The prevalence and demographic associations of headache in the adult population of Peru: a national cross-sectional population-based study.

BACKGROUND: The Global Campaign against Headache is conducting a series of population-based studies to fill the large geographical gaps in knowledge of headache prevalence and attributable burden. One major region not until now included is South America. Here we present a study from Peru, a country of 32.4 million inhabitants located at the west coast of South America, notable for its high Andes mountains. METHODS: The study was conducted in accordance with the standardized methodology used by the Global Campaign. It was a cross-sectional survey using cluster randomised sampling in five regions to derive a nationally representative sample, visiting households unannounced, and interviewing one randomly selected adult member (aged 18-65 years) of each using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire translated into South American Spanish. The neutral screening question ("Have you had headache in the last year?") was followed by diagnostic questions based on ICHD-3 and demographic enquiry. RESULTS: The study included 2,149 participants from 2,385 eligible households (participating proportion 90.1%): 1,065 males and 1,084 females, mean age 42.0 ± 13.7 years. The observed 1-year prevalence of all headache was 64.6% [95% CI: 62.5-66.6], with age-, gender- and habitation-adjusted prevalences of 22.8% [21.0-24.6] for migraine (definite + probable), 38.9% [36.8-41.0] for tension-type headache (TTH: also definite + probable), 1.2% [0.8-1.8] for probable medication-overuse headache (pMOH) and 2.7% [2.1-3.5] for other headache on ≥ 15 days/month (H15+). One-day prevalence of headache (reported headache yesterday) was 12.1%. Migraine was almost twice as prevalent among females (28.2%) as males (16.4%; aOR = 2.1; p < 0.001), and strongly associated with living at very high altitude (aOR = 2.5 for > 3,500 versus < 350 m). CONCLUSION: The Global Campaign's first population-based study in South America found headache disorders to be common in Peru, with prevalence estimates for both migraine and TTH substantially exceeding global estimates. H15 + was also common, but with fewer than one third of cases diagnosed as pMOH. The association between migraine and altitude was confirmed, and found to be strengthened at very high altitude. This association demands further study.

Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study.

OBJECTIVE: To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population. DESIGN: Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers' burden and interventions' effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model. FINDINGS: In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries' aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures. CONCLUSIONS: Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits.

[Performance of the MEDUC-PG14 instrument to evaluate teaching performance in medical residency programs]. / Validez y confiabilidad de los resultados del instrumento MEDUC-PG14 para medir el desempeño docente en la residencia médica en Perú.

BACKGROUND: There are few instruments to evaluate teachers' performance during medical residency in Spanish. AIM: To determine the validity and reliability of the MEDUC-PG14 instrument to evaluate teaching performance in the medical residency programs of the Faculty of Medicine, Universidad Peruana Cayetano Heredia (UPCH). MATERIAL AND METHODS: An open question about positive aspects that characterize a good teacher was added to the MEDUC-PG14 questionnaire. A pilot test was carried out with 15 residents to assess the correct comprehension of each question and carry out necessary changes. Subsequently, the instrument was sent by email to 366 residents of the UPCH Department of Medical Clinics. The reliability of the instrument was evaluated using Cronbach's Alpha. Construct validity was assessed by factor analysis, and the validity of content by a qualitative analysis of the answers to the open question added. RESULTS: Seventy residents answered the questionnaire evaluating 46 teachers. Each resident evaluated one teacher. The factor analysis showed two dimensions explaining 83% of the variance: the dimension "Teaching and Evaluation" (11 items) and the dimension "Respectful Behavior" (three items). The global Cronbach's Alpha was 0.97 (0.97 for the Teaching Dimension 0.96 and for the Behavioral Dimension). The concept of "professional competence as a medical specialist" was rescued from the responses to the open question. CONCLUSIONS: The MEDUC-PG14 is an instrument with valid and highly reliable results. It is useful and easy to apply to evaluate teaching performance in postgraduate studies. Its use is recommended in residency programs of Spanish-speaking countries. However, the inclusion of an item referring to the professional competence of the teacher is suggested.

Identification of biomedical journals in Spain and Latin America.

OBJECTIVES: Journals in languages other than English that publish original clinical research are often not well covered in the main biomedical databases and therefore often not included in systematic reviews. This study aimed to identify Spanish language biomedical journals from Spain and Latin America and to describe their main features. METHODS: Journals were identified in electronic databases, publishers' catalogues and local registries. Eligibility was determined by assessing data from these sources or the journals' websites, when available. FINDINGS: A total of 2457 journals were initially identified; 1498 met inclusion criteria. Spain (27.3%), Mexico (16.0%), Argentina (15.1%) and Chile (11.9%) had the highest number of journals. Most (85.8%) are currently active; 87.8% have an ISSN. The median and mean length of publication were 22 and 29 years, respectively. A total of 66.0% were indexed in at least one database; 3.0% had an impact factor in 2012. A total of 845 journals had websites (56.4%), of which 700 (82.8%) were searchable and 681 (80.6%) free of charge. CONCLUSIONS: Most of the identified journals have no impact factor or are not indexed in any of the major databases. The list of identified biomedical journals can be a useful resource when conducting hand searching activities and identifying clinical trials that otherwise would not be retrieved.

