Generación de un test predictivo para el diagnóstico de laetiología de la hemorragia digestiva alta variceal

Nuestro objetivo fue desarrollar un test diagnóstico para predecir la etiología de la Hemorragia Digestiva Alta Variceal (HDAV). Realizamos un estudio de cohorte retrospectivo. Se revisaron historias clínicas de pacientes mayores de 18 años con Hemorragia Digestiva Alta (HDA) que acudieron al servicio de emergencia del Hospital Cayetano Heredia (HCH) de Lima-Perú entre el 2019 a 2022, se recolectaron datos demográficos, de laboratorio y clínicos; posteriormente, se identificaron variables predictivas de HDAV mediante una regresión logística múltiple. A cada variable con capacidad predictiva se les asignó un puntaje con un punto de corte y sirvió para construir una escala predictiva de HDAV. Se incluyeron 197 historias clínicas de pacientes con HDA, de los cuales 127 (64%) tuvieron sangrado de causa no variceal, y, 70 (36%), variceal. Se identificaron 4 factores predictivos independientes: hematemesis (vómito rojo) (OR: 4,192, IC 95%: 1,586-11,082), recuento de plaquetas (OR: 3,786, IC 95%: 1,324-10,826), antecedente de HDA (OR: 2,634, IC 95%: 1,017-6,820), signos de enfermedad hepática crónica (OR: 11,244, IC 95%: 3,067-35,047), con los que se construyó una escala predictiva, con un punto de corte >7 y ≤7; que mostró una sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, cociente de probabilidad positivo, y, negativo de 58,6%, 90,6%, 77,4%, 79,9%, 6,20, y 0,46 respectivamente. En conclusión, la escala predictiva con un punto de corte >7 es útil para predecir la presencia de la HDAV en pacientes que acuden a la emergencia por HDA.

Our objective was to develop a diagnostic test to predict the etiology of Variceal Upper Gastrointestinal Bleeding (VUGIB). We conducted a retrospective cohort study. Medical records of patients over 18 years of age with Upper Gastrointestinal Bleeding (UGIB) who attended the emergency service of Hospital Cayetano Heredia (HCH) in Lima-Peru between 2019 and 2022 were reviewed; demographic, laboratory and clinical data were collected. Subsequently, predictive variables of variceal upper gastrointestinal bleeding (VUGIB) were identified using multiple logistic regression. Each variable with predictive capacity was assigned a score with a cut-off point and served to build a predictive scale for VUGIB. 197 medical records of patients with UGIB were included, of which 127 (64%) had non-variceal bleeding, and 70 (36%), variceal. Four independent predictors were identified: hematemesis (red vomit) (OR: 4,192, 95% CI: 1.586-11.082), platelet count (OR: 3.786, 95% CI: 1.324-10.826), history of UGIB (OR: 2.634, 95% CI: 1.017-6.820), signs of chronic liver disease (OR: 11.244, 95% CI: 3.067-35.047), with which a predictive scale was constructed, with a cut-off point >7 and ≤7; which showed a sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative of 58.6%, 90.6%, 77.4%, 79.9%, 6.20, and 0.46 respectively. In conclusion, the predictive scale with a cut-off point >7 is useful for predicting the presence of VUGIB in patients who attend the emergency room for UGIB.

Factors related to mortality in patients with stage 5 chronic kidney disease on dialysis with COVID-19: An exploratory case series analysis / Factores relacionados con mortalidad de pacientes con enfermedad renal crónica en estadio 5 en diálisis con COVID-19: Análisis exploratorio de una serie de casos

Introduction Different studies describe the clinical profile and factors that could explain the evolution and outcome of patients with chronic kidney disease and COVID-19. This study aims to evaluate the factors related to the mortality of patients with stage-5 chronic kidney disease on chronic dialysis hospitalized for COVID-19 at the Hospital Nacional Arzobispo Loayza from April to December 2020. Methods Retrospective case series and exploratory analysis were performed. Patients with stage-5 chronic kidney disease on dialysis, older than 18 years, and hospitalized for COVID-19 disease were included. Hospital medical records were the primary data source. Results A total of 105 medical records were reviewed. 57 were male (54.3%), with a mean age of 58.6 years (standard deviation: 14.3). Eighty-four patients survived (80%), and 21 died (20%). The main cause of hospital admission, present in 80 patients (76.2%), was respiratory failure; the mean hospital stay was of 11.8 days (SD: 7.8). In the bivariate analysis: patients with moderate to severe COVID-19, overweight and obesity, increased levels of leukocytes, D-dimer, ferritin, C-reactive protein, lactate dehydrogenase, as well as, decreased levels of lymphocytes, bicarbonate and arterial oxygen pressure/inspired oxygen fraction were related to mortality risk. In multivariate analysis, only severe COVID-19 disease (OR 1.48; 95% CI 2.24 to 7.77), C-reactive protein > 10 mg/dL (OR: 9.72; 95% CI: 1.41 to 18.58), and arterial oxygen pressure/inspired oxygen fraction ≤ 150 millimeters of mercury (OR: 10.23; 95% CI: 5.87 to 36.06) were factors associated with poor survival. Conclusions In patients with stage-5 chronic kidney disease hospitalized for COVID-19, severe COVID-19 disease, C-protein reactive levels > 10 milligrams per deciliter, arterial oxygen pressure / inspired oxygen fraction ≤ 150 millimeters of mercury and severe COVID-19 disease were the main factors related to mortality.

Introducción Diferentes estudios describen el perfil clínico y los factores que podrían explicar la evolución y el resultado de los pacientes con enfermedad renal crónica y COVID-19. El objetivo de este estudio fue evaluar los factores relacionados con la mortalidad de los pacientes con enfermedad renal crónica estadio-5 en diálisis crónica hospitalizados por COVID-19 en el Hospital Nacional Arzobispo Loayza de abril a diciembre de 2020. Métodos Serie de casos retrospectiva y análisis exploratorio. Se incluyeron pacientes con enfermedad renal crónica estadio 5 en diálisis, mayores de 18 años, hospitalizados por COVID-19. La fuente primaria de datos fueron las historias clínicas. Resultados Se revisaron 105 historias clínicas. 57 (54,3%) eran varones, con una edad media de 58,6 años (desviación estándar: 14,3). Sobrevivieron 84 (80%) pacientes y fallecieron 21 (20%). La principal causa de ingreso hospitalario fue la insuficiencia respiratoria en 80 (76,2%). La estancia hospitalaria fue de 11,8 días (desviación estándar: 7,8). En el análisis bivariante: los pacientes con COVID-19 moderada a grave, sobrepeso y obesidad, aumento de los niveles de leucocitos, dímero D, ferritina, proteína c reactiva, lactato deshidrogenasa, así como, disminución de los niveles de linfocitos, bicarbonato y presión arterial de oxígeno/fracción inspirada de oxígeno se relacionaron con el riesgo de mortalidad. En el análisis multivariante, sólo la enfermedad grave por COVID-19 (odds ratio: 1,48; intervalo de confianza del 95%: 2,24 a 7,77), la proteína C reactiva > 10 mg/dL (odds ratio: 9,72; intervalo de confianza del 95%: 1,41 a 18,58) y una presión arterial de oxígeno/fracción de oxígeno inspirado ≤ 150 milímetros de mercurio (odds ratio: 10,23; intervalo de confianza del 95%: 5,87 a 36,06) fueron factores asociados a una mala supervivencia. Conclusiones En los pacientes con enfermedad renal crónica en estadio-5 hospitalizados por COVID-19, la enfermedad grave por COVID-19, los niveles de proteína C reactiva > 10 miligramos por decilitro, la presión arterial de oxígeno/fracción inspirada de oxígeno ≤ 150 milímetros de mercurio y la enfermedad grave por COVID-19 fueron los principales factores relacionados con la mortalidad.

