Nasogastric versus nasojejunal tube feeding for severe acutepancreatitis: A systematic review of randomized controlled trials

Early enteral nutrition through a feeding tube is essential for the management of severe acute pancreatitis (SAP). Nasojejunal tube nutrition has been preferred on the assumption that it provided pancreatic rest in comparison to the nasogastric tube. However, nasojejunal tube placement is complex, may delay feeding initiation and can increase hospital costs. Our aim was to compare the efficacy and safety of enteral feeding with a nasogastric tube versus nasojejunal tube in patients with SAP. We searched four databases (PubMed, Web of Science, Scopus, and Embase) until December 1, 2022. We included randomized controlled trials (RCTs) comparing enteral feeding by nasogastric and nasojejunal tubes in patients with SAP. Primary outcome was all-cause mortality. Secondary outcomes were organ failure, infection, complications, surgical intervention, duration of tube feeding and length of hospital stay. Risk of bias assessment was completed independently by two investigators using the Cochrane RoB 2.0 tool. We performed random effects model meta-analyses using the inverse variance method. Effect measures were reported as relative risks (RR) and their 95% CIs for dichotomous outcomes and mean differences (MD) and their 95% CIs for continuous outcomes. We included four RCTs involving 192 patients with SAP. The mean ages ranged between 36 and 62 years old. There was no significant difference in all-cause mortality between the nasogastric and nasojejunal feeding arms (18/98 vs. 23/93; RR 1.34, 95%CI 0.77-2.30; p=0.30). There were no significant differences in all secondary outcomes between feeding arms. There were three RCTs with some concerns of bias, in the randomization process. In conclusion, in patients with SAP, enteral feeding delivered by nasogastric tube was as efficacious and safe as nasojejunal tube. Further randomized controlled trials with more participants and better design are needed to confirm these findings.

La nutrición enteral temprana a través de una sonda de alimentación es esencial para el tratamiento de la pancreatitis aguda severa (PAS). Se ha preferido la nutrición por sonda nasoyeyunal, bajo el supuesto de que proporciona descanso pancreático en comparación con la sonda nasogástrica. Sin embargo, la colocación de la sonda nasoyeyunal es compleja, puede retrasar el inicio de la alimentación y aumentar los costos hospitalarios. Nuestro objetivo fue comparar la eficacia y seguridad de la alimentación enteral con sonda nasogástrica versus sonda nasoyeyunal en pacientes con PAS. Se realizaron búsquedas en cuatro bases de datos (PubMed, Web of Science, Scopus y Embase) hasta el 1 de diciembre de 2022. Se incluyeron ensayos controlados aleatorios (ECA) que compararon la alimentación enteral mediante sondas nasogástricas y nasoyeyunales en pacientes con PAS. El resultado primario fue la mortalidad por todas las causas. Los resultados secundarios fueron insuficiencia orgánica, infección, complicaciones, intervención quirúrgica, duración de la alimentación por sonda y duración de la estancia hospitalaria. Dos investigadores completaron de forma independiente la evaluación del riesgo de sesgo mediante la herramienta Cochrane RoB 2.0. Realizamos metanálisis de modelos de efectos aleatorios utilizando el método de varianza inversa. Las medidas del efecto se informaron como riesgos relativos (RR) y sus IC del 95% para resultados dicotómicos y diferencias de medias (DM) y sus IC del 95% para resultados continuos. Se incluyeron cuatro ECA con 192 pacientes con PAS. La edad media osciló entre 36 y 62 años. No hubo diferencias significativas en la mortalidad por todas las causas entre los brazos de alimentación nasogástrica y nasoyeyunal Cambiar lo resaltado por: (18/98 vs. 23/93; RR 1.34, 95%CI 0.77-2.30; p=0.30). No hubo diferencias significativas en todos los resultados secundarios entre los brazos de alimentación. Hubo tres ECA con algunas preocupaciones de sesgo en el proceso de asignación aleatorizado. En conclusión, en pacientes con PAS, la alimentación enteral administrada por sonda nasogástrica fue tan eficaz y segura como la sonda nasoyeyunal. Se necesitan más ensayos controlados aleatorios con más participantes y mejor diseño para confirmar estos hallazgos.