Validez y confiabilidad de los resultados del instrumento MEDUC-PG14 para medir el desempeño docente en la residencia médica en Perú / Performance of the MEDUC-PG14 instrument to evaluate teaching performance in medical residency programs

Background: There are few instruments to evaluate teachers' performance during medical residency in Spanish. Aim: To determine the validity and reliability of the MEDUC-PG14 instrument to evaluate teaching performance in the medical residency programs of the Faculty of Medicine, Universidad Peruana Cayetano Heredia (UPCH). Material and Methods: An open question about positive aspects that characterize a good teacher was added to the MEDUC-PG14 questionnaire. A pilot test was carried out with 15 residents to assess the correct comprehension of each question and carry out necessary changes. Subsequently, the instrument was sent by email to 366 residents of the UPCH Department of Medical Clinics. The reliability of the instrument was evaluated using Cronbach's Alpha. Construct validity was assessed by factor analysis, and the validity of content by a qualitative analysis of the answers to the open question added. Results: Seventy residents answered the questionnaire evaluating 46 teachers. Each resident evaluated one teacher. The factor analysis showed two dimensions explaining 83% of the variance: the dimension "Teaching and Evaluation" (11 items) and the dimension "Respectful Behavior" (three items). The global Cronbach's Alpha was 0.97 (0.97 for the Teaching Dimension 0.96 and for the Behavioral Dimension). The concept of "professional competence as a medical specialist" was rescued from the responses to the open question. Conclusions: The MEDUC-PG14 is an instrument with valid and highly reliable results. It is useful and easy to apply to evaluate teaching performance in postgraduate studies. Its use is recommended in residency programs of Spanish-speaking countries. However, the inclusion of an item referring to the professional competence of the teacher is suggested.

[Psychometric validation of the International Index of Erectile Function in patients with erectile dysfunction in Perú]. / Validación psicométrica del instrumento Índice Internacional de Función Eréctil en pacientes con disfunción eréctil en Perú.

OBJECTIVES: To perform the psychometric validation of the International Index of Erectile Function (IIEF) in patients with erectile dysfunction. MATERIALS AND METHODS: Prospective case series to evaluate the validity and the reliability of the scale. RESULTS: More than 90 % of experts considered that the IIEF questions evaluated the domains and the construct (content validity). There was a perfect concordance between the expert evaluation and the IIEF results (criteria validity, Kappa = 1). Significant differences were found in the score media by domains between patients with and without ED but when severity was evaluated, only differences in the erectile function domain were found (discriminatory validity). The Chronic Prostatitis Symptom Index (ISPC) and the IIEF showed divergent results (Kappa < 0.01, p = 0.44) in relation with the severity and the total scores showed no correlation (divergent validity) (r(s) = -0.22, p = 0.16). The correlation coefficients by domains were mild to moderate and the correlation between the total scores was high (rs = 0.8, p < 0.001) (test retest repeatability). A high degree of internal consistency with Cronbach's alpha values > 0.8 in the five domains was found. CONCLUSIONS: The cross-culturally validated IIEF in Peru is a valid and reliable instrument for its local use in the fields of clinics and research.

[Basic principles and methodological considerations of health economic evaluations]. / Principios básicos y alcances metodológicos de las evaluaciones económicas en salud.

Health Economics is an essential instrument for health management, and economic evaluations can be considered as tools assisting the decision-making process for the allocation of resources in health. Currently, economic evaluations are increasingly being used worldwide, thus encouraging evidence-based decision-making and seeking efficient and rational alternatives within the framework of health services activities. In this review, we present an overview and define the basic types of economic evaluations, with emphasis on complete Economic Evaluations (EE). In addition, we review key concepts regarding the perspectives from which EE can be conducted, the types of costs that can be considered, the time horizon, discounting, assessment of uncertainty and decision rules. Finally, we describe concepts about the extrapolation and spread of economic evaluations in health.

