (ECAs) que reportaron desenlaces de eficacia y seguridad. Existe alta heterogeneidad entre los estudios en cuanto a la dosis, combinaciones con otros fitoestrógenos, duración de la suplementación, escalas de medición y reporte de desenlaces. En cuanto a la eficacia, un estudio reportó disminución significativa en todos los síntomas somáticos, en el grupo con resveratrol, con mayor reducción en el ítem de molestias musculares y articulares, donde solo el 16.7% de la población reportó estas molestias al final de la intervención, comparado a un 73.3% del brazo placebo (p<0.001). Por otro lado, un segundo estudio demostró mejoría significativa en el número (p=0.0077) e intensidad (p=0.018) de los episodios vasomotores en el grupo de la intervención. En contraparte, un tercer estudio mostró diferencias no significativas en el puntaje total de la subescala somática (7.7 ± 2.2; p ITT= 0.760) para el grupo de la intervención y (8.6 ± 2.2; p ITT= 0.760) para el grupo control. En relación a la eficacia de los estilbenos en sintomatología urogenital y psicológica, los resultados fueron contradictorios. En términos de seguridad, dos de los cuatro ECAs reportaron la ausencia de eventos adversos con la suplementación de resveratrol. Conclusión: La evidencia proveniente de los ECAs incluidos no es concluyente con respecto a la eficacia en la suplementación con estilbenos, particularmente con resveratrol, en el manejo de la sintomatología climatérica. Los ensayos clínicos reportaron la ausencia de eventos adversos con la suplementación de resveratrol, aunque este desenlace fue evaluado solo en la mitad de los estudios. Por ello, se requiere llevar a cabo futuros ensayos clínicos aleatorizados con un mejor diseño y mayor muestra, con el fin de alcanzar una conclusión definitiva sobre el uso de estilbenos.
    Acceso abierto
  • Asociación entre tiempo de abandono y falla terapéutica en adultos inmigrantes venezolanos con infección por el Virus de Inmunodeficiencia Humana que reinician Terapia Antirretroviral de Gran Actividad atendidos en el Hospital Nacional Arzobispo Loayza durante 2014 – 2018 en Lima, Perú

    Mezones Holguín, Edward Manuel Adriano; Lucchetti Rodríguez, Aldo Javier; Rebolledo Ponietsky, Kirbeliz Estefania (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-01-31)
    Objetivo: Evaluar si existe asociación entre el abandono con la falla terapéutica en inmigrantes venezolanos con infección por el virus de inmunodeficiencia humana (VIH) que reinicien tratamiento antirretroviral de gran actividad (TARGA). Métodos: Llevamos a cabo una cohorte retrospectiva en el Hospital Nacional Arzobispo Loayza. Incluimos pacientes que reiniciaron tratamiento TARGA. La variable de resultado fue la falla terapéutica (FT), compuesta por falla inmunológica (FI), virológica (FV) y clínica (FC). La variable de exposición fue el abandono terapéutico, aquellos que no recibieron tratamiento por 30 días, de 30 días a seis meses y de seis meses a más. Las variables control fueron el sexo, la orientación sexual, el nivel de instrucción, la edad y comorbilidades. Utilizamos modelos lineales generalizados de Poisson con errores estándar robustos para calcular riesgo relativo a nivel crudo (RR) y ajustado por criterio estadístico (RRa1) y epidemiológico (RRa2). Resultados: Incluimos 294 pacientes, 47,7% de ellos abandonaron TARGA, 32,7% abandono menos de seis meses, 15% abandonó mas de seis meses y el 27,9% tenían FT. Comparado con aquellos que no abandonaron, un abandono menor a 6 meses [RRa1: 1,98 (IC95%: 1,27 a 3,09);] y de seis meses a más [RRa1: 3,17 (IC95%: 2,02 a 4,95);] incrementó el riesgo de FT. El abandono de hasta seis meses [RRa1: 2,32 (IC95%: 1,40 a 3,84)] y de seis meses a más [RRa1: 3,93 (IC95%: 2,39 a 6,45)]; aumentó el riesgo de FV. En el caso de la FC [RRa1: 1,96 (IC95%: 0,67 a 5,79)] y la FI [RRa1: 2,99 (IC95%: 0,87 a 10,30)] no encontramos evidencia estadística de asociación con el abandono terapéutico. Conclusiones: El abandono del TARGA incrementa el riesgo de FT y FV en pacientes inmigrantes venezolanos. Dentro de la valoración integral que los pacientes con VIH debe explorarse el abandono como una variable de alta a importancia.
    Acceso abierto
  • Análisis de estudio de cohorte: factores asociados a la adherencia mensual a la suplementación oral de hierro en gestantes de Ayacucho y Andahuaylas entre 2006 y 2007