Prevalencia y factores asociados a la intención de vacunarse contra la COVID-19 en el Perú / Prevalence and factors associated with the intention to be vaccinated against COVID-19 in Peru

RESUMEN Objetivos: Estimar la prevalencia y los factores asociados a la intención de vacunación (IDV) contra la COVID-19 en el Perú. Materiales y métodos: Estudio transversal analítico utilizando una encuesta realizada por la Universidad de Maryland, EUA, en Facebook. La variable dependiente fue la IDV. Se calcularon razones de prevalencia (RP) crudas y ajustadas, con sus intervalos de confianza al 95% (IC95%), mediante modelos lineales generalizados de la familia Poisson para evaluar la asociación de variables sociodemográficas, el cumplimiento de estrategias comunitarias de mitigación, los síntomas de la COVID-19, la salud mental y la aceptación de la vacunación ante la recomendación (AVR) por diversos actores y autoridades sanitarias. Resultados: Se analizaron los datos de 17 162 adultos. La prevalencia general de la IDV fue del 74,9%. Se asociaron a una menor prevalencia de la IDV ser de sexo femenino (RP=0,95; IC95%:0,94-0,97), vivir en un pueblo (RP=0,95; IC95%:0,91-0,99) o en una aldea u otra área rural (RP=0,90; IC95%:0,86-0,93) y la AVR de políticos (RP=0,89; IC95%: 0,87-0,92). Contrariamente, tener síntomas de COVID-19 (RP=1,06; IC95%:1,03-1,09), inseguridad económica (RP=1,04; IC95%: 1,01-1,06), miedo a enfermar o que un familiar enferme de COVID-19 (RP=1,49; IC95%: 1,36-1,64) y la AVR de familiares y amigos (RP=1,10; IC95%: 1,08-1,12), trabajadores de la salud (RP=1,29; IC95%: 1,26-1,32), la Organización Mundial de la Salud (RP=1,34; IC95%: 1,29-1,40) y funcionarios del gobierno (RP=1,18; IC95%: 1,15-1,22) se asociaron con mayor prevalencia de IDV. Conclusiones: Tres cuartas partes de los encuestados manifiestan IDV. Existen factores potencialmente modificables que podrían mejorar la aceptación de la vacuna.

ABSTRACT Objectives: To estimate the prevalence and factors associated with the intention to be vaccinated (ITV) against COVID-19 in Peru. Materials and methods: Analytical cross-sectional study using the survey conducted by the University of Maryland, USA, on Facebook. The dependent variable is the ITV. Crude and adjusted prevalence ratios (PR) were calculated, with their 95% confidence intervals (95% CI) using generalized linear models of the Poisson family, in order to evaluate the association of sociodemographic variables, compliance with community mitigation strategies, symptoms of COVID-19, mental health and acceptance of vaccination before the recommendation (AVR) by various actors and health authorities, with the ITV. Results: Data from 17,162 adults were analyzed. The overall prevalence of the ITV was 74.9%. A lower prevalence of the ITV was associated with the female sex (PR=0.95; 95% CI: 0.94-0.97), living in a town (PR=0.95; 95% CI: 0.91-0.99) or village or other rural area (PR=0.90; 95% CI: 0.86-0.93) and the AVR of politicians (PR=0.89; 95% CI: 0.87-0.92). Conversely, having COVID-19 symptoms (PR=1.06; 95% CI: 1.03-1.09), economic insecurity (PR=1.04; 95% CI: 1.01-1.06), fears of becoming seriously ill or that a family member becomes seriously ill from COVID-19 (PR=1.49; 95% CI: 1.36-1.64) and the AVR of family and friends (PR=1.10; 95% CI: 1.08-1.12), healthcare workers (PR=1.29; 95% CI: 1.26-1.32), World Health Organization (PR=1.34; 95% CI: 1.29-1.40) and government officials (PR=1.18; 95% CI: 1.15-1.22) was associated with a higher prevalence of the ITV. Conclusions: Three-quarters of the respondents had the ITV. There are potentially modifiable factors that could improve vaccine acceptance.

Desarrollo de un modelo de predicción de infección mayor posterior a cirugía cardiaca pediátrica / Development of a model for predicting major infection following pediatric heart surgery