Relación del residuo post-miccional, grado de ôtrabeculaciónõ vesical y el flujo urinario en pacientes con hiperplasia prostática benigna sintomática / Relationship between post-mictional residue, degree of bladder trabeculation and urinary flow in patients with benign prostatic hyperplasia

Objetivo: Determinar la relación entre el grado de ôtrabeculaciónõ vesical, el residuo pos miccional y el grado de obstrucción al flujo de salida urinario en pacientes con hiperplasia benigna de próstata (HBP) sintomática. Material y métodos: Serie de casos analítico y retrospectivo que incluyó 37 pacientes con HBP sintomática atendidos ambulatoriamente en el servicio de Urología del Hospital Nacional Cayetano Heredia en el 2009. El grado de ôtrabeculaciónõ vesical se determinó por cistoscopia, el residuo vesical post-miccional por ecografía y el grado de obstrucción mediante uroflujometría. Resultados: La edad de los pacientes fue: 68,2 ± 7,9 (50-83) años. Los valores del volumen prostático, porcentaje de residuo post-miccional y el flujo máximo fueron: 46,4 ± 20,6 cc (20-113); 33,4% ± 20,7 (5- 80) y 6,7 ± 2,12 7 ml/seg (3-10), respectivamente. No se encontró correlación entre: el porcentaje de residuo post-miccional y el flujo urinario máximo (rs = -0,07; p=0,67) y entre el volumen prostático y el flujo máximo con (rs= 0,05; p= 0,7). Tampoco se encontró concordancia entre el grado de ôtrabeculaciónõ vesical y el flujo máximo (Kappa= 0,0034; p=0,5) y entre el porcentaje de residuo post-miccional y el grado de ôtrabeculaciónõ (Kappa= 0,18; p=0,06). Conclusión: No se encontró relación entre el flujo máximo urinario, el porcentaje de residuo post-miccional y el grado de ôtrabeculaciónõ, en pacientes con HBP sintomática.

Objective: To determine the relationship between the degree of bladder trabeculation, post mictional residue and degree of urinary outflow obstruction in patients with benign prostatic hyperplasia (BPH). Methods: Retrospective case series of 37 ambulatory patients with symptomatic BPH attended at the Urology Service of Hospital Nacional Cayetano Heredia in 2009. The degree of bladder trabeculation was determined by cystoscopy, post-mictional residue was measured by ultrasound, and the degree of outflow obstruction was measured by uroflowmetry. Results: Mean (SD) age of patients was 68.2 ± 7.9 years. Mean (SD) values for prostatic volume, percentage of postmictional residue and maximum flow were 46.4 ± 20.6 ml; 33.4 ± 20.7% y 6.7 ± 2.1 ml/seg, respectively. No correlation between the percentage of post-mictional residue and maximum urinary flow (rs = -0.07; p = 0.67), and between prostatic volume and maximum urinary flow was found (rs = 0.05; p = 0.7). There were also no correlations between the degree of bladder trabeculation and maximum urinary flow (Kappa = 0.0034; p = 0.5), and between the percentage of post-mictional residue and the degree of bladder trabeculation Kappa = 0.18; p = 0.06). Conclusions: No relationship was found between the maximum urinary flow, percentage of post-mictional residue and degree of trabeculation in patients with symptomatic BPH.

Double-blind randomized placebo-controlled study of Bixa orellana in patients with lower urinary tract symptoms associated to benign prostatic hyperplasia.

OBJECTIVE: To determine the efficacy of Bixa Orellana (BO) in patients with benign prostatic hyperplasia (BPH) presenting moderate lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: It is a prospective double-blind randomized placebo-controlled study. One thousand four hundred and seventy eight patients presenting moderate LUTS associated to BPH were interviewed, from whom we selected 136 to fulfill the criteria of inclusion and exclusion. Assignation was performed at random in blocks of four to receive B0 at a dose of 250 mg 3 times a day or placebo (Pbo) for 12 months, 68 patients were assigned to each group. From the patients in the study we obtained data of demographic, epidemiologic, symptom score, uroflowmetry and post void residual urine variables. RESULTS: Basically both groups were compared clinically, demographically and biochemically. Throughout the study variations of symptom score, mean delta symptom score during each visit and the final average delta were similar for both groups (BO - 0.79 +/- 1.87 and Pbo - 1.07 +/- 1.49) (p = 0.33). Similarly variations of Qmax mean, Qmax average delta and final average delta were similar (BO 0.44 +/- 1.07 and Pbo 0.47 +/- 1.32) (p = 0.88). Variations of post void residual urine mean, post void residual urine average delta in each visit and the final average delta were similar for both groups (BO 4.24 +/- 11.69 and Pbo 9.01 +/- 18.66) (p = 0.07). No differences were found in the answers of clinically significant improvement assessed with relative risk and risk differences, even though the proportion of adverse effects was similar for both groups. CONCLUSION: Patients with BPH that present moderate LUTS did not show any benefit receiving BO when compared to placebo.

