Search

Copyright of Revista del Cuerpo Médico del Hospital Nacional Almanzor Aguinaga Asenjo is the property of Cuerpo Medico del Hospital Nacional Almanzor Aguinaga Asenjo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Habanera de Ciencias Médicas is the property of Universidad de Ciencias Medicas de La Habana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Updates to the Guidelines for the Management of High Blood Pressure and the Guidelines for the Management of Dyslipidemia have been recently published in the eighth report of the Joint National Committee. Both are evidencebased and rely on clinical trial results, leaving aside, when possible, recommendations made by experts. Both have introduced important methodological changes in the form of cataloging and summarizing the evidence used. The High Blood Pressure Guideline is considered to be a reliable guide; it has simplified recommendations and is easy to implement. A potentially interesting change in the Dyslipidemia Guideline is the abandonment of the numerical therapeutic target in order to use the modification of the level of risk, which could promote a discussion about the intensity of treatment, and initiate shared decision-making. [ABSTRACT FROM AUTHOR]

The progressive increase in the prevalence of chronic non-communicable diseases (CNCD) has generated a need to change the paradigms in interpreting research about therapeutic and disease control strategies. One aspect to keep in mind is the incorporation of risk awareness that CNCD treatment implies, which creates uncertainty in the treatment result, compared to the curative paradigm that occurs in communicable diseases where a cure is expected. Another aspect is related to clinical trials result reports, where substitute results are used frequently. For example, the therapeutic goal of reducing glycosylated hemoglobin in a diabetic patient instead of showing the results based on treatment benefit (such as prevention of myocardial infarction). Problems arise when looking for a substitute that can replace the result that really matters. That is why we must be alert to the widespread use of results grouping (composite outcomes) which while they allow studies with fewer patients with shorter follow-up times and less expense, they can generate misleading results and show presumed untrue benefits due to improper selection of components of the "composite outcomes". In this article we draw attention to new challenges in the interpretation of scientific studies related to CNCDs. [ABSTRACT FROM AUTHOR]

The participation of the National Institute of Health as a leader in ethical and methodological assessment and its responsibility to approve the implementation of studies dates back to 1995. Since then, clinical trials have increased significantly until 2009; for this reason, a preliminary analysis was made to assess whether this increase has had an impact in the production of clinical trials on endemic topics or disease burden problems that must be researched and resolved by Peruvian people. For this purpose, a search in SCOPUS and MEDLINE was conducted, with 102 clinical trials in humans found, all of them designed, implemented and carried out in Peru on endemic or domestic health issues. Observation over time does not reveal any parallel increase or the inclusion of new research groups or researchers, no research on endemic problems has been carried out in our country; for example, clinical trials on the "Carrion's Disease" have not been conducted. Very few clinical trials have been promoted during this period by academic institutions and the civil society. Taking this into consideration, we can affirm that there is no positive influence in the generation of native clinical trials on local problems that Peruvian people need to resolve. [ABSTRACT FROM AUTHOR]

There is a case of a 38 year-old male patient coming from an area where hepatic fascioliasis is endemic in Peru. He was hospitalized because he showed 4 weeks of symptoms like fever, intense myalgias, erythematous and painful injuries on limb extensions. The electromyography and nerve conduction velocity showed a global inlammatory myopathy. A skin biopsy showed polyarteritis nodosa-type vasculitis. During the evaluation process prior to the immunosuppressive therapy, hepatic Fasciola eggs were found in the parasitological examination of stools. The fascioliasis diagnosis was conirmed by fas2-ELISA: 0.46 (VN <0.20). Clinical symptoms started to subside after treatment with ticlabendazol. Contact with the patient was maintained for a year and there was no evidence of disease recurrence, and he was asymptomatic. [ABSTRACT FROM AUTHOR]

We report a 15-year-old male patient who presented with pain and edema on the right knee, fever, diaphoresis, headache, palpable lymph nodes and weight loss. Marked alteration of the epiphysis and proximal metaphysis of the tibia, and of the distal metaphysis of the femur were observed in the plain x-ray and MRI images. Biopsy and immunohistochemistry findings were compatible with diffuse large B-cell non-Hodgkin lymphoma. [ABSTRACT FROM AUTHOR]

Copyright of Revista Medica Herediana is the property of Universidad Peruana Cayetano Heredia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We present the case of a young woman who suffered cardiogenic due to by Coxsackie virus B6. The patient attended a private clinic with an acute gastroenteritis and after one hour of receiving hydratation,she developed hypotension and shock, severe hypoxemia and bilateral lung infiltrate. The patient entered the Intensive Care Unit, where she received hemodynamic support. Due to the clinical picture and cardiac enzymes increase, a cardiac failure was suspected and the echocardiographic findings suggested 'myocarditis". The evolution was successful and Coxsackie B6 virus infection diagnosis was made during the follow up by increase of the levels of antibodies for virus Coxsackie B6. [ABSTRACT FROM AUTHOR]