RESUMEN Objetivo: Desarrollar un modelo de predicción de riesgo para infección posoperatoria mayor (IPM) a cirugía cardiaca pediátrica y validar el de la Society of Thoracic Surgeons (STS). Materiales y métodos: Se analizó una cohorte retrospectiva de 1025 niños sometidos a cirugía cardiaca con circulación extracorpórea (CEC) del 2000 al 2010. Se empleó un modelo de regresión logística y se validó el modelo. Resultados: De los 1025 pacientes, 59 (5,8%) tuvieron al menos un episodio de IPM (4,8% sepsis, 1% mediastinitis, 0% endocarditis). La mortalidad hospitalaria (63% vs. 13%; p<0,001), al igual que la duración de la ventilación posoperatoria (301,6 vs. 34,3 horas; p<0,001) y la estancia en la unidad de cuidados intensivos (20,9 vs. 5,1 días; p <0,001) fueron mayores en los pacientes con IPM. Los factores predictores fueron: edad, sexo, peso, cardiopatía cianótica, RACHS-1 3-4, clase funcional IV modificada por Ross, estancia hospitalaria previa y antecedente de ventilación mecánica. El modelo tuvo un c-estadístico de 0,80 (intervalo de confianza [IC] al 95%: 0,74-0,86) y es clínicamente útil. El modelo de la STS mostró un c-estadístico de 0,78 (IC 95%: 0,71-0,84) y Hosmer-Lemeshow de 18,2 (p = 0,020). Se realizó una comparación entre ambos modelos empleando una prueba exacta de Fisher. Conclusión: Se desarrolló un modelo para identificar preoperatoriamente a niños con alto riesgo de infección grave después de una cirugía cardiaca con CEC con buen desempeño y calibración. Asimismo, se validó el modelo de la STS con moderada discriminación.

ABSTRACT Objective: The aim of this study was to develop a risk prediction model for major postoperative infection (MPI) after pediatric heart surgery and to validate the model of the Society of Thoracic Surgeons (STS). Materials and methods: We analyzed a retrospective cohort of 1,025 children who underwent heart surgery with cardiopulmonary bypass (CPB) from 2000 to 2010. We used a logistic regression model, which was validated. Results: Of the 1,025 patients, 59 (5.8%) had at least one episode of MPI (4.8% had sepsis, 1% had mediastinitis, 0% had endocarditis). Hospital mortality (63% vs. 13%; p < 0.001), as well as duration of postoperative ventilation (301.6 vs. 34.3 hours; p < 0.001) and intensive care unit stay (20.9 vs. 5.1 days; p < 0.001) were higher in patients with MPI. The predictive factors found were age, sex, weight, cyanotic heart disease, RACHS-1 3-4, Ross-modified functional class IV, previous hospital stay, and previous history of mechanical ventilation. The proposed model had a c-statistic of 0.80 (95% CI: 0.74-0.86) and was considered as clinically useful. The STS model showed a c-statistic of 0.78 (95% CI: 0.71-0.84) and a Hosmer-Lemeshow of 18.2 (P = 0.020). A comparison between the two models was made using an accurate Fisher test. Conclusion: A model with good performance and calibration was developed to preoperatively identify children at high risk for severe infection after cardiac surgery with CPB. The STS model was also validated and was found to have a moderate discrimination performance.

Possible association between dysnatremias and mortality during hospitalization in patients undergoing acute hemodialysis: analysis from a Peruvian retrospective cohort / Possível associação entre distúrbios do sódio e mortalidade hospitalar em pacientes submetidos a hemodiálise aguda: análise de uma coorte retrospectiva peruana

Abstract Objective: To evaluate the association between dysnatremias or dyschloremias and mortality during hospitalization in patients with acute kidney injury (AKI) or chronic kidney disease (CKD) undergoing acute hemodialysis. Methods: We carried out a retrospective cohort study on adult patients undergoing acute hemodialysis with AKI or CKD diagnosis at a public hospital in Lima, Peru. Dysnatremias were categorized as hyponatremia (Na < 135mmol/L) or hypernatremia (Na > 145mmol/L), and dyschloremias were defined as hypochloremia (Cl < 98 mmol/L) or hyperchloremia (Cl > 109mmol/L). The outcome of interest was mortality during hospitalization. We performed generalized lineal Poisson family models with bias-corrected and accelerated non-parametric bootstrap to estimate the risk ratios at crude (RR) and adjusted analysis (aRR) by gender, age, HCO3 (for all patients) and Liaño score (only for AKI) with CI95%. Results: We included 263 patients (mean age: 54.3 years, females: 43%): 191 with CKD and 72 with AKI. Mortality was higher in patients with AKI (59.7%) than in patients with CKD (14.1%). In overall, patients with hypernatremia had a higher mortality during hospitalization compared to those who had normal sodium values (aRR: 1.82, 95% CI: 1.17-2.83); patients with hyponatremia did not have different mortality (aRR: 0.19, 95% CI: 0.69-2.04). We also found that hyperchloremia (aRR: 1.35, 95% CI: 0.83-2.18) or hypochloremia (aRR: 0.66, 95% CI: 0.30-14.78) did not increase mortality in comparison to normal chloride values. No association between dysnatremias or dyschloremias and mortality during hospitalization was found in CKD and AKI subgroups. Conclusions: In our exploratory analysis, only hypernatremia was associated with mortality during hospitalization among patients with AKI or CKD undergoing acute hemodialysis.