Prevalencia del síndrome metabólico entrabajadores activos en la Red Asistencial de EsSalud en Huánuco, 2007 / Prevalence of the metabolic syndrome in active workers of HuanucoÆs Medical Assistance Network EsSalud, 2007

Objetivo: Determinar la prevalencia del síndrome metabólico en trabajadores activos en una población asegurada adscrita a la Red Asistencial de EsSalud en Huánuco. Material y métodos: Diseño transversal analítico con un muestreo probabilístico poli û etápico, por conglomerados en 8 ciudades de Huánuco. Se diagnosticó síndrome metabólico según los criterios del IDF y ATP. Resultados: Se incluyeron 620 participantes. La prevalencia del síndrome metabólico fue 35,16 por ciento (31,40 e 39,06) utilizando el criterio de la IDF, y según el criterio de la ATP III modificada fue 25,64 por ciento (22,25 û 29,27). En el análisis multivariado según los criterios de la IDF, los factores relacionados a la presencia del síndrome metabólico fueron la edad > 35 años [OR 2,18 (1,14 û 4,18)], ocupación (no profesionales) [OR 1,78 (1,24 û 2,58)], IMC ≥ 25 [OR 5,08 (3,18 û 8,12)] y el índice cintura cadera (varón > 0,90 y mujer > 0,85) [OR 3,41 (1,90 û 6,10)]. Con los criterios de la ATP III modificada fueron: edad ≥40 años [OR 1,87 (1,16 û 3,03)], IMC ≥ 25 [OR 5,17 (2,96 û 9,03)] y el índice cintura cadera (varón > 0,90 y mujer > 0,85) [OR 2,41 (1,31 û 4,46)]. Conclusiones: La prevalencia del síndrome metabólico en trabajadores activos en la Red asistencial de EsSalud en Huánuco es similar a las tasas descritas en la literatura nacional e internacional.

Objective: To determine the prevalence of the metabolic syndrome in active workers in an insured population included in HuanucoÆs Medical Assistance Network EsSalud. Material and methods: Analytical cross-sectional design with multi-stage probabilistic sampling by conglomerations in 8 towns of Huanuco. The metabolic syndrome was diagnosed following the IDF and ATP criteria. Results: In total, 620 participants were included The prevalence of the metabolic syndrome amounted to 35.16 percent (31.40 û 39.06) according to the IDF criteria, and it amounted to 25.64 percent (22.25 û 29.27) according to the ATP III criteria. In the multivariate analysis following the IDF criteria the factors related to the presence of the metabolic syndrome were age > 35 [OR 2.18 (1.14 û 4.18)], occupation (no professionals) [OR 1.78 (1.24 û 2.58)], BMI ≥ 25 [OR 5.08 (3.18 û 8.12)] and the waist/hip index (men > 0.90 and women > 0.85) [OR 3.41 (1.90 û 6.10)]. With the modified ATP III criteria they were age ≥40 [OR 1.87 (1.16 û 3.03)], BMI ≥ 25 [OR 5.17 (2.96 û 9.03)] and the waist/hip index (men > 0.90 and women > 0.85) [OR 2.41 (1.31 û 4.46)].Conclusions: According to the IDF and modified ATP criteria, prevalence of the metabolic syndrome in active workers of HuanucoÆs Medical Assistance Network EsSalud is similar to the rates described in the national and international literature.

Validación psicométrica del instrumento índice internacional de función eréctil en pacientes con disfunción eréctil en Perú / Psychometric validation of the international index of erectile function in patients with erectile dysfunction in Perú

Objetivos. Realizar la validación psicométrica del instrumento Índice Internacional de Función Eréctil (IIFE) en pacientes con Disfunción Eréctil (DE). Materiales y métodos. Serie de casos prospectivo donde se evaluó la validez y confiabilidad del cuestionario. Resultados. Más del 90 por ciento de los expertos consideraron que las preguntas del IIEF evaluaban los dominios y el constructo (validez de contenido). Hubo una concordancia perfecta entre la evaluación del experto y los resultados del IIFE (Kappa = 1). Se encontró diferencias significativas en las medias del puntaje por dominios entre los pacientes con DE y sin DE pero al evaluar la severidad solo hubo diferencias en el dominio de función eréctil (validez discriminante). Con relación a la severidad, el Índice de Síntomas de Prostatitis Crónica (ISPC) y el IIFE mostraron resultados divergentes (Kappa < 0,01, p=0,44), y los puntajes totales no correlacionaron (validez divergente) (rs = - 0,22, p = 0,16). Los coeficientes de correlación por dominios fueron leves a moderados y la correlación entre los puntajes totales fue alta (rs = 0,8, p < 0,001) (fiabilidad test retest). Se encontró un alto grado de consistencia interna con un α-Cronbach > 0,8 en los cinco dominios. Conclusiones. El IIFE validado culturalmente en el Perú es un instrumento válido y confiable para su uso a nivel local en el campo clínico y de investigación.

