Repositorio Académico UPC

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Objectives. We aimed to assess if Caesarean section is a risk factor for overnutrition in early- and late-childhood, and to assess the magnitude of the effect of child- versus family-related variables in these risk estimates. Methods. Longitudinal data from Peruvian children from the Young Lives Study was used. Outcomes assessed were overweight, obesity, overnutrition (overweight plus obesity), and central obesity (waist circumference) at the age 5 (first follow-up) and 7 (second follow-up) years. The exposure of interests was delivery by Caesarean section. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated using multivariable models adjusted for child-related (e.g., birth weight) and familyrelated (e.g., maternal nutritional status) variables. Results. At baseline, mean age was 11.7 (± 3.5) months and 50.1% were boys. Children born by Caesarean section were 15.6%. The 10.5% of the children were overweight and 2.4% were obese. For the obesity outcome,...

BACKGROUND: Among patients with obstructive sleep apnea (OSA) a higher number of medical morbidities are known to be associated with those that have obesity hypoventilation syndrome (OHS) compared to OSA alone. OHS can therefore pose a higher risk of postoperative complications after elective non-cardiac surgery (NCS) and is often unrecognized at the time of surgery. The objective of this study was to retrospectively identify patients with OHS and compare their postoperative outcomes with those who have OSA alone. METHODS: Patients meeting criteria for OHS were identified within a large cohort of patients with OSA who underwent elective NCS at a major tertiary care center. We identified postoperative outcomes associated with OSA and OHS as well as the clinical determinants of OHS (BMI, AHI). Multivariable logistic or linear regression models were used for dichotomous or continuous outcomes, respectively. RESULTS: Patients with hypercapnia from definite or possible OHS, and overlap...

Importance Cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear. Objective To conduct a systematic review of the benefits and adverse events (AEs) of cannabinoids. Data Sources Twenty-eight databases from inception to April 2015. Study Selection Randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome. Data Extraction and Synthesis Study quality was assessed using the Cochrane risk of bias tool. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis. Main Outcomes and Measures Patient-relevant/disease-specific outcomes, activities of daily living, quality of life, g...

This cross-sectional study analyzed the association between poor quality of sleep and adherence to highly active antiretroviral therapy (HAART) in 389 Peruvian patients with HIV/AIDS. Poor quality of sleep was measured with the Pittsburgh Sleep Quality Index (PSQI) and adherence with the CEAT-VIH (Peruvian adaptation). A Poisson generalized linear model with robust standard errors was used to estimate prevalence ratios and 95%CI. A crude model showed that mild, moderate, and severe poor quality of sleep were associated with inadequate treatment adherence. In the adjusted model for variables associated in the bivariate analysis or variables theoretically associated with adherence, only moderate/severe poor quality of sleep remained associated (PR = 1.34, 95%CI: 1.17-1.54; and PR = 1.34, 95%CI: 1.16-1.57, respectively). The study concluded that moderate/severe poor quality of sleep was independently associated with adherence to HAART. Assessing quality of sleep may be helpful in the comp...

A 37-year-old woman with history of Evans Syndrome with poor response to high-dose corticoid treatment presented to the emergency department with gastrointestinal and vaginal bleeding. The patient was later diagnosed with severe thrombocytopenia and a stage G1, well-differentiated gastric neuroendocrine tumor, confirmed by a biopsy. A total gastrectomy was performed to eradicate the tumor. After being treated with a total splenectomy for her Evans Syndrome with no clinical or laboratory improvement, she began regular treatment with octreotide on the basis of a possible hepatic metastasis. Days after the initiation of the octreotide, an increase in the platelet count was evidenced by laboratory findings, from 2,000 platelets/mm3 to 109,000 platelets/mm3 . Weeks later, the hepatic metastasis is discarded by a negative octreotide-body scan, and the octreotide treatment was interrupted. Immediately after the drug interruption, a progressive and evident descent in the platelet count...