Resumo Objetivo: Avaliar a associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar de pacientes com insuficiência renal aguda (IRA) ou doença renal crônica (DRC) submetidos a hemodiálise aguda. Métodos: O presente estudo de coorte retrospectiva incluiu pacientes adultos submetidos a hemodiálise aguda com diagnóstico de IRA ou DRC em um hospital público de Lima, Peru. Os distúrbios do sódio foram classificados como hiponatremia (Na < 135mmol/L) ou hipernatremia (Na > 145mmol/L), enquanto os distúrbios do cloro foram classificados como hipocloremia (Cl < 98 mmol/L) ou hipercloremia (Cl > 109mmol/L). O desfecho de interesse foi mortalidade hospitalar. Utilizamos modelos de Poisson da família de modelos lineares generalizados com bootstrap não-paramétrico e correção de viés acelerado para estimar os riscos relativos na análise bruta (RR) e ajustada (RRa) para sexo, idade, HCO3 (para todos os pacientes) e escore de Liaño (apenas para IRA) com IC 95%. Resultados: Foram incluídos 263 pacientes (idade média 54,3 anos; 43% do sexo feminino), 191 com DRC e 72 com IRA. A mortalidade foi mais elevada nos pacientes com IRA (59,7%) do que nos indivíduos com DRC (14,1%). No geral, os pacientes com hipernatremia tiveram mortalidade hospitalar mais elevada do que os indivíduos com valores normais de sódio (RRa: 1,82; IC 95%: 1,17-2,83). Os pacientes com hiponatremia não apresentaram mortalidade diferente (RRa: 0,19; IC 95%: 0,69-2,04). Também identificamos que hipercloremia (RRa: 1,35; IC 95%: 0,83-2,18) e hipocloremia (RRa: 0,66; IC 95%: 0,30-14,78) não elevaram a mortalidade em comparação a indivíduos com níveis normais de cloro. Não foi encontrada associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar nos subgrupos com DRC e IRA. Conclusões: Em nossa análise exploratória, apenas hipernatremia apresentou associação com mortalidade hospitalar em pacientes com IRA ou DRC submetidos a hemodiálise aguda.

Depression and geriatric assessment in older people admitted for hip fracture / Depresión y evaluación geriátrica en adultos mayores ingresados por fractura de cadera

ABSTRACT Background: Depression is common among older people with hip fracture. Aim: To assess depression scores and other mental and physical health variables in older people with and without depression, admitted to a traumatology ward for a hip fracture. Material and Methods: Cross sectional study of older patients admitted for surgical treatment of hip fracture. Demographic, clinical and laboratory variables were recorded. Twelve surveys were applied to assess general wellbeing, mental health, fall risk, nutritional status, basic and instrumental activities of daily living, social resources and depression (using Yesavage Depression Scale). Results: We assessed 310 patients aged 78 (72-83) years, 72% women. Overall depression prevalence was 46% and its frequency was significantly higher in women, people over 81 years of age, diabetics and subjects with anxiety. The Yesavage score in patients with and without depression was 6.5 and 3, respectively. The median number of medications used by patients with and without depression was 3 and 2 (p < 0.01). Conclusions: There is a high frequency of depression in these patients, especially in women and subjects older than 81 years of age. Routine geriatric assessments should be performed in hospitalized older patients with hip fracture.

