Search

Background There is conflicting evidence about the use of biomarkers to diagnose left atrial thrombus in patients with atrial fibrillation. Objective The purpose of this study was to assess the diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation. Methods We searched 4 electronic databases from inception to December 16, 2020. The reference standard was left atrial thrombus detected by transesophageal echocardiography. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. We used a bivariate model to calculate the pooled sensitivity and specificity with their 95% confidence intervals (CIs). The optimal cutoff and predictive values were also estimated. Results Eleven cross-sectional studies involving 4380 patients were included. The median prevalence of left atrial thrombus was 12%. In 7 studies, the pooled sensitivity of D-dimer at 500 ng/mL was 50% (95% CI 26%–74%) and the pooled specificity was 88% (95% CI 76%–95%). The pooled sensitivity of age-adjusted D-dimer was 36% (95% CI 14%–66%) and the pooled specificity was 99% (95% CI 96%–99%) in 2 studies. The optimal cutoff of D-dimer was 390 ng/mL in 10 studies with a pooled sensitivity of 68% (95% CI 44%–85%) and a pooled specificity of 73% (95% CI 54%–86%). The positive and negative predictive values were 21.8% and 95.4%, respectively. The risk of bias was low or unclear for all domains. Concerns about applicability were low for almost all studies. Conclusion Our meta-analysis suggests that D-dimer has the potential to be useful to rule out left atrial thrombus in patients with atrial fibrillation.

Background and 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; I 2 =53%), early rebleeding (RR: 0.91; 95%CI: 0.66-1.24: I 2 =0%), late rebleeding (RR: 0.94; 95 CI: 0.56-1.60; I 2 =0%), blood transfusion (MD: 0.04; 95%CI: -0.31-0.39; I 2 =68%) and hospital stay (MD: -1.06; 95%CI: -2.80-0.69; I 2 =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; I 2 =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.

Purpose Hydroxychloroquine, chloroquine, azithromycin, and lopinavir/ritonavir are drugs that were used for the treatment of coronavirus disease 2019 (COVID‐19) during the early pandemic period. It is well‐known that these agents can prolong the QTc interval and potentially induce Torsades de Pointes (TdP). We aim to assess the prevalence and risk of QTc prolongation and arrhythmic events in COVID‐19 patients treated with these drugs. Methods We searched electronic databases from inception to September 30, 2020 for studies reporting peak QTc ≥500 ms, peak QTc change ≥60 ms, peak QTc interval, peak change of QTc interval, ventricular arrhythmias, TdP, sudden cardiac death, or atrioventricular block (AVB). All meta‐analyses were conducted using a random‐effects model. Results Forty‐seven studies (three case series, 35 cohorts, and nine randomized controlled trials [RCTs]) involving 13 087 patients were included. The pooled prevalence of peak QTc ≥500 ms was 9% (95% confidence interval [95%CI], 3%–18%) and 8% (95%CI, 3%–14%) in patients who received hydroxychloroquine/chloroquine alone or in combination with azithromycin, respectively. Likewise, the use of hydroxychloroquine (risk ratio [RR], 2.68; 95%CI, 1.56–4.60) and hydroxychloroquine + azithromycin (RR, 3.28; 95%CI, 1.16–9.30) was associated with an increased risk of QTc prolongation compared to no treatment. Ventricular arrhythmias, TdP, sudden cardiac death, and AVB were reported in

espanolLas enfermedades no transmisibles (ENT) son causa importante de carga de enfermedad en el Peru asi como en otros paises en desarrollo. Las respuestas para el control de las ENT requieren de investigacion multidisciplinaria, tanto a nivel local como internacional. Desde hace mas de 10 anos, CRONICAS: Centro de Excelencia en Enfermedades Cronicas, de la Universidad Peruana Cayetano Heredia, realiza investigacion en el campo de las ENT en el Peru. En el presente articulo se describen algunos estudios realizados, incluyendo los estudios epidemiologicos PERU MIGRANT, y la cohorte CRONICAS. Tambien se presentan resultados de revisiones sistematicas y resultados de intervenciones frente a las ENT. A traves de estos estudios llevados a cabo por el centro CRONICAS se senalan potenciales areas para afrontar las ENT en paises en desarrollo. EnglishNoncommunicable diseases (NCDs) are a major cause of disease burden in Peru as well as in other developing countries. Responses to control NCDs require multidisciplinary research, both locally and internationally. The CRONICAS Center of Excellence in Chronic Diseases at Universidad Peruana Cayetano Heredia, in Peru, has conducted scientific research in the field of NCDs in Peru for more than 10 years. This article highlights some of the scientific research, including epidemiological studies such as the PERU MIGRANT study, and the CRONICAS cohort study. We also summarize our results from systematic reviews in the field of NCDs and results of interventions to tackle NCDs. The scientific research studies conducted by CRONICAS signal potential advancements to counter NCDs in developing countries