Background: Gastroenteritis by rotavirus is responsible for approximately 810 annual deaths/year in children under 5 years in Peru and emerging rotavirus genotypes have led to concerns regarding cross-protection by the vaccines available. Moreover, there are no reports on the molecular-epidemiology of rotavirus diarrhea in Peru Methodology: A total of 131 stool samples were obtained from children under 5 years old hospitalized from January 2010 to December 2012 in the Hospital Regional de Cajamarca, Peru. ELISA and RT-PCR techniques were performed for rotavirus detection. G and P typing of rotavirus-positive samples were obtained by semi-nested multiplex RT-PCR and sequencing was performed to confirm the PCR results. Results: Of the 117 samples available, 18.80% (22/117) tested positive for rotavirus by ELISA and 35.90% (42/117) by RT-PCR. Among the G-genotype identified, G9 in 35.71% (15/42) and G12 in 33.33% (14/42) were the most prevalent. With the most common combination being G1...

Background Persistent diarrhoea (diarrhoea lasting more than 14 days) accounts for one third of all diarrhoea related deaths in developing countries in some studies. Probiotics may help treatment. Objectives To evaluate probiotics for treating persistent diarrhoea in children. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, and LILACS. We also contacted authors of included trials and organizations working in the field, and checked reference lists. The date of the most recent search was 13 December 2012 Selection criteria Randomized controlled trials comparing a specified probiotic agent with placebo or no probiotic in children with persistent diarrhoea. Data collection and analysis Two review authors assessed the eligibility, risk of bias, extracted and analysed data. Differences were resolved by discussion. Statistical analysis were performed using the fixed-effect model and the results were expressed as me...

Background: Long-term exposure to anti-tuberculosis medication increases risk of adverse drug reactions and toxicity. The objective of this investigation was to determine factors associated with anti-tuberculosis adverse drug reactions in Lima, Peru, with special emphasis on MDR-TB medication, HIV infection, diabetes, age and tobacco use. Methodology and Results: A case-control study was performed using information from Peruvian TB Programme. A case was defined as having reported an anti-TB adverse drug reaction during 2005–2010 with appropriate notification on clinical records. Controls were defined as not having reported a side effect, receiving anti-TB therapy during the same time that the case had appeared. Crude, and age- and sex-adjusted models were calculated using odds ratios (OR) and 95% confidence intervals (95%CI). A multivariable model was created to look for independent factors associated with side effect from anti-TB therapy. A total of 720 patients (144 cases and...

Facebook, a social networking service with over 100 million unique users, is widely established in many contexts around the world. A significant number of physicians have opened Facebook accounts [1, 2] , which is resulting in major ramifications for the medical profession. Authors:  Pereyra Elías, Reneé ;  Nizama-Vía, Ayar ;  Mayta Tristán, Percy Source:  Med Princ Pract   URL:  http://hdl.handle.net/10757/313796

Although often viewed as an action of last resort, going on strike remains a legal and often effective option for physicians seeking labor improvements and better working conditions. Indeed, in some countries, there have been reports of strikes by physicians (1, 2), followed by ensuing discussions of potential ethical implications (3 5). However, little has been said about the consequences of such a mass labor stoppage on undergraduate medical education and those students who aspire to the profession. Authors:  Carrillo-Larco, Rodrigo M. ;  Taype-Rondan, Alvaro ;  Pereyra Elías, Reneé Source:  Med Educ Online URL:  http://hdl.handle.net/10757/313754

Editor: La identificación de eventos adversos es un componente de alta relevancia en salud. En América Latina y el Caribe, tal medición no siempre es tenida en cuenta pese a la considerable frecuencia con que tales eventos son reportados — esto sin contar la proporción de casos que no se consignan en los registros. Se estima que 10 de cada 100 pacientes hospitalizados han presentado efectos adversos alguna vez durante la hospitalización y se espera que la tasa aumente a 20 si se duplica el número de días hospitalizados. En el Estudio Iberoamericano de Efectos Adversos (IBEAS), el primer trabajo a gran escala en la región sobre incidentes que causan daño en la asistencia sanitaria, realizado en 58 hospitales de cinco países, la prevalencia estimada de efectos adversos fue de 10%, hallándose además que más de 28% de los efectos adversos desencadenaron discapacidad y 6%, muerte. Authors:  Mondragón Cardona, Álvaro ;  Rojas Mirquez, Johana Carolina ;  Gómez Ossa, Ricardo ;...