Resistencia antibiótica de Helicobacter pylori en la población peruana: una revisión sistemática y metaanálisis sobre su prevalencia en la población general

La infección por Helicobacter pylori es bastante común a nivel mundial, y tiene asociación con el adenocarcinoma gástrico. Las altas tasas de resistencia encontradas en países latinoamericanos justifican la investigación de tasas de resistencia local, lo que podría mejorar el enfoque terapéutico y las tasas de erradicación. El objetivo es evaluar la prevalencia de la resistencia de Helicobacter pylori a los antibióticos de uso común en Perú. Se incluyeron todos los estudios en población peruana que revelaron tasas de resistencia antibiótica de Helicobacter pylori. Se realizó una búsqueda sistemática de la literatura hasta enero del 2021, utilizando PubMed y otras bases de datos. Para el grupo de estudios de pacientes con punto de corte EUCAST, la resistencia fue la siguiente: Amoxicilina 14% (IC 95%: 6-25), Claritromicina 43% (IC 95%: 30-57), Metronidazol 58% (IC 95%: 22-90) y Quinolonas 51% (IC 95%: 38-64). Para el grupo de estudios de muestras con punto de corte EUCAST, los siguientes: Amoxicilina 57% (IC del 95%: 51-63), Claritromicina 35% (IC 95% 30-41), Metronidazol 67% (IC 95%: 62-72) y Tetraciclina 4% (IC 95%: 2-7). Se encontró una alta resistencia antibiótica de Helicobacter pylori en la mayoría de los grupos estudiados, aunque con heterogeneidad entre los estudios. La tasa de resistencia a tetraciclinas fue baja y los estudios mostraron ser homogéneos.

Helicobacter pylori infection is quite common worldwide and is associated with gastric adenocarcinoma. The high rates of resistance found in Latin American countries justify the investigation of local resistance rates, which could improve the therapeutic approach and eradication rates. The objective is to evaluate the prevalence of resistance in Peru of Helicobacter pylori to commonly used antibiotics. All studies in the Peruvian population that revealed rates of antibiotic resistance of Helicobacter pylori were included. A systematic literature search was conducted up to January 2021, using PubMed and other databases. For the group of patient studies with the EUCAST cut-off point, the resistance was as follows: Amoxicillin 14% (95% CI: 6-25), Clarithromycin 43% (95% CI: 30-57), Metronidazole 58% (95% CI: 22-90) and 51% Quinolones (95% CI: 38-64). For the EUCAST cut-off group of sample studies, the following: Amoxicillin 57% (95% CI: 51-63), Clarithromycin 35% (95% CI 30-41), Metronidazole 67% (95% CI: 62-72) and 4% Tetracycline (95% CI: 2-7). A high antibiotic resistance of Helicobacter pylori was found in most of the groups studied, although with heterogeneity between the studies. The rate of resistance to tetracyclines was low and the studies were shown to be homogeneous.

Características de la colocación y permanencia de catéteres venosos centrales temporales para hemodiálisis en un hospital público 2015-2019 / Characteristics of the placement and permanence in temporary central venous catheters for hemodialysis in a public hospital 2015-2019

RESUMEN Objetivo : Describir las características y permanencia de los catéteres venosos centrales temporales (CVCT) para en hemodiálisis en el servicio de Nefrología de un hospital público en el periodo del 2015 al 2019. Métodos : Estudio analítico longitudinal de cohorte retrospectiva. Se incluyeron 2156 registros de procedimientos de colocación de CVCT para hemodiálisis en pacientes con enfermedad renal crónica estadio 5 (ERC-5), se registró la condición final de los catéteres durante el periodo de seguimiento. Se excluyeron los pacientes que se perdieron en el seguimiento. Resultados : Se evaluaron 2156 procedimientos en 1650 pacientes. La localización del catéter fue: Yugular 1019 (51,9 %), Subclavia 198 (9,2 %), Femoral 129(5,9%). Las principales causas de retiro fueron por: disfunción de catéter 730 (33,9 %) e infección 410 (19,1 %). En el curso de 5 años se observaron variaciones en la proporción pacientes que inician hemodiálisis con Fístulas Arteriovenosa (FAV) de 9,6 % a 17,1 % (p=0,042) y en la colocación de Catéteres Venoso Central (CVC) tunelizados al año de inicio de 8 % a 23,03 % (p<0.001). La mediana del tiempo de permanencia de un CVCT disminuyó de 81 días a 58 días. Los factores relacionados al retiro de CVCT disfuncional fueron: edad mayor de 60 años [HR: 5.31 (IC 95 %: 1,8 - 9,74), p<0.001] y etiología diabética [HR: 6,82 (IC95 %: 1,3 - 18,2), p=0,021]. Conclusión : El CVCT, es el acceso vascular más frecuente para inicio de hemodiálisis crónica, y tiene una prolongada permanencia. Los factores asociados al retiro de catéter disfuncional son la edad avanzada (> 60 años) y la etiología diabética. En el periodo de estudio las variaciones en la proporción de pacientes que inician terapia de hemodiálisis crónica con FAV son muy bajas.

ABSTRACT Objective : To describe the characteristics and permanence of temporary central venous catheters (CVCT) for hemodialysis in the Nephrology Service of a public Hospital in the period 2015-2019. Methods : Retrospective cohort longitudinal analytical study. 2156 records of CVCT placement procedures for hemodialysis in patients with stage 5 chronic kidney disease (CKD-5) were included, the final condition of the catheters was recorded during the follow-up period. Patients lost to follow-up were excluded. Results : Twenty-one hundred and fifty-six procedures were evaluated in 1,650 patients. Locations of catheters were Jugular, 1019 (51,9%); Subclavian, 198 (9,2%); and Femoral 129 (5,9%). Main causes of withdrawal were catheter dysfunction in 730 cases (33,9%) and infection in 410 (19,1%). During the five-year course, changes were observed, such as: variation in starting hemodialysis with AVF from 9.6% to 17,1% (p = 0,042), placement of tunneled CVCs during the first year of starting hemodialysis, from 8% to 23,0% (p 60 years), and diabetic etiology. During the study period, the variations in the proportion of patients who start chronic hemodialysis therapy with AVF are very low.

