9 results on '"Lourdes Aranda"'
Search Results
2. Out-of-pocket Expenditure in Childhood Cancer during the COVID-19 pandemic in an LMIC
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Rodolfo Paredes, Miguel Gonzales, Sharon Chavez, Christopher Machado, Isabel Hurtado, Essy Maradiegue, Lourdes Aranda, Victor Palacios, Erick Mattos, Annaly Benavente, Henry Garcia, Liliana Vasquez, Mariela Tello, Betsy Cabrera, Carolina Riojas, Ivan Maza, and Claudia Pascual
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Informal sector ,Vulnerability model ,Coronavirus disease 2019 (COVID-19) ,Political science ,Environmental health ,Childhood cancer ,Pandemic ,medicine ,Cancer ,medicine.disease ,Economic Income - Abstract
The COVID-19 pandemic has led to unprecedented economic and health vulnerability and inequities globally. This study aims to determine the out-of-pocket (OOP) expenditure of families of children with cancer in Peru before and during the COVID-19 pandemic. We conducted a cross-sectional survey of 235 parents and caregivers of children diagnosed with cancer in Peru. Our study suggests that OOP expenses in these families constitute a catastrophic expense for health. This situation was aggravated due to a decrease in the economic income for most families due to the disruption in formal and informal employment.
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- 2021
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3. Guía de Práctica Clínica para el manejo de pacientes con Leucemia Linfoblástica Aguda en el Seguro Social del Perú (EsSalud)
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Alvaro Taype-Rondan, Wendy Nieto-Gutierrez, Sergio Goicochea Lugo, Raúl Timaná Ruiz, Ninoska Rojas Soto, Renee Mercedes Eyzaguirre Zapata, Cecilia Arteta Altamirano, Franko O. Garcia-Solorzano, Mariela del Carmen Moreno Larrea, Marlies Pizarro Perea, and Lourdes Aranda Gomero
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Clinical Practice ,General Computer Science ,Clinical evidence ,business.industry ,Pharmacological management ,Medicine ,Guideline development ,business ,Humanities - Abstract
espanolIntroduccion: El presente articulo resume la guia de practica clinica (GPC) para el manejo de pacientes con leucemia linfoblastica aguda (LLA) en el Seguro Social del Peru (EsSalud). Objetivo: Proveer recomendaciones clinicas basadas en evidencia para la evaluacion y el manejo de pacientes con LLA en EsSalud. Metodos: Se conformo un grupo elaborador de la guia (GEG) que incluyo medicos especialistas y metodologos. El GEG formulo 8 preguntas clinicas a ser respondidas por la presente GPC. Se realizo busquedas sistematicas de revisiones sistematicas y –cuando fue considerado pertinente– estudios primarios en PubMed y CENTRAL durante el 2019. Se selecciono la evidencia para responder cada una de las preguntas clinicas planteadas. La certeza de la evidencia fue evaluada usando la metodologia Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periodicas, el GEG uso la metodologia GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas practicas clinicas y el flujograma de evaluacion y manejo. Finalmente, la GPC fue aprobada con Resolucion N° 23-DGPCFyT–IETSI-ESSALUD-2019. Resultados: La presente GPC abordo 8 preguntas clinicas, divididas en cuatro temas: diagnostico, medidas generales, manejo farmacologico, y manejo quirurgico de la LLA. En base a dichas preguntas se formulo 5 recomendaciones (3 recomendaciones fuertes y 2 recomendaciones condicionales), 20 puntos de buena practica clinica, y 3 flujogramas. Conclusion: El presente articulo resume la metodologia y las conclusiones basadas en evidencias de la GPC para el diagnostico y manejo de LLA en EsSalud. EnglishIntroduction: This article summarizes the clinical practice guidelines (CPG) for the management of patients with ALL in the Social Security of Peru (EsSalud). Objective: To provide clinical evidence-based recommendations for the evaluation and management of patients with ALL in EsSalud. Methods: A CPG for the diagnosis and management of patients with ALL in EsSalud was developed. To this end, a guideline development group (local GDG) was established, including medical specialists and methodologists. The local GDG formulated 8 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when it was considered pertinent- primary studies were conducted in PubMed and CENTRAL during 2019. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and flowcharts of evaluation and management. Lastly, the CPG was approved with Resolution N° 23-DGPCFyT–IETSI-ESSALUD-2019. Results: This CPG addressed 8 clinical questions, divided into four topics: diagnosis, general measures, pharmacological management, and surgical management of ALL. Based on these questions, 5 recommendations (3 strong recommendations and 2 weak recommendations), 20 points of good clinical practice, and 3 flowcharts were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions from the CPG for the diagnosis and management of ALL in EsSalud.