    Munayco Escate, Cesar Vladimir; Méndez Francia, Paola Alexandra; Misayauri Capcha, Talia Lizbethy (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-01-30)
    La anemia en gestantes es un problema de salud pública importante a nivel mundial. Según la prevalencia registrada, en Perú persiste como un problema moderado. La pobre adherencia a la suplementación oral de hierro es una de las principales barreras para la efectividad de esta intervención. El objetivo del presente estudio fue determinar la variación de la adherencia a la suplementación oral de hierro en el tiempo y los factores asociados a esta. Para ello, se reanalizó la base de datos de la vigilancia centinela: “Estudio de adherencia a la suplementación con Hierro durante la gestación en las direcciones de salud de Apurímac y Ayacucho” de la Dirección General de Epidemiología (DGE), el cual tuvo un diseño de cohorte prospectiva longitudinal. Se realizó un análisis descriptivo de las 416 gestantes registradas y un análisis bivariado y multivariado en base a 376 gestantes. Se identificaron las variables sociodemográficas, gestacionales, relacionadas a la suplementación en el embarazo anterior y actual. Para el análisis de los factores asociados a la adherencia se usó el modelo GEE. En la segunda y tercera visita de seguimiento la adherencia incrementó en 4% y 8%, mientras que en la quinta y sexta, se redujo en 8% y 20,6%, respectivamente. Los factores que redujeron la adherencia fueron: falla en la dispensación (25, 3%), náuseas (9,5%), interacción de náuseas y vómitos (13,5%), y no le cae bien el suplemento (11%). En conclusión, la adherencia disminuye con el tiempo y los factores relacionados al suplemento y la falla en la distribución se relacionan a la reducción de esta
    Acceso abierto
  • Factores asociados a los diferentes patrones de marcadores para Virus de la Hepatitis B en pacientes peruanos viviendo con VIH, 2016-2017

    Araujo Castillo, Roger V; Oré Ramos, Brunella; Patiño Espinoza, Alvaro (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-02-12)
    Introducción: La coinfección por virus de la hepatitis B (VHB) y VIH afecta a 2,7 millones de personas, que equivale a 5-10% de las personas viviendo con VIH. Esta comorbilidad cambia la historia natural de ambas patologías. En Perú, no están definidas las características de los pacientes VIH según los diferentes patrones serológicos del VHB. Métodos: Estudio transversal analítico secundario de una base de datos obtenida mediante revisión de historias clínicas en dos hospitales públicos de Lima, Perú. Se incluyeron personas con 18 años o más con diagnóstico confirmado de VIH, que iniciaron/reiniciaron tratamiento antiviral de gran actividad (TARGA) 2016-2017. Se evaluaron Antígeno de superficie (HBsAg), Anti-antígeno de superficie (anti-HBs), Anti-antígeno core, y los patrones serológicos según estos marcadores. Se obtuvieron Razones de Prevalencia crudos y ajustados (RPa) para las diferentes características usando regresión de Poisson con varianza robusta. Resultados: Se incluyeron 429 pacientes con una prevalencia de HBsAg de 4,43% (2.69%-6.83%). Existió asociación significativa entre prevalencia de HBsAg y drogas endovenosas (RPa:1,70; IC95% 1,07-2,68), transaminasemia (RPa:3,69; IC95% 2,97-4,57) y uso de TARGA (RPa:0,52; IC95% 0,35-0,77). 129 pacientes sin infección activa fueron evaluados para anti-HBs, siendo positivos 8.53% (4.33%-14.74%). Se encontró asociación con edad ≥30 años (RPa:5,09; IC95% 2,72-9,54), uso de TARGA previo (RPa:3,01; IC95% 1,84-4,93) y carga viral ≥1000 copias/ml (RPa:0,29; IC95% 0,13-0,63). Conclusiones: Uso de drogas endovenosas y transaminasemia se asociaron a mayor prevalencia de infección activa (HBsAg+), mientras que uso previo de TARGA a menor prevalencia. Edad ≥30 años y TARGA se asociaron a mayor prevalencia de anti-HBs en pacientes sin infección activa, y carga viral ≥1000 copias/ml se asoció a menor prevalencia.
    Acceso abierto
  • Attitudes, health lifestyle behaviors and cardiometabolic risk factors among relatives of individuals with type 2 diabetes mellitus (actitudes, comportamientos de estilo de vida y factores de riesgo cardio-metabólicos en familiares de individuos con diabetes melitus tipo 2)