Sr. Editor: El manejo de un paciente infectado por el virus de inmunodefi ciencia humana (VIH) implica un enfoque multidisciplinario que incluya diversas esferas de la salud de la persona1 . Sin embargo, en muchas oportunidades la evaluación se centra en marcadores meramente biológicos descuidando aspectos de índole psicológico y social que tendrían importante repercusión en la calidad de vida de estos pacientes. Dentro de ellos, las alteraciones del sueño (AS), son un factor a considerar, más aún cuando han demostrado tener un impacto negativo en la calidad de vida de las personas2 , asimismo, un incremento de la probabilidad de desarrollo de diabetes mellitus, enfermedad cardiovascular y dolencias respiratorias3 . Authors:  Díaz-Llanes, Bruno E. ;  Tello-Velásquez, Jorge R. ;  Mezones Holguin, Edward ;  Arévalo, Jorge ;  Rodríguez-Morales, Alfonso J. Source:  Revista Chilena Infectolología   URL:  http://hdl.handle.net/10757/313753

Introduction: One third of the world population is affected by latent tuberculosis, with 9.4 million new cases; medical students have 2 to 50 times the probability of acquiring the infection. Objectives: Establish the baseline prevalence of positive tuberculin skin test (TST) at the beginning of medical studies and determine the incidence and variables associated with TST conversion in medical students. Materials and Methods: Secondary analysis of a historical cohort (2007-2010) of medical students in a private Peruvian university. The TST conversion was evaluated. A binomial regression analysis was applied for each associated variable. Results: 707 medical students were included, of whom 219 (31%) were male. The basal prevalence of reactive TST was 14.4%. Signifi cant associations were found with the year of university entry of 2007-08 (p = 0.007) and a history of tuberculosis (p = 0.02). With a total of 822 person-years, the incidence of conversion was 2.92 cases per 100 pers...

Mucopolysaccharidosis I (MPS I) is a rare, recessively inherited, lysosomal storage disorder caused by deficiency on the enzyme α-L-iduronidase. This defect results in accumulation of heparan and dermatan sulfate in different tissues and organs due to a deficiency in the catabolism of glycosaminoglycans. The overall incidence of MPS I is 0.99-1.99/100.000 live births. There are three clinical presentations: Hurler (severe), Hurler Scheie (mild) and Scheie (mild). We report the case of a 10-years-old male patient diagnosed with Hurler syndrome, the severe presentation, 5 years ago by enzyme α-L-iduronidase activity measurement in leukocytes; with a history of recurrent respiratory infections, umbilical hernia, corneal opacity, coarse facial features, macroglossia, hearing loss, stiffness of joints, cardiac compromise, claw hands, mental retardation and stunted growth. After enzyme replacement therapy the patient has shown improvement of visceral symptoms, but the neurological damage con...

Sr. Editor. Una de las prioridades en salud pública a nivel global es el control de las enfermedades transmitidas por vectores, como el dengue, la malaria, la enfermedad de Chagas, la leishmaniasis, la bartonelosis, entre otras. El dengue es una enfermedad viral transmitida por la picadura de las especies del mosquito Aedes, cuya incidencia global se ha incrementado rápidamente en las últimas décadas, estimándose que causa alrededor de 230 millones de infecciones cada año, de los cuales 25 000 son mortales, localizándose principalmente en regiones tropicales y subtropicales (1). La región de las Américas, durante el año 2013, tuvo el mayor reporte histórico de casos, con más de 2,3 millones de casos notificados por los países. Autores:  Zamora, Antón ;  Galán Rodas, Edén ;  Ramírez, Eduardo ;  Rodríguez Morales, Alfonso J. ;  Mayta Tristán, Percy Fuente:  Revista Peruana de Medicina Experimental y Salud Pública URL:  http://hdl.handle.net/10757/558313