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- 2021
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4. CT-107: Coronavirus Disease in Bone Marrow Transplant (BMT) Recipients at Edgardo Rebagliati Martins Hospital (HNERM) Lima, Peru
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Lourdes Aranda, Ruben Rodriguez, Vladimir Espinioza, Alfredo Wong, Susy Bazan, Juan Ramon Navarro, and Melissa Morales-Coloma
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myalgia ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Hematopoietic stem cell transplantation ,Internal medicine ,medicine ,cancer ,education ,Multiple myeloma ,immunosuppressed ,education.field_of_study ,business.industry ,BMT ,Mortality rate ,COVID-19 ,Hematology ,medicine.disease ,mortality ,Cellular Therapy ,Lymphoma ,medicine.anatomical_structure ,Oncology ,Cohort ,Bone marrow ,medicine.symptom ,business ,CT - Abstract
SARS-CoV-2 and the COVID-19 pandemic have changed hematopoietic stem cell transplantation and medical practices worldwide. This is a single-institution cohort of 221 bone marrow recipients at HNERM in Lima, Peru. Patients were transplanted from January 2019 to December 2020. All were maintained under close SARS-CoV-2 vigilance and were followed up until April 2021.We excluded patients who had coronavirus disease prior to transplant. Among patients, 23 (10.4%) developed COVID-19. The detection of the virus based on PCR from nasopharyngeal swabs performed at the presentation of symptoms (fever, cough, and dyspnea) or if clinical/familiar/close contacts with COVID-19 was reported. We analyzed 109 (49.3%) autologous and 66 (29.8%) fully matched related allografts with methotrexate and cyclosporine as GVHD profilaxis and 46 (20.8%) haploidentical allografts with post-transplant cyclophospamide (PTCy). Median age for positive cases was 43.2 years (range 8.7–71.9). M/F ratio was 2/1. Median age for negative cases was 39.4 years (range 3.2–70.3). The median Hematopoietic Comorbidity Index (HCT-CI) score was 1.04 (range 0–5) for SARS-CoV-2-positive cases. COVID-19 disease was more often observed among haplo-identical (7/46, 15.2%), auto-BMT (12/109; 11%) and fully matched related allografts (4/66; 6.06%). Median time from BMT to positive SARS-CoV-2 PCR was 13.3 months (range 5.5–24.5). Six cases each (26%) were multiple myeloma (MM) and lymphoma (L), 5 cases were ALL (21.7%), 4 cases were AML (17.4%), and 1 case each (4.35%) was MDS and autoimmune disease. Most patients developed mild COVID-19 (n=19; 82.6%), with cough, fatigue, and myalgia as frequent symptoms. Severe COVID-19 developed in 4 cases (17.4%) requiring mechanical ventilation, 2 of whom died. Both of the lethal cases were middle-aged men who received auto-BMT for MM and L at 18.57 and 2.43 months after transplant. The HCT-CI scores were 3 and 1. The mortality rate for SARS-CoV-2 positive patients was 8.7%, much higher than among the general population in Peru (2.84%), but less than in HNERM (46.4%). Our cohort showed COVID-19 disease in BMT patients is more frequent in men, similar to the general population. Most of the cases were observed for auto-BMT, specifically among MM and L patients, with similar frequency for both.