    Araujo Castillo, Roger V; Urrunaga Poma, Nicole; Montoya Medina, José Enrique (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-02-01)
    Objetivo: Describir y comparar actitudes, conductas en el estilo de vida y factores de riesgo cardio-metabólicos en individuos que convivan o no con familiares diagnosticados con diabetes mellitus tipo 2 (DM2). Metodología: Análisis secundario de base de datos procedente de un estudio de implementación llevado a cabo en Perú. Las variables de interés fueron actitudes de cambio de estilo de vida (intención de pérdida de peso, aumento de actividad física, reducción en el consumo de sal, etc), conductas en el estilo de vida (tabaquismo, consumo de bebidas alcohólicas y actividad física) y factores de riesgo cardio-metabólicos (sobrepeso [índice de masa corporal >25 kg/m] e hipertensión); mientras que la variable de exposición fue la presencia de al menos un familiar diagnosticado de DM2 dentro del hogar. Se utilizó un modelo de Regresión logística multinivel de efectos mixtos para estimar la razón de probabilidades (OR) y un intervalo de confianza de 95% (IC 95%). Resultados: Se obtuvo un total de 2298 registros, 1134 (49.4%) varones, con una media de edad de 43.3 años (DE 0.36), todos sometidos a análisis. No se encontró evidencia de diferencia en actitudes de cambio de estilo de vida, tabaquismo, consumo de bebidas alcohólicas, niveles de actividad física e hipertensión entre los individuos con o sin familiar con DM2. El modelo multivariado señaló que el sobrepeso era 63% más frecuente entre individuos con familiares diabéticos (OR = 1.63; 95% IC: 1.3-2.61). Conclusiones: Individuos con familiares con DM2 tiene una probabilidad más alta de tener sobrepeso en comparación a personas que no cuentan con familiares diabéticos dentro del hogar. La ausencia de diferencias en actitudes de cambio y conductas en el estilo de vida resaltan la necesidad de incluir a los familiares de pacientes diabéticos dentro de las estrategias de prevención y manejo de DM2.
    Acceso abierto
  • Factores de riesgo para la amputación en pacientes mayores de 18 años con pie diabético en el servicio de endocrinología en un hospital de tercer nivel de la Seguridad Social

    Benites Zapata, Vicente Aleixandre; Pachas Talla, Arly Winny; Peralta Cuadros, Almendra Jazminne (Universidad Peruana de Ciencias Aplicadas (UPC)PE, 2021-02-08)
    Introducción: El pie diabético se asocia a una alta morbimortalidad siendo la principal causa de amputación no traumática de miembros inferiores. Las amputaciones conllevan a discapacidad, mortalidad prematura y una reducción en calidad de vida en los pacientes diabéticos. Objetivo: Identificar los factores de riesgo para la amputación de pacientes adultos con pie diabético en la primera hospitalización con úlcera pedia en el servicio de endocrinología del Hospital Nacional Edgardo Rebagliati durante el periodo 2009 al 2017. Material y Métodos: Se realizó un estudio retrospectivo, observacional, analítico tipo cohorte. Nuestra variable dependiente fue amputación la cual estuvo definida como la amputación primaria registrada en la historia clínica posterior a la primera hospitalización debido a úlcera pedia. Mediante la revisión de historias clínicas, se recopilaron datos sobre factores sociodemográficos, relacionados a diabetes mellitus 2 y valores de laboratorio durante la primera hospitalización por úlcera pedia. Se llevó a cabo un modelo de regresión crudo y ajustado de la familia Poisson con varianza robusta. Se presentó como medida de asociación al riesgo relativo (RR) con su respectivo intervalo de confianza al 95%. Aquellas variables con un p<0,05 en análisis crudo ingresaron al análisis ajustado. Resultados: En total analizamos 163 pacientes con úlcera pedia en su primera hospitalización, el 55.21% fue mayor a 60 años y 70.55% fueron varones. Los amputados fueron 63 participantes. En el análisis ajustado, las variables asociadas a un mayor riesgo de amputación fueron enfermedad arterial periférica (RR=1.57; IC95%: 1.09 - 2.25, p=0.01), Wagner grado IV (RR=4.25; IC 95%: 1.41 - 12.77, p=0.01) y glucosa de admisión>130 mg/dl (RR=2.40; IC 95%: 1.10 - 5.24, p= 0.02). Conclusión: Se reconocen como factores de riesgo para la amputación la enfermedad arterial periférica, el estadio avanzado de la úlcera y los niveles elevados de glucosa.
    Acceso abierto

View more