[Antibiotic resistance of Helicobacter pylori in the Peruvian population: a systematic review and meta-analysis of its prevalence in the general population]. / Resistencia antibiótica de Helicobacter pylori en la población peruana: una revisión sistemática y metaanálisis sobre su prevalencia en la población general.

Helicobacter pylori infection is quite common worldwide and is associated with gastric adenocarcinoma. The high rates of resistance found in Latin American countries justify the investigation of local resistance rates, which could improve the therapeutic approach and eradication rates. The objective is to evaluate the prevalence of resistance in Peru of Helicobacter pylori to commonly used antibiotics. All studies in the Peruvian population that revealed rates of antibiotic resistance of Helicobacter pylori were included. A systematic literature search was conducted up to January 2021, using PubMed and other databases. For the group of patient studies with the EUCAST cut-off point, the resistance was as follows: Amoxicillin 14% (95% CI: 6-25), Clarithromycin 43% (95% CI: 30-57), Metronidazole 58% (95% CI: 22-90) and 51% Quinolones (95% CI: 38-64). For the EUCAST cut-off group of sample studies, the following: Amoxicillin 57% (95% CI: 51-63), Clarithromycin 35% (95% CI 30-41), Metronidazole 67% (95% CI: 62-72) and 4% Tetracycline (95% CI: 2-7). A high antibiotic resistance of Helicobacter pylori was found in most of the groups studied, although with heterogeneity between the studies. The rate of resistance to tetracyclines was low and the studies were shown to be homogeneous.

Nefrectomía laparoscópica en un hospital general

Objetivo: Describir los resultados de la nefrectomía laparoscópica en pacientes con riñones excluidos benignos, malignos y de donantes. Material y métodos: Estudio de serie de casos, retrospectivo, realizado en el Hospital Cayetano Heredia entre agosto del 2013 y mayo del 2019. Se incluyeron pacientes con riñones no funcionantes de cualquier etiología y riñón contralateral funcionante. Se excluyendo pacientes con pionefrosis severa. Se registraron sus características clínicas, demográficas, índice de masa corporal, etiología del riñón no funcionante, tasa de conversión, lateralidad, tiempo operatorio, histopatología de los riñones intervenidos, complicaciones, necesidad de transfusión, estancia hospitalaria y evolución de los pacientes intervenidos. Resultados: Se evaluaron 70 pacientes; en 39 (55,8%) se realizó nefrectomía laparoscópica simple por patología benigna, en 23 (32,8%) nefrectomía radical laparoscópica por cáncer y en 8 (11,4%) nefrectomía laparoscópica donante vivo. En 7 pacientes se tuvo que convertir a cirugía abierta. La media del tiempo operatorio fue 188,94 ± 33,41 min. Los resultados histopatológicos fueron pielonefritis crónica y carcinoma renal. No hubo variaciones clínicamente significativas en los niveles de hemoglobina, hematocrito, urea, creatinina. Las complicaciones según clasificación de Clavien: Grado I: 21(30%), II: 9(12,8%) y V: 1(1,4%). La media del tiempo de hospitalización fue 4,66 ± 2,97 días, con buena evolución postoperatoria en el 85,7% de los pacientes. Conclusión: La nefrectomía laparoscópica para riñones excluidos de patología benigna como maligna y de donantes de riñón, es una técnica mínimamente invasiva, reproducible, segura, efectiva y una alternativa a la cirugía abierta.

SUMMARY Objective: To report the findings of laparoscopic nephrectomies in patients with malignant, benignant and donor conditions. Material and Methods : A retrospective case series carried-out at Cayetano Heredia Hospital between August 2013 and May 2019. Patients with non-functioning kidneys of any etiology and contra lateral kidney functioning were included. Patients with severe pionephrosis were excluded. Demographic, clinical, body mass index, etiology of the nonfunctioning kidney, conversion rate, laterality, operating time, histopathology of the resected kidneys, complications, need for blood transfusion, hospital stay and clinical evolution. Results: 70 patients were evaluated; in 39 (55.8%) a simple laparoscopy for benign entities was performed; in 23 (32.8%) a radical nephrectomy for cancer was performed and in 8 (11.4%) a laparoscopy was performed for living donors. In 7 patients the laparoscopic procedure converted into open surgery. Mean operating time was 188.94 ± 33.41 min. Main histopathological findings were chronic pyelonephritis and renal carcinoma. Complications by Clavien classification were: Grade I: 21(30%), II: 9(12.8%) and V: 1(1.4%). Mean hospital stay was 4.66 ± 2.97 days; 85.7% had good clinical evolution. Conclusion : Laparoscopic nephrectomy for benign and malignant conditions as well as for kidney donors is a minimally invasive technique which is reproducible, safe, effective and therefore represents an alternative to open surgery.

Guía de práctica clínica para el tamizaje, diagnóstico y manejo de la enfermedad renal crónica en estadios 1 al 3 en el Seguro Social del Perú (EsSalud) / Clinical practice guideline for the screening, diagnosis, and management of chronic kidney disease stages 1-3 for the Peruvian Social Security (EsSalud)

RESUMEN El presente artículo resume la guía de práctica clínica (GPC) para tamizaje, diagnóstico y manejo de los pacientes con enfermedad renal crónica (ERC) en los estadios 1 al 3 en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló ocho preguntas clínicas. Para responder cada pregunta se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando fue considerado pertinente, de estudios primarios; y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron ocho recomendaciones (cuatro fuertes y cuatro condicionales), 29 puntos de buena práctica clínica, y tres flujogramas.

ABSTRACT This paper summarizes the clinical practice guidelines (CPG) for the screening, diagnosis, and management of patients with chronic kidney disease (CKD) stages 1-3 in the Social Security of Peru (EsSalud). A guideline development group (GDG) was established for develop this CPG, which included clinical and methodology specialists, who formulated 08 clinical questions. Systematic searches of systematic reviews and, when considered necessary, primary studies were conducted to answer each question; and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology for reviewing the evidence and for developing recommendations. At the end, this CPG formulated 08 recommendations (04 strong and 04 conditional), 29 points of good clinical practice, and 03 flowcharts were formulated.

The health and economic burden of smoking in 12 Latin American countries and the potential effect of increasing tobacco taxes: an economic modelling study.