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- 2021
5. Evaluación de una intervención logopédica en pacientes con la enfermedad de Alzheimer en tratamiento colinérgico: Un estudio piloto
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Miguel López-Zamora, Lourdes Aranda, and Miriam Cánovas-Cano
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Gynecology ,Psychiatry and Mental health ,Clinical Psychology ,medicine.medical_specialty ,Tratamiento farmacologico ,Pharmacological therapy ,business.industry ,medicine ,Cognitive deterioration ,In patient ,business ,Speech therapy ,Pharmacological treatment - Abstract
Evaluation of a speech therapy in patients with Alzheimer's disease under cholinergic treatment: A pilot study. The intervention on Alzheimer's disease (AD) has shown that pharmacological treatments with acetylcholinesterase inhibitors are highly beneficial. There is not much evidence if other treatments are effective, because it is difficult to find patients who are not medicated. In the present study a logopedic intervention in patients with AD in the mild phase, with and without pharmacological treatment, was verified. The results show that logopedic intervention slows the deterioration of the disease. The combination of logopedic intervention and pharmacological therapy is confirmed as the therapeutic option that most benefits the patient, while patients who only received one of the treatments show a more pronounced cognitive deterioration. The conclusions indicate that the pharmacological approach is necessary but insufficient, and that a logopedic intervention may be an adequate and effective complement in AD. Keywords : Alzheimer disease; Speech therapy; Acetylcholinesterase inhibitors. Resumen: Al intervenir en pacientes con la enfermedad de Alzheimer (EA) se ha comprobado que los tratamientos farmacologicos con inhibidores de acetilcolinesterasa resultan altamente beneficiosos, pero existen pocas evidencias sobre la efectividad de otros tratamientos debido a que es dificil encontrar pacientes que no esten medicados. En el presente estudio piloto se comprueba la efectividad de una intervencion logopedica en enfermos con EA en fase leve, con y sin tratamiento farmacologico. Los resultados muestran que la intervencion logopedica frena el deterioro de la enfermedad. La combinacion de intervencion logopedica y terapia farmacologica es la opcion terapeutica que mas beneficios reporta al paciente, mientras que los enfermos que solo recibieron uno de los tratamientos muestran un deterioro cognitivo mas pronunciado. Las conclusiones indican que la aproximacion farmacologica es necesaria pero insuficiente, y que una intervencion logopedica puede ser un complemento adecuado y eficaz de la EA. Palabras clave : Enfermedad de Alzheimer; Intervencion logopedica; Inhibidores de acetilcolinesterasa.