Antecedentes: La alta prevalencia de depresión en la población anciana con fractura de cadera rara vez se reconoce. Objetivo: Estimar la prevalencia de depresión y comparar la salud física, mental, y otras variables geriátricas, en ancianos hospitalizados por fractura de cadera con y sin depresión. Material y Métodos: Estudio transversal con muestreo probabilístico con reemplazo, de pacientes que ingresaron para su atención quirúrgica. Se recolectaron variables sociodemográficas, antropométricas, clínicas y de laboratorio. Se aplicaron 12 encuestas para evaluar el estado de salud general, mental, riesgo de caídas, estado nutricional, actividades básicas e instrumentadas de la vida diaria, recursos sociales y depresión, entre otras. Para detectar depresión se usó la escala de tamizaje de Depresión Geriátrica Yesavage (EDG-15). Resultados: Se revisaron 310 pacientes (grupos con y sin depresión). La prevalencia de depresión fue de 46%, significativamente mayor en mujeres, sujetos mayores de 81 años, diabéticos y aquellos con ansiedad. La mediana de la puntuación EDG-15 fue de 6,5 y 3 para sujetos con y sin depresión (n = 142), (n = 168), respectivamente. La mediana del número de fármacos fue de 3 y 2 en estos grupos (p < 0,01). Conclusiones: La evaluación geriátrica sistemática en la atención del adulto mayor con fractura de cadera es indispensable, lo que podría aumentar las tasas de detección de depresión y de otros padecimientos e impactar positivamente en la calidad de vida y restauración de la función.

Glicemia na admissão e mortalidade em unidade de terapia intensiva pediátrica / Glycemia upon admission and mortality in a pediatric intensive care unit

RESUMO Objetivos: Analisar a associação entre os níveis glicêmicos quando da admissão dos pacientes à unidade de terapia intensiva pediátrica e a mortalidade entre pacientes hospitalizados. Métodos: Estudo retrospectivo de coorte conduzido em pacientes de uma unidade de terapia intensiva, admitidos ao Instituto Nacional de Salud del Niño entre 2012 e 2013. Utilizou-se um modelo de regressão de Poisson com variância robusta para qualificar a associação. Foi feita avaliação do desempenho do exame diagnóstico, para descrever sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e razão de verossimilhança para cada faixa de glicemia. Resultados: Incluíram-se no total 552 pacientes (idade mediana de 23 meses; faixa de variação entre 5 meses e 79,8 meses). O nível glicêmico médio quando da admissão foi de 121,3mg/dL (6,73mmol/L). Faleceram durante a hospitalização 92 (16,6%) pacientes. Na análise multivariada, encontraram-se associações significantes entre glicemia < 65mg/dL (3,61mmol/L) (RR: 2,01; IC95% 1,14 - 3,53), glicemia > 200mg/dL (> 11,1mmol/L) (RR: 2,91; IC95% 1,71 - 4,55), desnutrição (RR: 1,53, IC95% 1,04 - 2,25), ventilação mecânica (RR: 3,71, IC95% 1,17 - 11,76) e mortalidade durante a hospitalização. Ocorreram baixa sensibilidade (entre 17,39% e 39,13%) e alta especificidade (entre 49,13% e 91,74%) para diferentes níveis glicêmicos de corte. Conclusão: Ocorreu maior risco de óbito entre os pacientes que desenvolveram hipoglicemia e hiperglicemia por ocasião da admissão à unidade de terapia intensiva pediátrica. Certas faixas de glicemia (> 200mg/dL (> 11,1mmol/L) e < 65mg/dL (3,61mmol/L)) tiveram uma alta especificidade como preditores de óbito.

ABSTRACT Objectives: To analyze the association between glycemia levels upon pediatric intensive care unit admission and mortality in patients hospitalized. Methods: A retrospective cohort of pediatric intensive care unit patients admitted to the Instituto Nacional de Salud del Niño between 2012 and 2013. A Poisson regression model with robust variance was used to quantify the association. Diagnostic test performance evaluation was used to describe the sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios for each range of glycemia. Results: In total, 552 patients were included (median age 23 months, age range 5 months to 79.8 months). The mean glycemia level upon admission was 121.3mg/dL (6.73mmol/L). Ninety-two (16.6%) patients died during hospitalization. In multivariable analyses, significant associations were found between glycemia < 65mg/dL (3.61mmol/L) (RR: 2.01, 95%CI 1.14 - 3.53), glycemia > 200mg/dL (> 11.1mmol/L) (RR: 2.91, 95%CI 1.71 - 4.55), malnutrition (RR: 1.53, 95%CI 1.04 - 2.25), mechanical ventilation (RR: 3.71, 95%CI 1.17 - 11.76) and mortality at discharge. There was low sensitivity (between 17.39% and 39.13%) and high specificity (between 49.13% and 91.74%) for different glucose cut-off levels. Conclusion: There was an increased risk of death at discharge in patients who developed hypoglycemia and hyperglycemia upon admission to the pediatric intensive care unit. Certain glucose ranges (> 200mg/dL (> 11.1mmol/L) and < 65mg/dL (3.61mmol/L)) have high specificity as predictors of death at discharge.