BACKGROUND: Worldwide, smoking tobacco causes 7 million deaths annually, and this toll is expected to increase, especially in low-income and middle-income countries. In Latin America, smoking is a leading risk factor for death and disability, contributes to poverty, and imposes an economic burden on health systems. Despite being one of the most effective measures to reduce smoking, tobacco taxation is underused and cigarettes are more affordable in Latin America than in other regions. Our aim was to estimate the tobacco-attributable burden on mortality, disease incidence, quality of life lost, and medical costs in 12 Latin American countries, and the expected health and economic effects of increasing tobacco taxes. METHODS: In this modelling study, we developed a Markov probabilistic microsimulation economic model of the natural history, medical costs, and quality-of-life losses associated with the most common tobacco-related diseases in 12 countries in Latin America. Data inputs were obtained through a literature review, vital statistics, and hospital databases from each country: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru, and Uruguay. The main outcomes of the model are life-years, quality-adjusted life-years, disease events, hospitalisations, disease incidence, disease cost, and healthy years of life lost. We estimated direct medical costs for each tobacco-related disease included in the model using a common costing methodology for each country. The disease burden was estimated as the difference in disease events, deaths, and associated costs between the results predicted by the model for current smoking prevalence and a hypothetical cohort of people in each country who had never smoked. The model estimates the health and financial effects of a price increase of cigarettes through taxes, in terms of disease and health-care costs averted, and increased tax revenues. FINDINGS: In the 12 Latin American countries analysed, we estimated that smoking is responsible for approximately 345 000 (12%) of the total 2 860 921 adult deaths, 2·21 million disease events, 8·77 million healthy years of life lost, and $26·9 billion in direct medical costs annually. Health-care costs attributable to smoking were estimated to represent 6·9% of the health budgets of these countries, equivalent to 0·6% of their gross domestic product. Tax revenues from cigarette sales cover 36·0% of the estimated health expenditures caused by smoking. We estimated that a 50% increase in cigarette price through taxation would avert more than 300 000 deaths, 1·3 million disease events, gain 9 million healthy life-years, and save $26·7 billion in health-care costs in the next 10 years, with a total economic benefit of $43·7 billion. INTERPRETATION: Smoking represents a substantial health and economic burden in these 12 countries of Latin America. Tobacco tax increases could successfully avert deaths and disability, reduce health-care spending, and increase tax revenues, resulting in large net economic benefits. FUNDING: International Development Research Centre (IDRC), Canada.

Alteraciones del equilibrio acido base y electrolíticas en pacientes con crisis hiperglicémica atendidos en emergencia de un hospital general de Chiclayo / Electrolyte and acid-base abnormalities in patients with hyperglycemic crisis attended at emergency in a general hospital in Chiclayo

Resumen Objetivo: Describir las alteraciones del equilibrio ácido base y electrolíticas en pacientes con crisis hiperglicémica atendidos en la emergencia de un hospital general de Chiclayo. Material y métodos: Serie de casos, prospectivo y de corte transversal; se seleccionaron pacientes diabéticos con crisis hiperglicémica que fueron vigilados por 3 horas. Se registraron los datos clínicos, demográficos, gases arteriales, glicemia y electrolitos. Resultados: Se evaluaron 52 pacientes con una edad promedio 55,1 ± 16,9 y 29 (55,8%) de sexo femenino. El tiempo promedio de diagnóstico fue 4,3 ± 5,4 meses; 13 (25,0%) eran episodios debut, 4 (7,7%) fallecieron. El síntoma más frecuente fue confusión mental en 14 (26,9%), 30 (57,7%) tuvieron falla renal aguda. Las alteraciones electrolíticas más frecuentes fueron hiponatremia en 26 (50,0%) e hipokalemia en 18 (34,6%). La acidosis metabólica fue más frecuente en cetoacidosis que en coma hiperosmolar (85,0 vs 15,0%; p= 0,000). La falla renal aguda ocurrió en 76,7% en cetoacidosis diabética y en 23,3% en el coma hiperosmolar (p= 0,74). Conclusiones: La frecuencia y las complicaciones de la cetoacidosis diabética y del coma hiperosmolar, así como de las alteraciones electrolíticas, muestran grandes diferencias con los datos reportados en la literatura.

Summary Objective: To describe electrolyte and acid-base imbalances in patients with hyperglycemic crisis attended at emergency in a general hospital in Chiclayo. Methods: A case series of diabetic patients with hyperglycemic crisis that were followed for 3 hours. Clinical, demographic, blood gases, serum glucose and electrolytes were gathered from patient´s charts. Results: 52 patients were evaluated; mean age was 55.1 ± 16.9 years and 29 (55.8%) were females. Mean time to diagnosis was 4.3 ± 5.4 months; 13 (25.0%) occurred at onset of diabetes and 4 (7.7%) died. The most common symptom was mental confusion in 14 (26,9%) of patients, 30 (57,7%) had acute renal failure. Hyponatremia in 26 (50.0%) patients and hypokalemia in 18 (34.6%) were the most common electrolyte abnormalities found. Metabolic acidosis was more frequently found in patients with ketoacidosis than in hyperosmolar coma (85.0 vs 15.0%; p<0.0001). Acute renal failure occurred in 76.7% among patients with ketoacidosis and in 23.3% of patients with hyperosmolar coma (p=0.74). Conclusions: the frequency and complications of diabetic ketoacidosis and of hyperosmolar coma as well as the electrolyte abnormalities differed from those reported in the literature.

Evolución de la tasa de filtración glomerular y proteinuria a largo plazo en niños monorrenos en un hospital nacional / Long-term evolution of glomerular filtration rate and proteinuria in single kidney children in a national hospital

Resumen Objetivos: Determinar la evolución de la tasa de filtración glomerular (TFG) y los niveles de proteinuria en 24 horas en pacientes monorrenos con un tiempo mínimo de seguimiento de 5 años. Material y métodos: Se utilizaron los registros de los pacientes monorrenos atendidos en el Hospital Nacional Edgardo Rebagliati Martins (HNERM) entre 2005-2016. Se consignaron los datos de proteinuria en 24 horas y tasa de filtración glomerular en orina de 24 horas de 50 pacientes que cumplieron los criterios de inclusión del estudio. Resultados: La mediana de la TFG de los 50 pacientes fue 109,74 ml/min/1,73m2 (RIQ 86,1-138,75). Hubo 22 pacientes en estadio I, 2 en estadio II y 5 en estadio III de acuerdo a la clasificación de enfermedad renal crónica (ERC). Se encontró 26 (52%) pacientes con proteinuria significativa y persistente, no hubo en rango nefrótico. Conclusiones: Los pacientes monorrenos presentan a largo plazo alteraciones como hiperfiltración y disminución de la TFG.