We performed a cross sectional study in Lari (3600 m), a highland rural community from Arequipa, Peru. We evaluated a body mass index (BMI), glycemia and lipid proile in 74 over 18 year persons. The mean age was 51.7 ± 18.0 years, 62.2% were women, mean of BMI was 25.6 ± 3.7. Prevalence of hypercholesterolemia was 40.6%, "low HDL" in 77% of the population (93.5% in women vs 50% in men, p <0.001) and elevated level of LDL was 71.7%. The prevalence of impaired fasting glycemia was 27%. In conclusion, we found high prevalence of impaired fasting glycemia, hypercholesterolemia and especially "low HDL" in high altitude rural natives. These indings must be considered to realize interventions in high altitude populations to avoid future cardiovascular complications. [ABSTRACT FROM AUTHOR]

We describe the case of a 37 year old woman, from Lima, with a clinical presentation characterized by arthralgia, not quantified fever, presence of erythematous nodules on lower limbs and erythematous papules on the dorsal region of fingers. A mediastinal lymphadenopathy was found on chest x-ray and CT scan. Lymph node biopsy was compatible with sarcoidosis. (Rev Med Hered 2010;21:51-55) [ABSTRACT FROM AUTHOR]

In order to determine the level of physical activity performed by outpatients with type 2 diabetes seen at a National Hospital in Lima, Peru, we surveyed 120 patients with the International Physical Activity Questionnaire (IPAQ). 66% were women, the mean age was 61.6 years, and 70% had poor glycemic control. 20% of the patients qualified as inactive, 68% as minimally active, and 12% had adequate physical activity. No relationship between physical activity, duration of disease, glycemic control, and body mass index was found. Age was negatively associated with physical activity. It is concluded that there are low levels of physical activity in patients with Type 2 diabetes and these are not focused on leisure activities that provide health benefits. [ABSTRACT FROM AUTHOR]

This study aimed to determine the use and perceptions towards information and communication technologies (ICT) in 206 patients with arterial hypertension, dyslipidemia and diabetes, recruited from the outpatient clinic in a national hospital in Lima, Peru. 54.4% were older adults and 70.4% were women. The use of daily phone calls was 44.7%. Most had never used a computer (78.2%), email (84%) or the Internet (84%). Many have never sent (80.6%) or received (69.9%) a text message. 70% had at some time forgotten to take their medicine. 72.8% would like to be reminded to take their medication and 67.9% had a family member who could help them with access to ICT. Despite the low use of ICT in this population, there is willingness and expectation from the patients to participate in programs that implement them. [ABSTRACT FROM AUTHOR]

Synthesis studies (SS): systematic review and meta-analysis are the basis for developing Health Economic Evaluations (HEE). SS allow us to obtain parameters for estimating probabilities and effectiveness from the combination of the results of primary studies, and, as they include in their methodology the selection, evaluation, systematization and synthesis processes, they are considered the irst level of hierarchy in scientiic evidence. Nevertheless, they can be prone to bias and methodological failures that can affect the validity of their results. This article initially presents the relevance of the randomization in the hierarchic classiication of research designs, then it reviews the main factors affecting the validity of the SS, emphasising the publication bias, the heterogeneity and the inclusion of primary studies with main objective differing from the one of the SS. Moreover, it presents individual studies like a valid alternative for the development of a SS. The conclusion is that one of the key aspects in a SS is the correct evaluation of the study types and the objective evaluation of their quality, being these primary or secondary. [ABSTRACT FROM AUTHOR]

Patients diagnosed with type 2 diabetes mellitus, who then become infected with SARS-CoV-2, are at greater risk of developing complications from COVID-19, which may even lead to death. Diabetes is a chronic condition that requires continuous contact with healthcare facilities; therefore, this type of patients should have regular access to medicines, tests and appointments with healthcare personnel. In Peru, care and treatment continuity have been affected since the national state of emergency due to COVID-19 began; because many healthcare facilities suspended outpatient consultations. The strategies presented in this study were developed by different Peruvian health providers in the pandemic context to ensure care continuity for people with diabetes. This article provides recommendations to strengthen primary healthcare, because it is the first level of healthcare contact for patients with diabetes. [ABSTRACT FROM AUTHOR]