Objectives. To perform the psychometric validation of the International Index of Erectile Function (IIEF) in patients with erectile dysfunction. Materials and methods. Prospective case series to evaluate the validity and the reliability of the scale. Results. More than 90 percent of experts considered that the IIEF questions evaluated the domains and the construct (content validity). There was a perfect concordance between the expert evaluation and the IIEF results (criteria validity, Kappa = 1). Significant differences were found in the score media by domains between patients with and without ED but when severity was evaluated, only differences in the erectile function domain were found (discriminatory validity). The Chronic Prostatitis Symptom Index (ISPC) and the IIEF showed divergent results (Kappa < 0.01, p = 0.44) in relation with the severity and the total scores showed no correlation (divergent validity) (rs = -0.22, p = 0.16). The correlation coefficients by domains were mild to moderate and the correlation between the total scores was high (rs = 0.8, p < 0.001) (test retest repeatability). A high degree of internal consistency with Cronbach’s alpha values > 0.8 in the five domains was found. Conclusions. The cross-culturally validated IIEF in Peru is a valid and reliable instrument for its local use in the fields of clinics and research.

Factors associated with mortality in acute renal failure (ARF) in children.

OBJECTIVE: To assess the factors that affect the mortality in acute renal failure (ARF) in children. PATIENTS AND METHODS: We studied 149 patients with ARF and described the findings by age, gender, pathophysiological mechanism of renal damage, and type of renal damage, which can be oligoanuric and/or septic. We used multiple logistic analysis, Cox analysis for survival, and Kaplan-Meier curves. RESULTS: The male/female ratio was 91/58. The most affected age groups were newborns (44.3%) and infants (37.6%). The ARF mechanism was ischemic in 87 cases (58%) and the most frequent clinical type was nonoliguric in 118 cases (79.2%). In the multiple logistic regression analysis, only oliguria (P=0.07) and age group (P=0.049) were associated with mortality. In the survival analysis using the Cox method, oliguria (P=0.003) and sepsis (P=0.03) were associated with mortality. The survival curves showed that the cumulative probability of dying in the first 10, 20, or 40 days after the event was 75, 70, and 45% respectively. When oliguria was present, the survival at day 10 was 47% and when sepsis was present it was 68%. CONCLUSION: Oliguria, age, and sepsis are factors associated with mortality in children with ARF.

Estudio descriptivo del uso de dosis única de heparina no fraccionada en pacientes en hemodiálisis. / Descriptive study using single dose of unfractionated heparin in patients undergoing hemodialysis

Objetivo: Evaluar la evolución de la anticoagulación con dosis única de heparina no fraccionada (HNF) de pacientes en hemodiálisis. Material y métodos: Evaluamos 31 pacientes en hemodiálisis crónica, quienes recibieron HNF 30 UI/Kg/hora en bolo único, obteniéndose una muestra de sangre al inicio, 5, 60, 120 minutos y al final de la hemodiálisis, midiéndose el tiempo parcial de tromboplastina activada (TTP) en cada punto para determinar el nivel de anticoagulación. Resultados: La relación de TTP al inicio fue de 1,22 ± 0,49, de ellos, trece pacientes (41,94%) ingresaron con relación de TTP anormal. Los valores de relación de TTP en todos los pacientes a los 5’ y a los 60’ fueron mayores a 6,9 (TTP > 300 segundos); a los 120’ once de ellos (35,8%) presentaron valores de relación de TTP mayores a 6,9 y veinte pacientes (64,52%) tuvieron una media de 5,59 ± 1,35; estando todos por encima del rango terapéutico recomendado. Al final del procedimiento la media de la relación TTP fue 2,17 ± 0,75 y sólo 4 pacientes mostraron relación de TTP por debajo del rango terapéutico. Se evidenciaron dos episodios de hemorragia macroscópica sin complicaciones y no hubo variación en la reducción del volumen efectivo de los dializadores. Conclusión: El empleo de heparina no fraccionada en bolo único durante la hemodiálisis presenta una anticoagulación muy por encima de los valores terapéuticos y se prolongan hasta el final de la hemodiálisis; por lo que se recomienda el desuso de esta práctica.(Rev Med Hered 2011;22:103-107).