Summary Objectives: To determine the glomerular filtration rate (GFR) and 24-hour proteinuria among single kidney patients with a minimum 5-year follow-up period. Material and methods: The medical charts of single kidney attended at Hospital Nacional Edgardo Rebagliati Martins (HNERM) from 2005-2016 were review. Information on 50 patients in whom data on GFR a 24-hour proteinuria was analyzed. Results: Median GFR was 109.74 ml/min/1.73m2 (RIQ 86.1-138.75); 22 patients were in the chronic renal disease stage classification I, 2 in chronic renal disease stage classification II and 5 in stage III; 26 patients (52%) had persistent and significant proteinuria, none of these had proteinuria in the nephrotic range. Conclusions: Single kidney patients present long-term complications such as hyperfiltration and reduction of the GFR.

Keywords: Solitary kidney, proteinuria, glomerular filtration rate

Eficacia de la embolización de las arterias prostáticas en el tratamiento de los síntomas del tracto urinario bajo asociados a hiperplasia benigna de la próstata: Reporte preliminar / Efficacy of prostatic artery embolization in the treatment of urinary symptoms associated to benign prostatic hyperplasia: A preliminary report

Objetivos: Determinar la eficacia de la embolización de las arterias prostáticas en el tratamiento de los pacientes con síntomas del tracto urinario bajo asociados a hiperplasia prostática benigna. Material y métodos: Estudio descriptivo, tipo reporte de casos, prospectivo. Se realizó embolización de arterias prostáticas (EAP) a 10 pacientes, 7 de los cuales tenían síntomas del tracto urinario bajo asociado a hiperplasia benigna de próstata (STUB/HBP) moderados y severos, refractarios a tratamiento médico durante 6 meses y 3 portadores de sonda vesical permanente; la edad promedio fue 69,4 ± 8,04 años. Se evaluaron a los pacientes antes de la EAP (tiempo 0), y a los meses 1, 3 y 6; el éxito se valoró por: disminución del volumen de la próstata (VP): >10%, mejora del puntaje internacional de síntomas prostáticos (IPSS), flujo urinario máximo (Q):>15 ml/seg, índice internacional de función eréctil (IIEF)sin variación o aumento en 10%,disminución del residuo post-miccional (RPM)>20% y efectos adversos: ≤2 eventos. Resultados: La EAP fue técnicamente exitosa en el 100% de pacientes. Las tasas de éxito clínico al mes 6 fueron: Disminución del VP en 40% (p=0,0009), APE en 15% (p=0,0464) y el IPSS mejoró en 63% (p=0,0010). No hubo variaciones significativas en el IIEF-15 (reducción del puntaje en 12,1% (p=0,1157)), el Q se incrementó máx en 80% (p=0,1088) y en la reducción del RPM (se redujo en 25% (p= 0,6177)). No se presentó complicaciones mayores durante el estudio. Conclusiones: La EAP es una opción de tratamiento para mejorar los parámetros críticos de los STUB/HBP sin afectar la función sexual. (AU)

Objectives: To determine the efficacy of prostatic artery embolization in the treatment of urinary symptoms associated to benign prostatic hyperplasia. Methods: A descriptive and prospective case report study was conducted. Embolization of prostatic arteries (EPS) was carried-out in 10 patients, 7 of whom had moderate and severe urinary tract symptoms to associated to benign prostatic hyperplasia (UTS/BPH) refractory to medical treatment during 6 months, 3 were using a permanent urinary catheter. Mean age was 69.4 ± 8.04 years. Patients were evaluated at time 0 of EPS and at 1, 3 and 6 months after. Success was defined as reduction in prostatic volume (PV) >10%; improvement in the international score of prostatic symptoms (ISPS); maximum urinary output (Qmáx) > 15 ml/ sec; international index of erectile function (IIEF) with no variation or increase in 10%; reduction on post void residual (PVR) >20% and ≤2 medical events. Results: The EPS was technically successful in 100% of patients. The evaluation of clinical parameters at 6 months was as follows: 40% reduction in PV (p=0.0009; the ISPS improved in 63% (p=0.0010). No variation was observed in the IIEF-15 (12.1% reduction (p=0.1157)); the Qmáx increased in 80% (p=0.1088), and a 25% reduction in PVR (p= 0.6177)). No complications were observed during the procedure. Conclusions: EPS is an option to improve clinical parameters of UTS/BPH without affecting the sexual function. No major complications were observed. (AU)

Carga de enfermedad por tabaquismo e impacto potencial del incremento de precios de cigarrillos en el Perú / Burden of smoking-related disease and potential impact of cigarette price increase in Peru

RESUMEN Objetivos . Estimar la carga de enfermedad asociada al tabaquismo y evaluar el potencial impacto económico y en salud del aumento de los impuestos a los cigarrillos en el Perú. Materiales y métodos. Mediante un modelo de microsimulación se estimó el impacto en mortalidad, calidad de vida y costos atribuibles al tabaquismo por enfermedad cardiaca y cerebrovascular, enfermedad pulmonar obstructiva crónica, neumonía, cáncer de pulmón y otras nueve neoplasias. Se evaluaron tres escenarios de aumento de impuestos. Resultados . Un total anual de 16 719 muertes, 6926 diagnósticos de cáncer, 7936 accidentes cerebrovasculares y 7548 hospitalizaciones por enfermedad cardiovascular se pueden atribuir al tabaquismo en Perú. Asimismo, se pierden 396 069 años de vida por muerte prematura y discapacidad cada año, y el costo de tratar los problemas de salud ocasionados por el tabaco asciende a 2500 millones de soles (PEN 2015). Actualmente, los impuestos al tabaco llegan a cubrir solamente el 9,1% de dicho gasto. Un incremento del 50% en el precio de los cigarrillos podría evitar 13 391 muertes, 6210 eventos cardiovasculares y 5361 nuevos cánceres en los próximos diez años, y representaría un beneficio económico de 3145 millones (PEN) por ahorro de costos sanitarios y aumento de la recaudación impositiva. Conclusiones . La carga de enfermedad y el costo para el sistema de salud asociados al tabaquismo son elevados en Perú. Incrementar los impuestos al cigarrillo podría derivar en importantes beneficios para el país, tanto sanitarios como económicos.