Background and aim There is a current debate on the best approach for blood pressure (BP) reduction in patients with spontaneous intracerebral hemorrhage (ICH). Through this scoping review, we aimed to examine how research on reducing BP in ICH patients has been conducted and to clarify the evidence on which approach is the best (intensive vs. standard BP reductions). Methods We performed a scoping review and overview of reviews of the literature. We systematically searched clinical practice guidelines (CPGs), systematic reviews (SRs), and randomized controlled trials (RCTs) that compared intensive versus standard BP reduction. We searched in three databases from inception until March 2020. Two independent authors conducted the study selection, data extraction, quality assessment, and overlapping analysis of SRs. We performed a description and critical appraisal of the current body of evidence. Results We included three CPGs (with moderate to high quality); all of them recommended intensive reduction in specific clinical settings. We included eight SRs (with high overlap and critically low quality): two supported intensive reduction and four supported its safety, but not effectiveness. One SR reported that patients with intensive reduction had a significant risk of renal adverse events. We included seven RCTs (with limitations in randomization process); trials with large population did not found significant differences in mortality and disability. One RCT reported a significantly higher number of renal adverse events. Conclusions CPGs support the use of intensive BP reduction; however, most recent SRs partially supported or did not support it due to the association with renal events. It seems the range goal between 140 and 180 mmHg could be safe and equally effective than intensive reduction. We recommend further research in serious and non-serious events promoted by intensive reduction and outcomes homogenization across studies to ensure correct comparison.

Transparency is a key factor to understand how recommendations were reached and to decide whether to adopt them or not. Currently, the American Diabetes Association (ADA) recommends the usage of real-time continuous glucose monitors in certain subgroups of people living with type 1 diabetes mellitus. In this commentary we sought to critically appraise this recommendation, mainly regarding the outcomes assessed, the evidence used for each outcome, and how the balance of benefits and harms was made. We found that the decision-making process followed to reach the ADA recommendation was not clear, and that the final recommendation does not seem to be supported in the assessed evidence.

We aimed to synthesize the evidence from randomized controlled trials (RCTs) that determined the efficacy of adding omega-3 supplementation to the continuous sertraline therapy in adults with depression. Meta-analyses were performed using random effects. We used the Revised Cochrane risk of bias tool for randomized trials version 2.0. to assess the risk of bias. Four RCTs were included. The follow-up ranged from eight to 12 weeks. Regarding the Beck Depression Inventory, the pooled SMD was 0.50 (95% CI: -0.51, 1.50; I2: 94.1%). A subgroup analysis was performed regarding the presence of coronary disease: SMD -0.17 (95% CI: -0.41, 0.07; I2: 0.0%). Regarding the Beck Anxiety Inventory, the pooled MD was 0.03 (95% CI: -2.22, 2.28; I2: 0.0%). Regarding the Hamilton Depression Rating Scale, the pooled MD was 0.42 (95% CI: -1.44, 2.29; I2: 35.7%). All pooled outcomes presented a very low certainty of the evidence. Three RCTs presented a low risk of bias in all domains; however, one study presented some concerns in two domains. No essential reductions in the outcomes were found. A subgroup analysis suggested that may be better not to provide the supplementation in patients with coronary disease. The evidence is not enough to make recommendations.

