Ventilación e intubación respiratoria como factores de riesgo para neumonía en un hospital del tercer nivel / Respiratory ventilation and intubation as risk factors for pneumonia in a tertiary hospital

Introducción: La neumonía asociada a la atención de salud empeora el pronóstico clínico del paciente y genera presión económica sobre los sistemas de salud. Objetivo: Determinar el riesgo de adquirir esta enfermedad en pacientes expuestos a ventilación/intubación y otros factores intrínsecos y extrínsecos. Métodos: Estudio transversal analítico. Población de estudio, pacientes hospitalizados en el Hospital Nacional Adolfo Guevara Velazco del Cusco en el 2017. Se seleccionó una muestra conformada por dos grupos: con diagnóstico de neumonía y sin este. El tamaño de muestra calculado fue de 67 (15 grupo neumonía y 52 grupo no neumonía). El análisis inferencial se realizó en dos etapas, utilizando pruebas de contraste de hipótesis y luego regresión logística. Se recogieron factores intrínsecos y extrínsecos de cada paciente. Resultados: La mayoría de pacientes correspondió al sexo femenino (53,7 por ciento). La mediana de edad fue de 70,6 años. El servicio de unidad de cuidados intensivos tuvo la mayor proporción de casos (42,9 por ciento). Se encontró asociación significativa con el uso de ventilación/ intubación y, además con los factores extrínsecos como traqueostomía, aspiración de secreciones, nutrición enteral y transfusión sanguínea. Ninguno de los factores intrínsecos tuvo asociación significativa en el análisis bivariado. En el análisis de regresión logística los pacientes sometidos a ventilación/intubación tuvieron 5,27 veces el riesgo de contraer neumonía y los pacientes sometidos a transfusión sanguínea tuvieron 12,75 veces el riesgo. Conclusiones: Los pacientes expuestos a ventilación/intubación tuvieron mayor riesgo de desarrollar neumonía asociada a la atención de salud. La transfusión sanguínea también fue un factor asociado(AU)

Introduction: Healthcare-associated pneumonia worsens the clinical prognosis of patients and exerts economic pressure on health systems. Objective: Determine the risk for healthcare-associated pneumonia among patients exposed to ventilation / intubation and other intrinsic and extrinsic factors. Methods: An analytical cross-sectional study was conducted of the patients admitted to Adolfo Guevara Velazco National Hospital in Cusco in the year 2017. A sample was chosen which was composed of two groups: with and without a pneumonia diagnosis. The estimated sample size was 67 (15 in the pneumonia group and 52 in the non-pneumonia group). Inferential analysis was performed along two stages, using hypothesis contrast tests followed by logistic regression. Intrinsic and extrinsic factors were collected for each patient. Results: Most patients were female (53.7 percent). Mean age was 70.6 years. The intensive care unit service had the highest proportion of cases (42.9 percent). A significant association was found with the use of ventilation / intubation, as well as with extrinsic factors such as tracheostomy, secretions aspiration, enteral nutrition and blood transfusion. None of the intrinsic factors had a significant association in the bivariate analysis. In the logistic regression analysis, patients subjected to ventilation / intubation had 5.27 times the risk of contracting pneumonia, whereas patients subjected to blood transfusion had 12.75 times the risk. Conclusions: Patients exposed to ventilation / intubation were at greater risk of developing healthcare-associated pneumonia. Blood transfusion was another associated factor(AU)

Publication and associated factors of clinical trials registered in Peru.

OBJECTIVE: We aim to determine the percentage of publication and its associated factors of clinical trials (CTs) registered in Peru. METHODS: Using a cross-sectional study design, we assessed CTs registered at the CT's Peruvian Registry (REPEC) during the 2011-2016 period, and evaluated its percentage of publication and associated factors. We used a bibliographic search algorithm to determine if the CTs were published and assessed the associated factors by using a Cox regression to estimate the adjusted hazard ratios (aHR) as the magnitude of association of interest. RESULTS: We analyzed 228 CTs, of which 63% were published. The regression analysis identified the year of registration (aHR 2012 = 1.15 [0.58-2.27]; aHR 2013 = 0.45 [0.21-0.95]; aHR 2014 = 0.89 [0.43-1.82]; aHR 2015-2016 = 0.16 [0.05-0.58]), total number of participants (aHR = 1.12; 1.05-1.18), and phase III-IV (aHR = 2.15; 0.1.16-4.03) as factors associated with the publication of the CTs. CONCLUSIONS: The percentage of publication of CTs executed in Peru is insufficient, and it increases the older the year of its registration in the REPEC, mayor of the number of participating countries, and if it is a phase III or IV study.