ABSTRACT Objectives . To calculate the burden of smoking-related disease and evaluate the potential economic and health impact of tax-induced cigarette price increase in Peru. Materials and methods. A microsimulation model was used to estimate smoking-attributable impact on mortality, quality of life, and costs associated with heart and cerebrovascular disease, chronic obstructive pulmonary disease, pneumonia, lung cancer, and another nine cancers. Three scenarios, involving increased taxes, were evaluated. Results . A yearly total of 16,719 deaths, 6,926 cancer diagnoses, 7,936 strokes, and 7,548 hospital admissions due to cardiovascular disease can be attributed to smoking in Peru. Similarly, 396,069 years of life are lost each year from premature death and disability, and the cost of treating smoking-attributable health issues rises to 2,500 million soles (PEN 2015). Currently, taxes on tobacco cover only 9.1% of this expense. If cigarette prices were to increase by 50% over the next 10 years, 13,391 deaths, 6,210 cardiovascular events, and 5,361 new cancers could be prevented, representing an economic benefit of 3,145 million (PEN) in savings in health costs and increases in tax revenues. Conclusions . Smoking-attributable burden of disease and costs to the health system are very high in Peru. Higher cigarette taxes could have substantial health and economic benefits for the country.

Isolation as a strategy for controlling the transmission of hepatitis C virus (HCV) infection in haemodialysis units.

BACKGROUND: The hepatitis C virus (HCV) infection affects about 2% of the world's population and can cause chronic liver infection and persistent long-term sequelae such as cirrhosis and liver cancer.The prevalence of HCV infection among people on haemodialysis is often higher than the general population. The virus is easily transmitted parenterally, and blood transfusions have previously played a significant role in transmission; however, erythropoietin therapy has reduced the need for transfusions, and coupled with improved screening of donated blood, has significantly decreased transmission by transfusion. Although control of hospital-acquired infection has improved with the advent of biosafety measures, stopping HCV transmission in haemodialysis units remains challenging.Isolating people infected with HCV involves physical separation from others to limit direct or indirect transmission and includes a number of strategies during dialysis. The evidence for isolating people infected with HCV during haemodialysis is sparse with some inconsistencies. OBJECTIVES: To evaluate the benefits and harms of isolation of HCV-infected patients during haemodialysis on the transmission of HCV to other patients. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Specialised Register to 26 November 2015 through contact with the Information Specialist using search terms relevant to this review. We also searched the Latin American and Caribbean Health Sciences Literature Database (LILACS) (1982 to 2015), Web of Science Conference Proceedings Citation Index-Science (CPCI-S, 1990 to 2015), ProQuest Dissertations & Theses Database (1990 to 2015), and Open Grey (1990 to 2015). SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs and cluster RCTs evaluating the clinical benefits and harms of isolating HCV-infected patients during haemodialysis on the transmission of HCV to other patients. We considered incidence of dialysis-acquired HCV infection, all-cause mortality, and adverse effects associated with isolation as the primary outcomes. DATA COLLECTION AND ANALYSIS: Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) or standardised mean difference (SMD) and 95% CI for continuous outcomes. MAIN RESULTS: Only one study, which included 12 centres was identified: four centres used dedicated haemodialysis machines for HCV-infected patients and eight centres used non-dedicated machines. The total number of patients enrolled was 593. One centre was excluded after randomisation. Random sequence generation was not described and allocation concealment was not performed. Participants and personnel were not blinded and blinding of outcome assessors was not reported. Only 74.5% of the patients were followed for 9 months; and 47.3% were followed for an additional 9 months. The authors only reported one outcome, measuring the difference in the incidence of HCV in both groups. The authors did not consider the exposure time, to determine the adjusted rate of seroconversion risk/patient-year. The study reported that the incidence of HCV infection during the first follow-up period (9 months) was 1.6% in the dedicated group, and 4.7% in the non-dedicated one (446 patients analysed out of 593 randomised; RR 0.34, 95% CI 0.11 to 1.07). During the second follow-up period (18 months) the incidence was 1.3% in the dedicated group and 5.8% in the control (281 patients analysed out of 593 randomised; RR 0.22, 95% CI 0.05 to 1.02). Therefore, we found no differences in terms of the number of participants developing HCV infection when comparing the dedicated group with the usual care. Moreover, the evidence was of very low quality, which means that we have very little confidence in the effect estimate. AUTHORS' CONCLUSIONS: The benefits and harms of isolation of HCV-infected patients during haemodialysis on the transmission of HCV to other patients are uncertain. Evidence from one short-duration cluster-randomised study with a high risk of bias did not find differences in terms of the number of participants developing HCV infection when comparing the use of dedicated haemodialysis machines for HCV infected patients with the use of non-dedicated machines.

Automedicación en un distrito de Lima Metropolitana, Perú / Self-medication in district of Lima Metropolitana, Peru

La automedicación es una práctica de riesgo cuyas consecuencias incluyen el enmascaramiento de la enfermedad, las reacciones adversas, interacciones de medicamentos, el aumento de la resistencia a ciertos tipos de drogas y las drogodependencias. Objetivos: Determinar la frecuencia de automedicación en los consumidores de medicamentos que acuden a los establecimientos farmacéuticos de un distrito de Lima Metropolitana y las variaciones de las tasas según edad, sexo y grado de instrucción. Material y métodos: Estudio observacional, descriptivo y trasversal, aplicando una encuesta durante los meses de setiembre a noviembre de 2013. La selección de la población fue por muestreo sistemático. Participaron 406 usuarios de establecimientos farmacéuticos del distrito de Pueblo Libre. Resultados: La frecuencia de automedicación en el distrito de Pueblo Libre fue 56,65% (IC 95% 0,4985 û 0,6302). El 36,09% fue en jóvenes de 18 a 24 años, el 51,30% fue de sexo masculino y el 58,70% tenía nivel de estudio básico (primario y secundario). Los tipos de automedicación más frecuentes fue la sugerida por el propio usuario en un 49,13% y la sugerida por los familiares en un 21,74%.El síndrome doloroso fue la causa más importante de automedicación en 40,35% y los tipos de fármacos más adquiridos fueron los AINE 30%, los antigripales 20,87%, medicamentos gastrointestinales 15,22%, los analgésicos 8,67%, los antialérgicos 7,39% y los antibióticos 4,35%. Conclusiones: La automedicación en los consumidores de medicamentos que acuden a los establecimientos farmacéuticos fue alta.

Self-prescription is a risk practice whose consequences include masking the diagnosis, side effects, drug interactions, rising of antimicrobial resistance to certain kind of drugs and drug dependence. Objective: To determine the frequency of self-medication among people attending drug stores in a district of metropolitan Lima, and to describe variations according by age, gender and degree of education. Methods: Observational, cross-sectional study in which a survey was applied between September and November of 2013. A systematics sampling was used to select 406 participants living in Pueblo Libre district of Lima. Results: Frequency of self-prescription was 56.65% (IC 95% 0.4985 û 0.6302); 36.09% were young people between 18-24 years of age; 51.3% were males, and 58.7% had basic level of education (primary and secondary school). The most common kind of self-prescription was that suggested by the customer (49.13%) followed by that suggested by relatives (21.7%). Pain was the most comom cause for self-prescription in 40.35% and NSAID (30%) were the most common drugs purchased, followed by anti-flu medications (20.87%), gastro-intestinal medications (15.22%), analgesics (8.67%), anti-alergic medications (7.39%) and antibiotics (4.35%). Conclusions: Self-medication in this setting is high.