Objective: To assess the evolution of anticoagulation with single dose of unfractionated heparin (UFH) in patients undergoing hemodialysis. Material and methods: We evaluated 31 patients undergoing chronic hemodialysis received one dose of UFH 30UI/Kg/hr, and got blood samples at 0, 5, 60, 120 minutes and at the end of the hemodialysis to measure the activated tromboplastin time (aTPT) to monitor the anticoagulation. Results: The aTPT ratio at time 0 was 1.22 ± 0.49, from these, 13 patients (41.94%) started the hemodialysis with abnormal aTPT ratio. At 5’and 60’, all the patients showed values of aTPT ratio higher than 6.9 (aTPT > 300 seconds); at 120’ eleven of these (35.8%) had aTPT ratio higher than 6.9 and 20 patients (64.52%) showed an aTPT ratio of 5.59 ± 1.35; all of them over the recommended interval. At the end of the procedure, the mean of the aTPT ratio was 2.17 ± 0.75 and only 3 patients showed aTPT ratio under the anticoagulation interval. We observed two cases of macroscopic bleeding without complications, and there were no contraindications for the reuse of the dializers. Conclusion: The use of UFH in one bolus dose during hemodialysis showed anticoagulation levels higher than the upper limit of the therapeutic range, which persist up to the end of the procedure. It is recommended to stop the practice of this method.(Rev Med Hered 2011;22:103-107).

Principios básicos y alcances metodológicos de las evaluaciones económicas en salud / Basic principles and methodological considerations of health economic evaluations

La economía de la salud es un instrumento indispensable para la gestión sanitaria y las evaluaciones económicas, se pueden considerar como la herramienta que asiste a la toma de decisiones para asignar recursos en el área de la salud. Hoy en día, su uso es creciente en todas las regiones del mundo y fomenta la toma de decisiones basadas en la evidencia, buscando alternativas eficientes y racionales dentro del conjunto de actividades de los servicios. En esta revisión se efecturá una visión general y se delinea los tipos básicos de evaluación económica, sobre todo de las Evaluaciones Económicas (EE) completas. Así mismo se revisará los conceptos más relevantes sobre las perspectivas desde las que se pueden realizar las EE, los tipos de costos, el horizonte temporal, los descuentos, la evaluación de la incertidumbre y las reglas de decisión. Finalmente, se describirán conceptos sobre la transferibilidad y la generalización de las Evaluaciones Económicas en salud.

Health Economics is an essential instrument for health management, and economic evaluations can be considered as tools assisting the decision-making process for the allocation of resources in health. Currently, economic evaluations are increasingly being used worldwide, thus encouraging evidence-based decision-making and seeking efficient and rational alternatives within the framework of health services activities. In this review, we present an overview and define the basic types of economic evaluations, with emphasis on complete Economic Evaluations (EE). In addition, we review key concepts regarding the perspectives from which EE can be conducted, the types of costs that can be considered, the time horizon, discounting, assessment of uncertainty and decision rules. Finally, we describe concepts about the extrapolation and spread of economic evaluations in health.

Actividad física global de pacientes con factores de riesgo cardiovascular aplicando el "International Physical Activity Questionaire (IPAQ). / Global physical activity in outpatients with cardiovascular risk factor aplying "International Physical Activity Questionaire (IPAQ)

Objetivo: Determinar el nivel de actividad física global de los pacientes con factores de riesgo cardiovascular, mediante el cuestionario IPAQ. Material y métodos: Estudio tipo serie de casos. La población estuvo compuesta por pacientes con hipertensión arterial, obesidad y diabetes mellitus entre 35 y 69 años de edad. Se utilizó el IPAQ para medir el nivel de actividad física. Resultados: De 180 entrevistados, 122 (67,8%) fueron del sexo femenino. La edad media fue 56,9 ± 8,8 años, el IMC promedio fue 29,0 ± 5,2 (18,6 - 48,5). Ciento nueve (60,5%) pacientes tenían un solo factor de riesgo cardiovascular modificable por medio de actividad física, 59 (32,8%) dos factores y 12 (6,7%) tres factores. El tiempo promedio de diagnóstico en meses fue 34,6 (hipertensos) y 51,1 (diabéticos). El nivel de actividad física fue trabajo en 30 (16,7%) pacientes, en 80 (44,4%) moderado y en 70 (38,9%) alto. No hubo diferencias en el nivel de actividad física según la edad y sexo. Se encontró diferencia significativa en los pacientes con hipertensión quienes tenían actividad moderada (p=0,02) en los hipertensos obesos quienes tenían actividad físca alta (p=0,07). Conclusión: El nivel de actividad física global de los pacientes con factores de riesgo cardiovascular seleccionados fue predominantemente moderado y alto.(Rev Med Hered 2011;22:115-120).