Percepción del Riesgo de Cáncer de Piel en un Hospital de Altura / Risk Perception Of Skin Cancer At A High-Altitude Hospital

Objetivo: Determinar el nivel de percepción de riesgo de cáncer de piel en una población de Cusco. Métodos: El estudio es observacional de tipo transversal descriptivo y se llevó a cabo en una campaña de despistaje de cáncer de piel en la ciudad de Cusco. El cuestionario aplicado fue diseñado y validado por Morales-Sánchez M y Cols, y mide la percepción de riesgo de cáncer de piel. El valor de alfa de Cronbach reportado es de 0,824. Resultados: La mayoría de pacientes fueron de sexo femenino (64,7%), de edad promedio fue de 44,9 años (DS: 14,2) y de grado de educación superior (51,0%). La mediana de horas de exposición solar fue de 4 (IC95%: 1 ­ 6), la procedencia más frecuente fue del Cusco (77,6%) y con una percepción normal del cáncer de piel (65,8%). Conclusión: La percepción de riesgo de cáncer de piel fue normal en la mayoría de la población.

Objective: To determine the level of risk perception of skin cancer in a population from Cusco. Methods: It is an observational descriptive cross-sectional study and was aplied in a skin cancer screening campaign in Cusco. The applied questionnaire was designed and validated by Morales-Sánchez M and Cols, and it measures the risk perception of skin cancer. The reported Cronbach's alpha value is 0.824. Results: The majority of patients were female (64.7%), average age was 44.9 years (SD: 14.2) and the 51.0% had higher education level. The median hours of sun exposure was 4 (95% CI: 1-6), the most frequent origin was from Cusco (77.6%) and most of the population have normal risk perception of skin cancer (65.8%). Conclusion:The risk perception of skin cancer was normal in the majority of the population.

Twenty-two years' experience registering trials in a low-middle income country: The Peruvian Clinical Trial Registry.

AIM: This study analyzes the quantitative and qualitative evolution of the Peruvian Clinical Trial Registry during the last 22 years. METHODS: Following a cross-sectional design, we reviewed all clinical trials registered at the Peruvian Clinical Trial Registry during 1995-2017. We downloaded and extracted all registries on 31 March 2018. We summarized qualitative variables and quantitative variables. Also, we performed trends analysis of the records by year, clinical phase, institutional review board, and children's participation. RESULTS: The Peruvian Clinical Trial Registry recorded 1748 clinical trials during 1995-2017. Considering World Health Organization 20-standard descriptors as the standard, the registry suitably recorded four of them in 1995 and 19 since 2013. There was a meaningful change in the trend of the registries, showing a significant upward registry trend until 2008 and a significant downward registry trend since then. This trend could be influenced by new regulation in clinical trials registry. Several trials had incomplete entries for different studied variables. Most of the clinical trials (82%) included male and female participants, and only 14% included children. Oncological disorders were the diseases most frequently investigated (20%). Most of clinical trials were registered by pharmaceutical companies. A few institutional review boards evaluated most of the clinical trials. CONCLUSION: The registration of clinical trials in Peru has improved quantitatively and qualitatively since it started, but its quantitative grow stopped in 2008. Since then, the number of registries has declined steadily. There is an influence of pharmaceutical companies in clinical trial registration.

Neonatal anthropometry at 3400 m above sea level compared with INTERGROWTH 21st standards.