[Burden of smoking-related disease and potential impact of cigarette price increase in Peru]. / Carga de enfermedad por tabaquismo e impacto potencial del incremento de precios de cigarrillos en el Perú.

OBJECTIVES: . To calculate the burden of smoking-related disease and evaluate the potential economic and health impact of tax-induced cigarette price increase in Peru. MATERIALS AND METHODS.: A microsimulation model was used to estimate smoking-attributable impact on mortality, quality of life, and costs associated with heart and cerebrovascular disease, chronic obstructive pulmonary disease, pneumonia, lung cancer, and another nine cancers. Three scenarios, involving increased taxes, were evaluated. RESULTS: . A yearly total of 16,719 deaths, 6,926 cancer diagnoses, 7,936 strokes, and 7,548 hospital admissions due to cardiovascular disease can be attributed to smoking in Peru. Similarly, 396,069 years of life are lost each year from premature death and disability, and the cost of treating smoking-attributable health issues rises to 2,500 million soles (PEN 2015). Currently, taxes on tobacco cover only 9.1% of this expense. If cigarette prices were to increase by 50% over the next 10 years, 13,391 deaths, 6,210 cardiovascular events, and 5,361 new cancers could be prevented, representing an economic benefit of 3,145 million (PEN) in savings in health costs and increases in tax revenues. CONCLUSIONS: . Smoking-attributable burden of disease and costs to the health system are very high in Peru. Higher cigarette taxes could have substantial health and economic benefits for the country.

Early versus delayed erythropoietin for the anaemia of end-stage kidney disease.

BACKGROUND: Anaemia is a common complication in people with chronic kidney disease (CKD) and mainly develops as a consequence of relative erythropoietin (EPO) deficiency. Anaemia develops early in the course of disease and peaks among people with end-stage kidney disease (ESKD). Many types of EPO - also called erythropoiesis-stimulating agents (ESAs) - are used to treat anaemia in people with ESKD.ESAs have changed treatment of severe anaemia among people with CKD by relieving symptoms and avoiding complications associated with blood transfusion. However, no benefits have been found in relation to mortality rates and non-cardiac fatal events, except quality of life. Moreover, a relationship between ESA use and increased cardiovascular morbidity and mortality in patients with CKD has been reported in studies with fully correcting anaemia comparing with partial anaemia correction. Until 2012, guidelines recommended commencing ESA treatment when haemoglobin was less than 11 g/dL; the current recommendation is EPO commencement when haemoglobin is between 9 and 10 g/dL. However, advantages in commencing therapy when haemoglobin levels are greater than 10 g/dL but less than 11 g/dL remain unknown, especially among older people whose life expectancy is limited, but in whom EPO therapy may improve quality of life. OBJECTIVES: To assess the clinical benefits and harms of early versus delayed EPO for anaemia in patients with ESKD undergoing haemodialysis or peritoneal dialysis SEARCH METHODS: We searched the Cochrane Kidney and Transplant Specialised Register to 8 July 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA: We planned to include randomised controlled trials (RCTs) and quasi-RCTs evaluating at the clinical benefits and harms of early versus delayed EPO for anaemia in patients with ESKD undergoing haemodialysis or peritoneal dialysis. Studies comparing EPO with another EPO, placebo or no treatment were eligible for inclusion. DATA COLLECTION AND ANALYSIS: It was planned that two authors would independently extract data from included studies and assess risk of bias using the Cochrane risk of bias tool. For dichotomous outcomes (all-cause mortality, cardiovascular mortality, overall myocardial infarction, overall stroke, vascular access thrombosis, adverse effects of treatment, transfusion), we planned to use the risk ratio (RR) with 95% confidence intervals (CI). We planned to calculate the mean difference (MD) and CI 95% for continuous data (haemoglobin level) and the standardised mean difference (SMD) with CI 95% for quality of life if different scales had been used. MAIN RESULTS: Literature searches yielded 1910 records, of these 1534 were screened after duplicates removed, of which 1376 were excluded following title and abstract assessment. We assessed 158 full text records and identified 18 studies (66 records) that were potentially eligible for inclusion. However, none matched our inclusion criteria and were excluded. AUTHORS' CONCLUSIONS: We found no evidence to assess the benefits and harms of early versus delayed EPO for the anaemia of ESKD.

[Clinical and biochemical characteristics in patients with histology compatible with steatothepatitis in National Hospital Arzobispo Loayza, Lima, Peru, from 2010 to 2012]. / Características clínicas y bioquímicas en pacientes con histología compatible con esteatohepatitis del Hospital Nacional Arzobispo Loayza, Lima, Perú en el 2010-2012.

OBJECTIVES: Describe the clinical and biochemical characteristics of patients with histopathological findings compatible with steatohepatitis of HNAL patients between 2010-2012. Determine the frequency of alcoholic and non-alcoholic steatohepatitis, presence of metabolic syndrome and other factors associated to non-alcoholic steatohepatitis, its main indications for liver biopsy and biochemical characteristics according to the severity of the histological findings. MATERIALS AND METHODS: We evaluated all histological slides of liver biopsies of the period between 2010-2012, of which, those with the diagnosis of steatohepatitis were selected. Their medical records were then reviewed. RESULTS: 32 patients met inclusion criteria. 28 were female and 4 male, the average age was 49±12 years. Two patients had a history of chronic alcohol consumption, representing the group of alcoholic steatohepatitis. The more frequent clinical finding in patients with NASH (non-alcoholic steatohepatitis), was obesity (37%). 50% of patients had AST/ALT ratio <1. CONCLUSIONS: Among population studied, non-alcoholic steatohepatitis was more common than alcoholic steatohepatitis, being obesity the most associated factor.