Objetivos. Evaluar la asociación entre tener una especialidad médica y el ingreso económico mensual en médicos peruanos, y comparar los ingresos económicos entre áreas con mayor y menor densidad de médicos en Perú. Materiales y métodos. Se analizaron los datos de la Encuesta Nacional de Satisfacción de Usuarios de Salud realizada en Perú el año 2015. Esta encuesta con nivel de inferencia nacional fue realizada a médicos que laboran en establecimientos de salud de Perú. Se evaluó el ingreso económico considerando todas las actividades remuneradas del médico. Se calcularon las razones de prevalencia crudas y ajustadas (RP y RPa) y sus intervalos de confianza al 95% (IC95%) mediante regresiones de Poisson con varianza robusta, tomando en cuenta el muestreo complejo de la encuesta. Resultados. De 2219 médicos encuestados, se analizaron 2154 (97,0%) observaciones. La frecuencia de ganar >S/ 5000 (1572,3 USD) mensuales fue de 29,1% en médicos generales; 65,6% en especialistas; 63,0% en especialidades clínicas; 70,5% en especialidades quirúrgicas, y 55,7% en otras especialidades. En comparación a los médicos generales, los médicos con especialidades clínicas, quirúrgicas, y otras especialidades, tuvieron más probabilidades de ganar >S/ 5000 mensuales (RPa = 1,44, 1,49, y 1,26, respectivamente). La probabilidad de ganar >S/ 5000 fue mayor en quienes laboraban en departamentos con baja densidad de médicos. Conclusiones. Los ingresos económicos fueron mayores en médicos especialistas que en no especialistas. Los ingresos económicos fueron mayores en departamentos con menor densidad de médicos, lo cual puede animar a que los médicos laboren en dichos departamentos. Objectives. To evaluate the relationship between having a medical specialty and the monthly income of Peruvian doctors, and to compare the economic incomes among areas with higher and lower density of medical doctors in Peru. Materials and methods. We analyzed data of the National Satisfaction Survey of Health Users (in Spanish: ENSUSALUD) carried out in Peru in the year 2015. This survey, with a national level of inference, was performed on physicians working at health facilities in Peru. Monthly income was measured considering all paid activities of the physician. Crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence intervals (95% CI) were calculated through Poisson regression models with robust variance, taking into account the complex sampling of the survey. Results. Out of 2 219 Physicians surveyed, 2 154 (97.0%) observations were analyzed. The probability of earning > S/5 000 (1 572.3 USD) per month was 29.1% for general practitioners; 65.6% for specialists; 63.0% for clinical specialists; 70.5% for surgeons, and 55.7% for other specialties. Compared to general practitioners, physicians with clinical, surgical, and other specialties were more likely to earn > S/5 000 per month (aPR = 1.44, 1.49, and 1.26, respectively). The probability of earning > S/5 000 was higher in those working in departments with low medical density. Conclusions. Monthly incomes were higher for specialist physicians than for non-specialists. Economic incomes were higher in departments with lower density of physicians, which may encourage physicians to work in these departments.

To evaluate the relationship between having a medical specialty and the monthly income of Peruvian doctors, and to compare the economic incomes among areas with higher and lower density of medical doctors in Peru.: We analyzed data of the National Satisfaction Survey of Health Users (in Spanish: ENSUSALUD) carried out in Peru in the year 2015. This survey, with a national level of inference, was performed on physicians working at health facilities in Peru. Monthly income was measured considering all paid activities of the physician. Crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence intervals (95% CI) were calculated through Poisson regression models with robust variance, taking into account the complex sampling of the survey.Out of 2 219 Physicians surveyed, 2 154 (97.0%) observations were analyzed. The probability of earningS/5 000 (1 572.3 USD) per month was 29.1% for general practitioners; 65.6% for specialists; 63.0% for clinical specialists; 70.5% for surgeons, and 55.7% for other specialties. Compared to general practitioners, physicians with clinical, surgical, and other specialties were more likely to earnS/5 000 per month (aPR = 1.44, 1.49, and 1.26, respectively). The probability of earningS/5 000 was higher in those working in departments with low medical density.Monthly incomes were higher for specialist physicians than for non-specialists. Economic incomes were higher in departments with lower density of physicians, which may encourage physicians to work in these departments.Evaluar la asociación entre tener una especialidad médica y el ingreso económico mensual en médicos peruanos, y comparar los ingresos económicos entre áreas con mayor y menor densidad de médicos en Perú.Se analizaron los datos de la Encuesta Nacional de Satisfacción de Usuarios de Salud realizada en Perú el año 2015. Esta encuesta con nivel de inferencia nacional fue realizada a médicos que laboran en establecimientos de salud de Perú. Se evaluó el ingreso económico considerando todas las actividades remuneradas del médico. Se calcularon las razones de prevalencia crudas y ajustadas (RP y RPa) y sus intervalos de confianza al 95% (IC95%) mediante regresiones de Poisson con varianza robusta, tomando en cuenta el muestreo complejo de la encuesta.De 2219 médicos encuestados, se analizaron 2154 (97,0%) observaciones. La frecuencia de ganarS/ 5000 (1572,3 USD) mensuales fue de 29,1% en médicos generales; 65,6% en especialistas; 63,0% en especialidades clínicas; 70,5% en especialidades quirúrgicas, y 55,7% en otras especialidades. En comparación a los médicos generales, los médicos con especialidades clínicas, quirúrgicas, y otras especialidades, tuvieron más probabilidades de ganarS/ 5000 mensuales (RPa = 1,44, 1,49, y 1,26, respectivamente). La probabilidad de ganarS/ 5000 fue mayor en quienes laboraban en departamentos con baja densidad de médicos.Los ingresos económicos fueron mayores en médicos especialistas que en no especialistas. Los ingresos económicos fueron mayores en departamentos con menor densidad de médicos, lo cual puede animar a que los médicos laboren en dichos departamentos.