OBJECTIVE: To determine the 3rd, 10th, 50th, 90th and 97th percentile of weight, length and head circumference (HC) of male and female neonates born at 3400 m above sea level and compare with published INTERGROWTH 21st standards. METHODS: Observational, transverse analytical study conducted in the National Hospital Adolfo Guevara Velazco of the ESSALUD hospital system in Cusco, Peru, at 3400 m altitude, during the period of January 2005 to December 2010. Using inclusion criteria, 7635 newborns were selected. The 3rd, 10th, 50th, 90th and 97th percentiles for the anthropometric measurements of birthweight, length and HC were determined for each sex and the results analyzed via polynomial regression for each percentile in order to compare the results with INTERGROWTH 21st standards. RESULTS: No statistically significant difference was observed with the exception of female HC at the 97th percentile when compared with the INTERGROWTH 21st standards. CONCLUSIONS: Based on tables generated in the present study, neonatal anthropometric percentiles at term at 3400 m above sea level demonstrate no appreciable difference with INTERGROWTH 21st standards with the exception of female HC at the 97th percentile.

Publicación de tesis de pregrado en una facultad de Medicina en Cusco, Perú / Publication of pre-graduate thesis in a School of Medicine in Cuzco, Peru

Determinar la tasa de publicación de las tesis de pregrado de Medicina Humana de una Universidad estatal de Cusco (Perú), en revistas científicas indizadas, así como las características y el impacto de estas publicaciones. Material y métodos: Se realizó un estudio retrospectivo; se recolectaron todas las tesis de pregrado de la universidad mencionada entre el 2000 y 2012, se determinó si fueron o no publicadas en alguna revista científica, mediante una búsqueda realizada en Google Académico, Lilacs, Lipecs, SciELO y Medline. Resultados: En el periodo de estudio se registraron 398 tesis de pregrado de Medicina Humana; fueron publicadas 20 (5,0%). Las bases de datos Lilacs (100,0%) y Lipecs (95,0%) fueron donde se encontraron la mayor cantidad de tesis. Solo una de las tesis fue publicada en una revista no peruana. Conclusiones: La tasa de publicación de las tesis fue baja en comparación con otros estudios nacionales...

To determine the publication rate, in indexed scientific journals and their impact, of pre-graduate thesis of Medicine in a public University in Cuzco, Peru. Methods: A retrospective study was carried-out in which all pregraduate thesis of Medicine was gathered between 2000 and 2012. A search in Academic Google, LILACS, SciELO and MEDLINE was performed to determine the publication of these theses. Results: 398 theses were found; 20 were published (5.0%). Two databases concentrated the majority of publications: LILACS (100%) and Lipecs (95%). Only one thesis was published in non-Peruvian journal. Conclusions: Publication rate is low compared to national surveys...

Satisfacción del usuario en la consulta externa del primer nivel de atención - Red asistencial EsSalud Cusco 2014 / User´s satisfaction in the outpatient service of primary care ­ Health care network EsSalud Cusco 2014

Objetivo: Identificar la proporción usuarios satisfechos atendidos en el servicio de consulta externa del primer nivel de atención, en la Red Asistencial EsSalud ­Cusco. Material y métodos: Estudio de tipo descriptivo transversal, realizado el 2014 en la Consulta Externa del Primer Nivel de Atención, utilizándose la metodología SERVQUAL para determinar la satisfacción de 605 usuarios externos. Resultados: Se consideraron 575 encuestas, el 70% (402) de los encuestados fueron usuarios directos de la prestación asistencial, el 75% (436) son personas con educación superior, la población femenina abarcó el 75% del total de encuestados y el asegurado titular hizo un mayor uso de los servicio de salud 54,8% (315). La satisfacción global se presentó en el 35% (201) de usuarios, siendo las dimensiones con mayor porcentaje de satisfechos: Seguridad 38%, Empatía 36%, y Aspectos Tangibles 37% y las dimensiones con menor satisfacción: Fiabilidad 33% y Capacidad de Respuesta 30%. Conclusiones: La proporción de usuarios satisfechos en el primer nivel de atención - Red asistencial ESSALUD - Cusco es baja (35%).