Neurological infection by herpes simplex virus type 2 (HSV-2) is the cause of significant morbidity and mortality; and should be diagnosed and treated as soon as possible. Typically, it is characterized by fever, headache and behavioral changes. Symptoms association, laboratory tests results and diagnostic imaging are essential for early diagnosis and treatment of this disease, in order to prevent its fatal progression. We present the case of a 45-year-old male patient diagnosed with HSV-2 encephalitis due to chronic steroid use. In previously healthy adult patients, neurological HSV-2 infection due to chronic steroid use is extremely rare; and the association has not been previously described. [ABSTRACT FROM AUTHOR]

Objectives. To assess the level of health literacy and treatment compliance in high-blood pressure patients attending an outpatient clinic in a hospital in Lima, Peru. Materials and Methods. A cross-sectional study was conducted in 276 patients, who filled out a questionnaire with general characteristics, the SAHLSA-50 Test, and the Morisky-Green Test. The Chi-square test was used to assess the association between independent variables with treatment compliance and health literacy. Results. We found a 36% of inadequate health literacy and 15% treatment compliance. No association was found between these variables (p=0.155). There was an association between being a head of household (p=0.033) and having a partner (p=0.044) with the degree of health literacy. Conclusions. The percentage of health literacy was similar to that of Peruvian and Latin American studies, and the degree of treatment compliance was one of the lowest reported. No significant association was found between these two variables. [ABSTRACT FROM AUTHOR]

A cross-sectional study was conducted aimed at determining the frequency and the risk factors for bacteremia caused by extended-spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae in patients hospitalized in a public hospital in Lima. The study included patients over 14 years of age, with positive blood cultures during their hospitalization in Hospital Nacional Cayetano Heredia in 2016. Patients were classified according to the isolated bacterium (ESBL-producing or not). Bacteremia was caused by ESBL-producing Enterobacteriacea in 50.6% of the cases; 55.8% and 32.6% by E. Coli and K. pneumoniae, respectively. No differences were found regarding co-morbidity, or prior antibiotic use (62.8% of bacteremia due to ESBLproducing strains and 57% in the non-producing strains [p=0.595]). Half of the bacteremia cases due to Enterobacteriaceae in hospitalized patients are produced by ESBL-producing Enterobacteriaceae and, of these, 40% are acquired in the community. [ABSTRACT FROM AUTHOR]

This non-systematic bibliographic review examines the published Peruvian medical literature on arterial hypertension (HTN) as of December 2016. The results were divided into three thematic areas: self-knowledge, adherence to treatment, and control. We identified 197 articles, although only 15 were used for the analysis. Despite improvement in recent years, we found that the level of self-knowledge about HTN is poor. The level is better in urban areas, but is generally worse than in other Latin American cities. Moreover, despite improvement, HTN control is insufficient and worse than in other Latin American countries. Finally, adherence to treatment may be worse in the provinces. [ABSTRACT FROM AUTHOR]

In Latin America, there is almost nonexistense information about the prognosis of patients with stroke. We tried to ind one-year vital and functional prognosis from patients with "irst-ever stroke". We did a prospective cohort study, recruiting patients in the medicine service of a public hospital, and follow them up to one year after their irst-ever stroke. We collected baseline data, such as previous medical history and information about their stroke. We found mortality proportions, differences among subgroups, and compared their actual and initial functionality. We included 101 patients, 20.8% of whom died during the follow-up, with higher mortality in people over 65 years old and those severely disabled after the stroke. The functionality did not improve after one year. One out of ive patients with a irst-ever stroke dies a year after it, with higher mortality in elders and in people with severe disability. We conclude it is mandatory to develop a follow-up and support program to prevent unfavorable outcomes in patients who suffer stroke. [ABSTRACT FROM AUTHOR]

Objectives. Determine the prognosis at three months and associated factors of patients with altered mental status (AMS). Materials and methods. Cross-sectional study that included patients over 18 years of age admitted to the emergency room in a national hospital, with AMS, within twenty-four hours of onset and that required observation. The demographic, clinical and functional assessment information were taken from the medical record. A follow-up was made at three months by telephone. Results. The study included 290 patients, representing 4.1% of the total patients in the emergency room. Overall mortality was 24.2%, whereas in the subgroup of older adults was 28.1%; 19.3% in adults and 15.2% in young adults. The average age was 63.5 years and the elderly group constituted nearly two thirds of the population. 51% were males. The average hospital stay was 7 days. The most frequently associated causes were infectious diseases (44.1%), neurological (40.3%), respiratory (28.3%), metabolic (18.6%), and cardiovascular (17.2%) disorders. Mortality was associated with a) GCS levels <7 (OR 2.9, p<0.001) and b) functionality score of 5 on the modified Rankin scale (OR 8.2, p=0.03). Conclusions. AMS, present in 4% of emergency admissions, is associated with mortality in one in four people. The predominant cause infectious diseases. The commitment of the functionality was the main predictor of mortality. [ABSTRACT FROM AUTHOR]

