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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.

Background Coronary disease (CD) is the main cause of mortality worldwide. Data about trends and geographical variation in CD mortality is available in some American countries. This information varies among countries since CD risk factors frequencies vary. Objective To describe the trend and geographical variation of coronary disease (CD) mortality in Peru, 2005–2017. Methods Analysis of secondary data of the Peruvian Ministry of Health’s registry of deaths. We analyzed CD mortality. We described the absolute and relative frequency of deaths and age-standardized mortality rate (ASMR) by natural regions, departments, age, sex, and year. We also described the change of ASMR between two periods (2005–2010 vs. 2011–2017). Results There were 64,721 CD deaths between 2005 and 2017 (4.12% among all deaths). The absolute frequency of CD deaths was 5,665 and 6,565 in 2005 and 2017, respectively. CD mortality was more frequent in men and older adults. The ASMR varied among natural regions, being higher in the Coast (19.61 per 100,000 inhabitants). The change between the two periods revealed that almost all departments reduced their ASMRs, except for Callao, Lambayeque, and Madre de Dios. Conclusion CD mortality has increased in Peru. Mortality was higher in men and older adults, and it varied among departments. More political efforts are needed to reduce these trends.

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

Noncommunicable diseases (NCDs) are a major cause of disease burden in Peru as well as in other developingcountries. Responses to control NCDs require multidisciplinary research, both locally and internationally. TheCRONICAS 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 highlightssome of the scientific research, including epidemiological studies such as the PERU MIGRANT study, andthe CRONICAS cohort study. We also summarize our results from systematic reviews in the field of NCDsand results of interventions to tackle NCDs. The scientific research studies conducted by CRONICAS signalpotential advancements to counter NCDs in developing countries., Las enfermedades no transmisibles (ENT) son causa importante de carga de enfermedad en el Perú asícomo en otros países en desarrollo. Las respuestas para el control de las ENT requieren de investigaciónmultidisciplinaria, tanto a nivel local como internacional. Desde hace más de 10 años, CRONICAS: Centro deExcelencia en Enfermedades Crónicas, de la Universidad Peruana Cayetano Heredia, realiza investigación enel campo de las ENT en el Perú. En el presente artículo se describen algunos estudios realizados, incluyendolos estudios epidemiológicos PERU MIGRANT, y la cohorte CRONICAS. También se presentan resultados derevisiones sistemáticas y resultados de intervenciones frente a las ENT. A través de estos estudios llevadosa cabo por el centro CRONICAS se señalan potenciales áreas para afrontar las ENT en países en desarrollo.

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

Supplementary material

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.

Introducción: El año 2018 se publicó la Guía de práctica clínica (GPC) para la evaluación y el manejo de la hemorragia digestiva alta (HDA) del Seguro Social de Salud del Perú (EsSalud). Esta emite enunciados basados en evidencias, que buscan optimizar el manejo de estos pacientes. Objetivo: Evaluar la adherencia a los enunciados de dicha GPC en el Hospital Nacional Edgardo Rebagliati Martins (HNERM) de EsSalud (Lima, Perú). Materiales y métodos: Estudio retrospectivo, que analizó la base de datos de todos los pacientes que acudieron al servicio de emergencia del HNERM con sospecha de HDA y fueron programados para endoscopía entre el 19 de octubre del 2019 y el 15 de abril del 2020. Se incluyó a aquellos con ≥ 18 años de edad. Esta base contiene las principales características de la historia clínica estandarizada para pacientes con HDA. Se evaluó el cumplimiento de 13 de los 34 enunciados de la GPC de EsSalud. Los resultados se presentaron descriptivamente, y se evaluaron los factores asociados al cumplimiento de los enunciados con inadecuada adherencia (< 80%) y con más de 100 participantes evaluados. Resultados: Se obtuvieron datos de 184 pacientes que cumplieron con los criterios de inclusión (varones: 59,8%, mediana de edad: 70 años). El rango de adherencia a los 13 enunciados fue de 63,2% a 99,5%. Sólo dos enunciados tuvieron adherencia inadecuada ( 60, y menor hemoglobina al ingreso. Conclusión: De los 13 enunciados evaluados, 11 tuvieron una adherencia adecuada. Resulta importante profundizar en los motiv s cuales laadherencia no es adecuada para algunos enunciados, y valorar estrategias para aumentar esta adherencia.