Objective: To evaluate the global physical activity level of patients with cardiovascular risk factors, using IPAQ. Material and methods: Serial cases type. We included patients with arterial hypertension, obesity, diabetes between 35 to 69 years old. We used IPAQ, to measure physical activity level. Results: From 180 interviewed patients, 122 (67.8%) were female. The media age was 56.9 ± 8.8 years, the average BMI was 29.0 ± 5.2 (18.6 - 48.5). 109 (60.5%) presented one cardiovascular risk factor, 59 (32.8%) two risk factors and 12 (6.7%) three risk factors. The media diagnostic time in months was 34.6 (hypertensive patients) and 51.1 (diabetic patients). 30 (16.7%) patients had low level, 80 (44.4%) moderate and 70 (38.9%) high. There was no statistical difference between level of physical activity and sex or age. Hypertensive patients presented predominantly moderate level of physical activity (p = 0.02) and patients with hypertension + obesity showed predominantly high level of activity (p = 0.07). Conclusion: The level of global physical activity of patients with selected cardiovascular risk factors of our study was predominantly moderate and high.(Rev Med Hered 2011;22:115-120).

Reactividad de la prueba de tuberculina en contactos intradomiciliarios de pacientes con tuberculosis en Huánuco, Perú / Tuberculin test reactivity in household contacts of tuberculosis patients from Huanuco, Peru

Objetivos. Determinar la frecuencia y factores epidemiológicos asociados con la reactividad de la prueba de tuberculinaen contactos intradomiciliarios de pacientes con tuberculosis en cuatro hospitales de la ciudad de Huánuco. Materiales y métodos. Desde abril de 2006 a enero de 2007 se desarrolló un estudio transversal analítico sobre 390 contactosintradomiciliarios, a quienes se les realizó la prueba de tuberculina, con lectura de induración a las 48 horas, usando la prueba de Mantoux. A los negativos (induración menor que 10 mm) se les repitió el procedimiento a las cuatro semanas. Se exploró asociaciones bivariadas y multivariadas considerando la reactividad a la prueba de la tuberculina como variable de respuesta. Resultados. La frecuencia de reactividad a la prueba de tuberculina fue de 64,6 por ciento entre los contactos intradomiciliarios. Sólo la presencia de TB pulmonar [OR=2,6 (IC95 por ciento 1,35; 4,84) p=0,004], edad mayor igual 25 años [OR=3,5 (IC95 por ciento 2,15; 5,67) p menor que 0,001] y tiempo de convivencia mayor igual 1 año [OR=1,9 (IC95 por ciento 1,11; 3,33) p=0,020] estuvieron asociados independientemente con la reactividad a la prueba de tuberculina. Conclusiones. El 64,6 por ciento de los contactos intradomiciliarios de los pacientes con TB pulmonar son reactivos a la prueba de tuberculina. Por otro lado, la TB pulmonar, la edad mayor igual 25 años y el tiempo de convivencia mayor igual 1 año, fueron factores independientemente asociados.

Objectives. To determine the frequency and epidemiological factors related with the tuberculin test reactivity in householdcontacts of tuberculosis patients in four hospitals of the Andean city of Huanuco (Peru). Material and methods. Ananalytical cross-sectional study was carried out since April 2006 to January 2007 with 390 household contacts wereconsidered. The tuberculin test was performed with induration reading at 48 hours, the Mantoux test was used. Patients with negative readings (induration minor that 10 mm) were subjected to another test four weeks later. Bivariate and multivariateassociations were explored, tuberculin test reactivity was the outcome. Results. The reactivity frequency to the tuberculintest in the four hospitals amounted to 64.6 per cent among household contacts. Only the presence of pulmonary TB [OR = 2.6 (95 per cent CI = 1.35 - 4.84) p = 0.004], age major equal 25 years [OR = 3.5 (95 per cent CI = 2.15 û 5.67) p minor that 0.001] and time living together major equal 1 year [OR = 1.9 (95 per cent CI = 1.11 û 3.33) p = 0.020] were related to tuberculin test reactivity. Conclusions. The frequency of the tuberculin test reactivity in household contacts in four hospitals of the city of Huanuco was 64.6 per cent. Independently related factors were pulmonary TB, age major equal 25 years, and time living together major equal 1 year.

Double-blind randomized placebo-controlled study of bixa orellana in patients with lower urinary tract symptoms associated to benign prostatic hyperplasia