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- 2019
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6. Haploidentical Bmt and Post Transplant Cyclophosphamide: First Peruvian Experience
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Alfredo Wong, Mariela Moreno, Juan Ramon Navarro, Mayra Castillo, and Lourdes Aranda
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Transplantation ,Pediatrics ,medicine.medical_specialty ,business.industry ,Post transplant cyclophosphamide ,medicine ,Hematology ,business - Published
- 2018
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7. Temporary inactivation of the supramammillary area impairs spatial working memory and spatial reference memory retrieval
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Jorge L. Arias, Luis J. Santín, Jose A. Aguirre, Lourdes Aranda, Azucena Begega, and Jorge Sánchez-López
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Male ,medicine.medical_specialty ,Time Factors ,Microinjections ,Mammillary Bodies ,Experimental and Cognitive Psychology ,Tetrodotoxin ,Audiology ,Spatial memory ,Task (project management) ,Developmental psychology ,Rats, Sprague-Dawley ,Behavioral Neuroscience ,medicine ,Animals ,Anesthetics, Local ,Maze Learning ,Spatial analysis ,Memory Disorders ,Behavior, Animal ,Working memory ,Cognition ,Spatial knowledge ,Rats ,Memory, Short-Term ,Space Perception ,Reference memory ,Mental Recall ,Exploratory Behavior ,Psychology - Abstract
The aim of our study was to examine the supramammillary (SuM) area involvement in spatial memory. Sprague-Dawley rats with chronically implanted cannula in the supramammillary area were trained in two spatial memory tasks with different memory demands: reference and working memory. In the spatial reference memory task, the rats received microinjections in the SuM area of tetrodotoxin (TTX) (0.5 ng diluted in 0.5 microL of saline) or saline (0.5 microL). The microinjections were administered 30 min before the spatial training (day 4) (to assess the effect on acquisition) and on the following two days (days 5 and 6) the training was conducted without microinjections (to study the effect on consolidation). On the last training day (day 7), in order to assess the retrieval of spatial information, the rats received the microinjections 30 min before the spatial training. The spatial working memory used was a delayed-matching-to-position (DMTP) task. Spatial training was performed for seven days. During the first three days of the spatial training, the rats achieved a good spatial knowledge and learnt the working memory rule necessary to solve the spatial task. On days 4 and 6, the rats received microinjections to study involvement of the SuM area in working memory. The results showed that temporary inactivation of SuM area impairs both the rat's ability to solve a spatial working memory task with DMTP demands and the recovery of spatial information in a spatial reference memory task. We suggest that SuM area is involved in the rearrangement of spatial information during spatial working memory tasks with DMTP memory demands.
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- 2008
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8. General Outcome of Four Years Experience in the Treatment of Acute Lymphoblastic Leukemia in the National Hospital Edgardo Rebagliati Martins. Lima- Peru
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Jackeline Rodriguez, Lourdes Aranda, Ninoska Rojas, Sergio Murillo, Juan Ramon Navarro, and Mariela Moreno
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education.field_of_study ,Acute leukemia ,Pediatrics ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Immunology ,Population ,Cell Biology ,Hematology ,Disease ,medicine.disease ,Biochemistry ,Leukemia ,Prednisone ,Acute lymphocytic leukemia ,medicine ,Sibling ,education ,business ,medicine.drug - Abstract
Abstract 4105 Considering our Pediatric Hematology Unit (PHU), as a social security national reference Unit, one third of the hospitalized children population have acute leukemia in the Pediatrics Department of the National Hospital Hospital Edgardo Rebagliatti Martins- ESSALUD, Lima - Perú. PURPOSE: To analyze survival outcome and behavioral of the disease in children with acute lymphoblastic leukemia (ALL) in a Social Security Hospital of a Developing country. PATIENTS AND METHODS: We analyze 100 pediatrics patients (less than 14 years old) diagnosed with acute lymphoblastic leukemia (ALL) since 2005 to 2008. Disease-free survival (DFS) was computed according to the Kaplan-Meier method and long rank test, using the SPSS 15.0. RESULTS: A total of 100 children were evaluated. The major incidence according to age was in the group of children between 1 and 9 years old (76%); there were no difference between gender: 51% females and 49% males. The B type was the most common diagnosed leukemia: The B CALLA positive (CD10, CD19, HLA, DR) was the most frequent inmunophenotype, present in 87 children (87%). T-cell ALL was seen in 7%, bi-phenotype and Pro B in 3%. According to our risk stratification protocol, 34 patients were in the very high risk group (VHR), 47 patients in the high risk (HR) group and 19 patients in the intermediate-low risk (ILR) group. About Kariotype evaluation, the most common presentations were normal and hyperdiploid kariotype (67%). We achieved Complete Remission in 95% of our patients post 4 weeks Induction therapy (“A” Induction period). The Total 4th year disease free survival was 48.9% (36.3% VHR, 50.4% HR and 75.9% ILR); of these 61.8 ± 6.2% had DFS after 2 years of therapy and 55.9±6.9 % after 3 years. The Disease Free Survival was significantly increased on those with the following risk factors at diagnosis: white blood cell count < 100 000/mm3 (P= 0.002), normal or hyperdiploid kariotype (P CONCLUSION: The Total DFS was 48.9%. WBC count below 100,000 mm3; normal and hyperdiploid kariotypes, correlate with best DFS. The MDR >1%, was correlated with poor DFS (less than 10 months). The no responding prednisone group must receive a more intensive chemotherapy (the treatment of the immediately superior risk group). The poor DFS at 4 years explain the reason of our therapeutic decision to perform a sibling stem cell Transplant, in those pediatric patients with HR or VHR Acute Lymphoblastic Leukemia (BMT with a 12 year disease free survival of 59.8%). Disclosures: No relevant conflicts of interest to declare.