BackgroundMost commonly used equations to estimate the glomerular filtration rate (GFR) are the CKD-Epidemiology Collaboration (CKD-EPI) and the Modification of Diet in Renal Disease (MDRD). However, it is not clear which one shows a better performance in Latin America. Objective To assess the performance of both estimated GFR (eGFR) equations in Latin American countries. Methods In January 2019, we performed a systematic search in PubMed, Scopus, and “Biblioteca Regional de Medicina” (BIREME) to identify studies that reported eGFR using CKD-EPI and MDRD equations and compared them with a measured GFR (mGFR) using exogenous filtration markers, among adults from Latin American countries. Study selection, data extraction, and risk of bias evaluation were performed by two reviewers independently. We performed meta-analyses of P30, bias (using mean difference [MD] and its 95% confidence intervals [95% CI]), sensitivity, and specificity; and evaluated certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results We included 12 papers, six of them were meta-analyzed (5 from Brazil and 1 from Mexico). Meta-analyses that compared CKD-EPI using creatinine measured with calibration traceable to isotope dilution mass spectrometry (CKD-EPI-Cr IDMS) and MDRD-4 IDMS did not show statistically significant differences in bias (5 studies, MD: 0.55 mL/min/1.73m 2 , 95% CI: -3.34 to 4.44), P30 (2 studies, MD: 4%, 95% CI: -4% to 13%), sensitivity (2 studies, 76% and 75%), and specificity (2 studies, 91% and 89%), with very low certainty of evidence for bias and P30, and low certainty of evidence for sensitivity and specificity. Conclusions We found that the performance of CKD-EPI-Cr IDMS and MDRD-4 IDMS do not differ significantly, although CKD-EPI-Cr IDMS tends to have a non-significant better performance in terms of P30. However, since most of the meta-analyzed studies were from Brazil, results may not be extrapolated to other Latin American countries. Trial registration CRD42019123434, PROSPERO. Registered 18 February 2019.

Protocol for critical and systematic review of the evidence of blood pressure reduction in patients with spontaneous intracerebral haemorrhage

Protocol for systematic review and meta-analysis of accuracy of the Geriatric Depression Scale-4 and Geriatric Depression Scale.5 for screening of depression among older adults.

BackgroundThe Geriatric Depression Scale (GDS) is a widely used instrument to assess depression in older adults. The short GDS versions that have four (GDS-4) and five items (GDS-5) represent alternatives for depression screening in limited-resource settings. However, their accuracy remains uncertain.ObjectiveTo assess the accuracy of the GDS-4 and GDS-5 versions for depression screening in older adults.MethodsUntil May 2020, we systematically searched PubMed, PsycINFO, Scopus, and Google Scholar; for studies that have assessed the sensitivity and specificity of GDS-4 and GDS-5 for depression screening in older adults. We conducted meta-analyses of the sensitivity and specificity of those studies that used the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases-10 (ICD-10) as reference standard. Study quality was assessed with the QUADAS-2 tool. We performed bivariate random-effects meta-analyses to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI) at each reported common cut-off. For the overall meta-analyses, we evaluated each GDS-4 version or GDS-5 version separately by each cut-off, and for investigations of heterogeneity, we assessed altogether across similar GDS versions by each cut-off. Also, we assessed the certainty of evidence using the GRADE methodology.ResultsTwenty-three studies were included and meta-analyzed, assessing eleven different GDS versions. The number of participants included was 5048. When including all versions together, at a cut-off 2, GDS-4 had a pooled sensitivity of 0.77 (95% CI: 0.70–0.82) and a pooled specificity of 0.75 (0.68–0.81); while GDS-5 had a pooled sensitivity of 0.85 (0.80–0.90) and a pooled specificity of 0.75 (0.69–0.81). We found results for more than one GDS-4 version at cut-off points 1, 2, and 3; and for more than one GDS-5 version at cut-off points 1, 2, 3, and 4. Mostly, significant subgroup differences at different test thresholds across versions were found. The accuracy of the different GDS-4 and GDS-5 versions showed a high heterogeneity. There was high risk of bias in the index test domain. Also, the certainty of the evidence was low or very low for most of the GDS versions.ConclusionsWe found several GDS-4 and GDS-5 versions that showed great heterogeneity in estimates of sensitivity and specificity, mostly with a low or very low certainty of the evidence. Altogether, our results indicate the need for more well-designed studies that compare different GDS versions.

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.Objectives. To evaluate the relationship between having a medical specialty and the monthly income of Peruviandoctors, and to compare the economic incomes among areas with higher and lower density of medical doctors inPeru. 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. 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.

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.

Objetivo: Determinar las expectativas y motivaciones institucionales de los estudiantes del primer semestre que ingresaron por primera vez a la carrera de Medicina de la Universidad Nacional Mayor de San Marcos en el año 2017. Metodología: Estudio cuanti-cualitativo, descriptivo, transversal que explora expectativas y motivaciones institucionales de los estudiantes de la carrera de Medicina Humana que ingresaron por primera vez a una universidad y cursaron el primer semestre en la Facultad de Medicina de San Fernando durante el año 2017. Se solicitó el consentimiento informado y aplicó un cuestionario previamente validado a la totalidad de ingresantes que cumplían con los criterios de inclusión. Resultados: De los 158 estudiantes encuestados, 100 (63.3%) ingresaron por primera vez a una universidad. Sus expectativas institucionales variaron entre BUENAS a REGULARES en relación a los diversos servicios que debería proporcionarles la universidad. Con respecto a las motivaciones, los estudiantes consideraron decisivas sus motivaciones familiares y los antecedentes médicos personales para la elección de la carrera; sin embargo, gran parte de estos estudiantes no considera relevante las motivaciones económicas. Por otro lado, existió desconocimiento de lo que significa la salud pública en este grupo de estudiante. Conclusiones: Los estudiantes de medicina de primer año ingresan con ciertas expectativas y motivaciones sobre la universidad, las cuales se encuentran influenciadas por algunos factores, como la familia o el conocimiento sobre el tema. La universidad debería conocer las expectativas y las motivaciones de los estudiantes para mejorar los servicios educativos que ofrece.

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.