OBJECTIVE: To determine the efficacy of Bixa Orellana (BO) in patients with benign prostatic hyperplasia (BPH) presenting moderate lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: It is a prospective double-blind randomized placebo-controlled study. One thousand four hundred and seventy eight patients presenting moderate LUTS associated to BPH were interviewed, from whom we selected 136 to fulfill the criteria of inclusion and exclusion. Assignation was performed at random in blocks of four to receive B0 at a dose of 250 mg 3 times a day or placebo (Pbo) for 12 months, 68 patients were assigned to each group. From the patients in the study we obtained data of demographic, epidemiologic, symptom score, uroflowmetry and post void residual urine variables. RESULTS: Basically both groups were compared clinically, demographically and biochemically. Throughout the study variations of symptom score, mean delta symptom score during each visit and the final average delta were similar for both groups (BO - 0.79 ± 1.87 and Pbo - 1.07 ± 1.49) (p = 0.33). Similarly variations of Qmax mean, Qmax average delta and final average delta were similar (BO 0.44 ± 1.07 and Pbo 0.47 ± 1.32) (p = 0.88). Variations of post void residual urine mean, post void residual urine average delta in each visit and the final average delta were similar for both groups (BO 4.24 ± 11.69 and Pbo 9.01 ± 18.66) (p = 0.07). No differences were found in the answers of clinically significant improvement assessed with relative risk and risk differences, even though the proportion of adverse effects was similar for both groups. CONCLUSION: Patients with BPH that present moderate LUTS did not show any benefit receiving BO when compared to placebo.

Factores pronósticos de sobrevida en pacientes con cáncer de endometrio tratados con radioterapia preoperatoria / Prognostic factors for survival in patients with endometrial cancer treated with preoperative radiotherapy

Objetivo: determinar la sobrevida global (SG), los factores pronósticos de sobrevida libre de enfermedad y SG, el porcentaje de complicaciones en pacientes con cáncer de endometrio tratados con radioterapia preoperatoria en el INEN. Material y Métodos: se realizó un estudio retrospectivo analítico de 381 historias clínicas de pacientes con cáncer de endometrio entre 1995 a diciembre del 2004, 53 pacientes cumplieron con los criterios de inclusión: estadiaje clínico I, II, III según FIGO 1971, radioterapia externa (RTE) a la pelvis a dosis de 50Gy a 50,4Gy en 25-28 sesiones más Braquiterapia (BT) seguido de cirugía. Resultados: la dosis promedio de BT fue 45Gy (rango 25Gy a 70Gy) administradas en una sola aplicación de baja tasa de dosis. La sobrevida Global (SG) a los 5 años fue 86,39%. La sobrevida diferenciada por estadios clínicos fue 85,71%, 83,52% y 84,03% para los estadíos I, II y III respectivamente sin diferencia significativa (p=0,55). El 20,75% (11/53) fallecieron por enfermedad, de las cuales 36,36% (4/11) recurrieron a nivel loco regional y 63,64% (7/11) metástasis a distancia. El análisis Bivariado no demostró factores de riesgo asociados con la mortalidad. Sin embargo el análisis multivariado de Regresión de Cox solo la enfermedad extra-pélvica es un factor de mal pronóstico y se relacionó con mayor mortalidad [HR: 5,27 IC 95% (1,10-25,28)] (p=0,038). Las pacientes con viabilidad en la pieza quirúrgica recibieron mayor dosis de radiación al punto A (mayores a 90Gy) que las piezas quirúrgicas no viables (p=0,041). El porcentaje de complicaciones fue del 20,75% (11/53) siendo el 9,44% (5/53) complicaciones severas (grado 4). Conclusiones: La presencia de enfermedad extra-pélvica fue un factor de mal pronóstico para la sobrevida. Palabras Claves: cáncer endometrial, radioterapia preoperatoria, sobrevida global.

Objective: To determine overall survival (OS), prognostic factors for disease-free survival and OS, the percentage of complications in patients with endometrial cancer treated with preoperative radiotherapy at the Instituto Nacional de Enfermedades Neoplásicas (INEN). Material and Methods: An analytical retrospective study of 381 patient records with endometrial cancer between 1995 and December 2004 was done; Only 53 patients full filed the inclusion criteria: clinical stage I, II, III according to FIGO 1971, external beam radiation to the pelvis to a dose of 50Gy - 50.4Gy in 25-28 sessions followed Brachytherapy (BT) and then surgery. Results: The mean dose of BT was 45Gy (range 25Gy to 70Gy) administered in a single application with low dose radiation. The OS at 5 years was 86.39%. OS for clinical stages I, II and III were 85.71%, 83.52% and 84.03% respectively, with no significant difference (p=0.55). 20.75% (11/53) died of disease, of which 36.36% (4/11) had recurrence in the pelvis and 63.64% (7/11) was distant metastases. Bivariate analysis showed no risk factors associated with mortality. However in the multivariate Cox regression only the extra-pelvic disease is a poor prognostic factor and was associated with increased mortality [HR: 5.27 IC 95% (1.10-25.28)] (p=0.038). The patients with viability in the surgical specimen had higher radiation doses to point A than non-viable surgical specimens (greater than 90Gy) difference that was significant (p = 0.041). The complication rate was 20.75% (11/53) and 9.44% (5/53) of complications were grade 4. Conclusions: The presence of extra-pelvic disease proved to be a poor prognostic factor for overall survival. Keywords: endometrial cancer, preoperative radiotherapy, overall survival.