Prevalencia de fibromialgia en el distrito de Chiclayo / Prevalence of fibromyalgia in Chiclayo district

Determinar la prevalencia de fibromialgia en el distrito de Chiclayo. Material y métodos: Estudio descriptivo, transversal, exploratorio realizado en habitantes entre 18 a 65 años. Se realizó un muestreo aleatorio, por conglomerados, estratificado, multietápico. Se dividió al distrito en 34 zonas según el mapa catastral actualizado al año 2011; se aplicó el cuestionario LFESSQ (cuestionario inglés para el tamizaje epidemiológico de la Fibromialgia), versión en español: Los individuos con dolor corporal difuso en el tamizaje fueron evaluados por el investigador principal mediante los criterios del Colegio Americano de Reumatología de 1990. Resultados: Se entrevistaron 548 habitantes; 504 cumplieron los criterios de inclusión, 333 (66,3%) fueron mujeres. Los antecedentes más frecuentes fueron: diagnóstico previo de depresión 14 (2,5%); hipotiroidismo 11(2%) y ansiedad 8(1,4%). La media de edad fue 39,7 +- 13,6 años; la prevalencia de dolor corporal difuso fue 8,1 % (IC95%: 4,9-9,4%) y la de fibromialgia 2,99%, (IC95%: 1,5-4,4%); la prevalencia en hombres fue 4,1% Y en mujeres 2,4%; no se hallaron diferencias sociodemográficas entre los entrevistados con dolor corporal difuso y los que tuvieron fibromialgia; en los entrevistados con fibromialgia se halló mayor cantidad de puntos dolorosos (p= 0,0001) Y mayor frecuencia de insomnio (p=0,0024); Conclusiones: El dolor corporal difuso y la fibromialgia tienen una prevalencia similar a la reportada en otros estudios. Existen diferencias clínicas entre los pacientes con dolor corporal difuso y los pacientes con fibromialgia...

To determine the prevalence of fibromyalgia in Chiclayo district. Methods: A descriptive, exploratory, cross-sectional study was conducted among habitants from 18 to 65 years. A random, conglomerate and stratified sample was obtained. The district was divided in 34 zones based on a 2011 census. A Spanish version of a questionnaire that looked for symptoms of fibromyalgia was applied, Individuals with diffuse body aches identified through the questionnaire were evaluated by the principal investigator following the criteria of the American College of Rheumatology of 1990. Results: 548 habitants were interviewed; 504 fulfilled the inclusion criteria; 333 (66.3%) were females. The most common underlying medical conditions were depression (14, 2.5%); hypothyroidism (11, 2%) and anxiety (8, 1.4%). Mean age was 39.7 ± 13.6 years; the prevalence of diffuse body aches was 8.1 % (95% CI: 4.9-9.4) and of fibromyalgia was 2.99% (95% CI: 1.5-4.4); the prevalence in males was 4.1% and 2.4% in females; there were no sociodemographic differences between patients with diffuse body aches and fibromyalgia. Among those with fibromyalgia, there was higher number of painful zones (p=O.OOO 1) and higher frequency of insomnia (p=0.0024). Conclusions: Diffuse body aches and fibromyalgia had similar prevalence rates than previously reported in other studies. There are clinical differences between patients with diffuse body aches and fibromyalgia...

[Cultural adaptation and psychometric validation of the health-related quality of life questionnaire EORTC QLQ STO-22 for patients with gastric cancer in Peru]. / Adaptación cultural y validación psicométrica del cuestionario de calidad de vida EORTC QLQ STO-22 para los pacientes con cáncer gástrico en el Perú.

OBJECTIVE: To validate the health-related quality of life questionnaire EORTC QLQ STO-22 for patients with gastric cancer in Peru, evaluating cultural and psychometric characteristics. MATERIALS AND METHODS: The first phase consisted in measure the content and appearance validity. In the second phase, the questionnaire was applied to patients diagnosed with gastric cancer and the internal consistency, test-retest reliability, convergent validity, discriminant validity and criterion validity was determined. RESULTS: After performing the content and appearance validity the questions/items 31 and 39 were changed. The global Cronbach's α was 0.90 and α coefficients greater than 0.7 in the multi-item subscales was obtained. The test-retest reliability showed an overall correlation of 0.924. When analyzing the convergent and discriminant validity, the values of Pearson's "r" were higher between an item and its own subscale, than the same item with other multi-item sub-scales. The criterion validity of the EORTC QLQ STO-22 compared with the EORTC QLQ C-30 showed a positive correlation of 0.727 with items evaluating symptomatology, and a negative correlation of -0.587 when comparing with functional status items, both statistically significant. CONCLUSION: The modified questionnaire EORTC QLQ STO-22 meets the reliability and validity criteria for assessing the quality of life in patients with gastric cancer in Peru.

Características clínicas y bioquímicas en pacientes con histología compatible con esteatohepatitis del Hospital Nacional Arzobispo Loayza, Lima, Perú en el 2010-2012 / Clinical and biochemical characteristics in patients with histology compatible with steatothepatitis in National Hospital Arzobispo Loayza, Lima, Peru, from 2010 to 2012

Describir las características clínicas y bioquímicas en pacientes con histología compatible con esteatohepatitis del Hospital Nacional Arzobispo Loayza en el periodo 2010-2012. La frecuencia de esteatohepatitis alcohólica y no alcohólica, la presencia de síndrome metabólico y otros factores asociados a esteatohepatitis no alcohólica, sus principales indicaciones de biopsia hepática, y las características bioquímicas de acuerdo a la severidad del cuadro histológico. Materiales y métodos: Se evaluaron todas las biopsias hepáticas del período 2010-2012, se seleccionaron las muestras con diagnóstico de esteatohepatitis. Luego se revisaron sus respectivas historias clínicas. Resultados: 32 pacientes con esteatohepatitis cumplieron los criterios de inclusión, 28 fueron de sexo femenino y 4 masculino, cuya edad fue 49+/-12 años, 30 (94%) presentaba esteatohepatitis no alcohólica. Dos pacientes presentaban el antecedente de consumo crónico de alcohol, representando al grupo de esteatohepatitis alcohólica. La característica clínica más frecuente en pacientes con esteatohepatitis no alcohólica, fue obesidad en 11 (37%) pacientes. La relación de AST/ALT <1 estuvo presente en 15 (50%) pacientes. Conclusiones. En esta población la esteatohepatitis no alcohólica es mucho más frecuente que la alcohólica y la obesidad estuvo más relacionada con la presencia de esteatohepatitis no alcohólica...

Describe the clinical and biochemical characteristics of patients with histopathological findings compatible with steatohepatitis of HNAL patients between 2010-2012. Determine the frequency of alcoholic and non-alcoholic steatohepatitis, presence of metabolic syndrome and other factors associated to non-alcoholic steatohepatitis, its main indications for liver biopsy and biochemical characteristics according to the severity of the histological findings. Materials and methods: We evaluated all histological slides of liver biopsies of the period between 2010-2012, of which, those with the diagnosis of steatohepatitis were selected. Their medical records were then reviewed. Results: 32 patients met inclusion criteria. 28 were female and 4 male, the average age was 49+/-12 years. Two patients had a history of chronic alcohol consumption, representing the group of alcoholic steatohepatitis. The more frequent clinical finding in patients with NASH (non-alcoholic steatohepatitis), was obesity (37%). 50% of patients had AST/ALT ratio <1. Conclusions: Among population studied, non-alcoholic steatohepatitis was more common than alcoholic steatohepatitis, being obesity the most associated factor...