The healthcare model is shifting from a paternalistic towards a more inclusive and participative approach, such as shared decision making (SDM). SDM considers patients as autonomous and responsible agents. SDM is a therapeutic approach where healthcare providers and patients share the best evidence available to make a decision according to the values and preferences of the patient. Decision aids are tools that can facilitate this information exchange. These tools help patients to increase knowledge about options, reduce decisional conflict and improve satisfaction. Additionally, communication skills play a key role within the professional-patient relationship, as they facilitate sharing information and preferences in an effective and respectful manner. This therapeutic approach could support the reduction of health inequalities that affect Latin America, as it promotes an active and informed participation of patients in their healthcare process [ABSTRACT FROM AUTHOR]

Hashimoto's thyroiditis is the most frequent cause of hypothyroidism. In the regions with no iodine deficiency, it is more frequent in women and of tentimes has a familial association. The symptoms and signs of hypothyroidism are systemic and depend on the duration and intensity of the thyroid hormone deficiency. Neuromuscular manifestations are seldom the only symptoms and signs present. We present the case of a young patient with severe myopathy, where rhabdomyolysis was the sole manifestation of severe hypothyroidism secondary to Hashimoto's thyroiditis. [ABSTRACT FROM AUTHOR]

Objectives. Determine whether tachypnea and subcostal retractions can be eficient predictors for the diagnosis of Community-Acquired Pneumonia (CAP) among children. Materials and methods. These were the databases used: PubMed, LILACS, The African Journal Database and The Cochrane Central Library. Original studies were included which assessed the diagnostic performance of the clinical criteria for tachypnea or subcostal retraction deined in accordance with the criteria of the World Health Organization (OMS) for CAP diagnosis in children = 5 with cough and fever. The likelihood ratio (LR), the diagnosis odds ratio (DOR), and their respective conidence intervals at 95% (IC95%) were estimated for each clinical test. Results. 975 studies were found, eight were included in the review. 4740 patients were enrolled and 3584 (75%) were analyzed, 916 (19%) of which had a CAP diagnosis. When data were combined, tachypnea had a positive LR of 3.16, (95% CI 2.11-4.73) and a negative LR of 0.36 (95% CI 0.23-0.57). The DOR was 10.63 (95% CI 4.4-25.66, I2=93%). When subcostal retractions were analyzed, a positive LR of 2.49 (95%CI 1.41-4.37) and a negative LR of 0.59 (95%CI 0.4-0.87) were obtained. The DOR was 5.32 (95%CI 1.88-15.05, I2=89%). Conclusions. The presence or absence of tachypnea and subcostal retractions can be used in CAP diagnosis; it is worth considering the relative uncertainty in its diagnostic power and relatively modest LR. The conidence of these results is low due to the inadequate quality of the related evidence. [ABSTRACT FROM AUTHOR]

A cross-sectional study evaluated 182 students in the last two years of medical school and 70 residents of a national hospital in Peru on the risk indicators used for reporting results in clinical trials. A questionnaire was used to assess the ability to recognize and calculate risk indicators most widely used in the epidemiological literature. From the participants, 19.4% did not recognize any of the indicators and 81.4% was not able to calculate them. The relative risk reduction was the most recognized indicator (55.2%), followed by the number needed to treat (51.6%), the absolute risk reduction (26.6%), and the hazard ratio (9.5%). In conclusion, medical students in the last two years of school and medical residents do not recognize or are able to calculate properly the risk indicators used in clinical trials [ABSTRACT FROM AUTHOR]

We performed a descriptive study taking on account the characteristics of the registries of the patients hospitalized at the Hospital Nacional Cayetano Heredia between the years 2000 and 2009 with stroke as hospitalization diagnosis. 2225 records were obtained from patients older than 18, with stroke. According to ICD-10, 1071 had diagnosis of ischemic stroke, 554 were hemorrhagic, 183 were subarachnoid hemorrhage, 49 were ischemic plus hemorrhagic, 10 were transient ischemic attack (TIA) and in 358 we were unable to specify the type of stroke. 352 deaths were recorded (19.6 %), most of them during the first 3 days. The male / female ratio was 1.09, the mean age 64.1 ± 17.2 years and the median length of hospital stay was 9 days. The most common associated conditions were high blood pressure, atrial fibrillation and type 2 diabetes mellitus. The mortality found is the highest reported in our country, constant in all age groups and higher in women. [ABSTRACT FROM AUTHOR]