Objectives: Internet can accelerate information exchange. Social networks are the most accessed especially Facebook. This kind of networks might create dependency with several negative consequences in people’s life. The aim of this study was to assess potential association between Facebook dependence and poor sleep quality. Methodology/Principal Findings: A cross sectional study was performed enrolling undergraduate students of the Universidad Peruana de Ciencias Aplicadas, Lima, Peru. The Internet Addiction Questionnaire, adapted to the Facebook case, and the Pittsburgh Sleep Quality Index, were used. A global score of 6 or greater was defined as the cutoff to determine poor sleep quality. Generalized linear model were used to determine prevalence ratios (PR) and 95% confidence intervals (95%CI). A total of 418 students were analyzed; of them, 322 (77.0%) were women, with a mean age of 20.1 (SD: 2.5) years. Facebook dependence was found in 8.6% (95% CI: 5.9%–11.3%), whereas po...

Introduction:Insulinomas are pancreatic endocrine neoplasms with a low incidence between 1-4 cases per million per year. Case description: A female 49 years-old with neurological and psychiatric symptoms were treated for two years as a psychiatric patient. Presented a glucose value, which reflects hypoglycemia. The patient was operated with resolution of symptoms. Conclusion: Assess all patients with psychiatric symptoms and perform a complete medical history and laboratory findings, being the most opportune glucose. Key words: Insulinoma; hypoglycemia; psychiatry. Palabras clave: Insulinoma; hipoglicemia; psiquiátrico. Authors:  Colán T, Cristina ;  Gálvez G. , Andrea ;  Zevallos D., Carolina Source:  REV CHIL NEURO-PSIQUIAT URL:  http://hdl.handle.net/10757/311275

Dear editor: We read with greatinterestthe article Bullying among schoolchildren: differences between victims and aggressors, recently published in Gaceta Sanitaria.1 Motivated by this study, we would like to share information about the characteristics of victims and aggressors of bullying in Peru after an extensive literature search about this underexplored topic in our country and attempt some comparisons versus Spain as well as some concluding remarks and recomendations. Bullying in Peru, as very likely in Spain, is a hidden and yet latent phenomenon. Moreover, it varies across regions in our country and profiles might be different than what is found in Spain. In a study conducted in an urban Lima school in 2007, victims usually had fewer friends, spent more time alone at recess and exhibited decreased self-confidence than non-victims.2 Similarly, another study conducted in in 2009 found that adolescents with any physical defects are more prone to being bullied, being excluded by ag...

Sr. Editor. La formación en salud pública y atención primaria de la salud (APS) en las universidades del Perú, es un tema de vital importancia frente al gran reto del siglo XXI: subsanar las desigualdades en una generación, y alcanzar la equidad sanitaria (1). Para afrontar este reto, muchos de los gobiernos de países desarrollados y en vías de desarrollo han impulsado reformas en sus sistemas de salud, basados en la estrategia de atención primaria de la salud. En el Perú, el modelo integral de salud basado en familia y comunidad está siendo implementado por el Ministerio de Salud (MINSA) (2). Para llevar a cabo estas reformas, es indispensable contar con un número suficiente de profesionales de la salud formados en los principios y estrategias de la APS. Surge, entonces, otro gran reto del siglo XXI: transformar la educación en salud para que contribuya a reforzar los sistemas de salud (3). Authors:  Champin, Denisse ;  Risco de Domínguez, Graciela Source:  Rev Peru Med ...

Objectives. To design and validate a scale to assess Latin American medical students’ perception on first level of health care (FLHC). Materials and methods. An observational, analytic and multicentre study was carried out in two phases: i) A self-administered questionnaire regarding perceptions on FLHClabor was designed. ii) This questionnaire was applied to to medical students from 18 universities of eight Spanish-speaking Latin American countries. An exploratory factor analysis (EFA) was performed through a principal components analysis with orthogonal varimax rotation. Sample adequacy was evaluated. Factor extraction was based on Kaiser’s criteria, Cattell’s Scree test and the explained variance (>5%). Internal consistency was measured with Cronbach’s alpha. Results. 423 students were included in the analysis; 53.4% were from Peruvian universities. After the EFA, the questionnaire conserved 11 items, which were distributed in three domains, that explaining together 55.47% of the...