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- 2009
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9. 12 Years Experience in Peru with Related Allogeneic Stem Cell Transplantation (allo-sct) in Children with High Risk ALL
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Jackeline Rodriguez, Juan Ramon Navarro, Lourdes Aranda, Sergio Murillo, Gloria Chumpitaz, and Mariela Moreno
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Pediatrics ,medicine.medical_specialty ,Childhood leukemia ,business.industry ,Immunology ,Cell Biology ,Hematology ,medicine.disease ,Biochemistry ,Gastroenterology ,Transplantation ,Leukemia ,medicine.anatomical_structure ,Graft-versus-host disease ,Statistical significance ,Internal medicine ,medicine ,Bone marrow ,business ,Etoposide ,Progressive disease ,medicine.drug - Abstract
Abstract 3356 Poster Board III-244 Background: ALL accounts for approximately 70-83% of all childhood leukemia. High risk ALL is a big problem in our country and allogeneic related HSCT has proven to be a curative treatment for high risk patients with ALL. Patients and Methods: We analyzed the clinical data of 51 children (27 boys and 24 girls) with ALL undergoing related BMT/PSCT from Edgardo Rebagliati Hospital between 1996 and 2008. Survival probabilities were analyzed by Kaplan and Meier method. Outcome of different subgroups was compared by the log-rank test. Results: The recipients median age at transplantation was 10.7 years (range, 1 - 18 years). The disease status at conditioning were 1st CR (n=33), 2nd CR or more (n=18). The median interval from diagnosis to BMT was 14 months (range, 4 - 93 months). We have used two conditioning regimen: TBI/CTX/VP16 (TBI-1200Gy/CTX-120 mg/kg/ VP16-40mg/kg) in 34 patients (66.7%) or TBI/CTX 16 (31.4%) and 1 patient (2%) standard BuCy conditioning regimen. Graft-versus-host disease (GVHD) prophylaxis was methotrexate and cyclosporin. The median infused CD34 cell number was 6.21×106/kg (range 1.61-14.9×106/kg). The resource of hematopoietic cell was bone marrow 33.3% (17 patients), peripheral blood, 64.7% (33 patients) and both 2% (1 patient). Acute GVHD occurred in 10 (19.6%) patients, and chronic GVHD occurred in 15 (29.4%) patients. Twelve year overall survival (OS) is 59.8% ± 8.7% (n= 51) and leukemia-free survival probabilities (DFS) were 62.9% ± 8.2%. Patients with 1st CR and 2nd CR had a 5 year EFS of 60.1% and 67.3% (log-rank test, P 0.92), respectively. The mortality non related to transplant was 29.5%; 10 patients (19.6%) due to progressive disease and five patients (9.9%) by sepsis. Conclusions: Allo-SCT is well tolerated in high risk ALL children with prolonged OS and DFS. Not found statistical significance on OS and DFS between the conditioning regimen used, between status pre-transplant (1st CR vs 2nd CR) and we found statistical significance in favor to PB as a source of SC on DFS. Disclosures: No relevant conflicts of interest to declare.
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- 2009
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