Frecuencia y distribución de enfermedades periodontales asociadas a placa bacteriana en pacientes que acuden a una clínica universitaria / Frequency and distribution of periodontal diseases associated to dental plaque in patients who come to an university clinic

Introducción: La enfermedad periodontal‡ afecta los tejidos de soporte del diente y ocupa el segundo lugar dentro de las alteraciones orales de mayor prevalencia, misma que se caracteriza por ser una alteración infecciosa e infl amatoria, puede ser localizada o generalizada y a su vez aguda o crónica. Objetivo: Determinar la frecuencia y distribución de la enfermedad periodontal asociada a placa bacteriana en pacientes que acuden a atención estomatológica en una clínica universitaria. Material y métodos: Estudio observacional, prolectivo, transversal y descriptivo en 73 pacientes, con un promedio de edad de 38.5 (± 9.6) años; 34% (25) del sexo masculino y 66% (48) del femenino. Se valoró PDB con el índice de O'Leary y enfermedad periodontal con el índice periodontal de Russell. Resultados: La prevalencia de PB fue de 100%, con un índice de O'Leary de 74.2% (IC95% 64-84). La prevalencia de gingivitis para el total de la población fue de 25% (IC95% 15.1-34.9) y de periodontitis de 75% (IC95% 65.1-84.9). En el análisis de regresión lineal simple se encontró asociación ­débil a moderada­ entre presencia de PB y la enfermedad periodontal; para edad, el modelo explica para > 30 años (r = 0.384) 15% de la asociación y para los menores de esa edad (r = 0.440) 19%; por sexo, el modelo permite explicar en el caso del masculino (r = 0.557) 31% de la asociación y para el femenino (r = 0.354) sólo 13%. Conclusiones: La PB tiene el papel más importante en la aparición de la enfermedad periodontal; sin embargo, no es el único elemento que interviene para su desarrollo, porque no todas las colonias formadoras de bacterias dentro de la cavidad oral son afi nes a los tejidos periodontales. Esta enfermedad está asociada a múltiples factores de riesgo biológicos, sistémicos y socioeconómicos, entre otros. Su combinación puede variar el curso y agresividad de la enfermedad (AU)

Introduction: Periodontal disease affecting the supporting tissues of the tooth and occupies the second place in the most prevalent oral disorders, characterized for being an infectious and infl ammatory disorder, it can be localized or generalized and, in turn, acute or chronic. Objective: To determine the frequency and distribution of periodontal disease associated to dental plaque (DP) in patients attending stomatologic care at a university clinic. Material and methods: An observational, prolective, transverse and descriptive study in 73 patients, with a mean age of 38.5 (± 9.6) years; 34% (25) males and 66% (48) females. PDB was assessed with the O'Leary index and periodontal disease with the Russell periodontal index. Results: The prevalence of DP was 100%, with an O'Leary index of 74.2% (IC95% 64-84). The prevalence of gingivitis for the total population was 25% (IC95% 15.1-34.9) and 75% periodontitis (IC95% 65.1-84.9). In the simple linear regression analysis, a weak-to-moderate association was found between the presence of DP and periodontal disease; according to age, the model explains for the > 30 years (r = 0.384) 15% of the association and below said age (r = 0.440) 19%; by sex, the model allows to explain in the case of male (r = 0.557) 31% of the association, and for female (r = 0.354) only 13%. Conclusions: PB has the most important role in the appearance of periodontal disease, however, it is not the only element that intervenes for its development; because not all bacteriaforming colonies within the oral cavity are related to periodontal tissues. This disease is associated with multiple biological, systemic and socioeconomic risk factors, among others, its combination can vary the course and aggressiveness of the disease (AU)

Guía de práctica clínica para el diagnóstico y tratamiento de hemofilia en el Seguro Social de Salud del Perú (EsSalud)

Introducción. La hemofilia es un trastorno hemorrágico congénito poco común que requiere un manejo interdisciplinario, complejo, y frecuentemente costoso. El objetivo de la presente guía de práctica clínica (GPC) es proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de hemofilia en el seguro social del Perú (EsSalud). Métodos. Se conformó un grupo elaborador local (GEG-Local) conformado por especialistas en hematología y metodólogos. El GEG-Local formuló ocho preguntas clínicas a ser respondidas por la presente GPC. Se buscaron y seleccionaron GPC de hemofilia que respondieran a las preguntas planteadas y obtuvieran un puntaje mayor a 60% en los dominios uno y tres del instrumento Appraisal of Guidelines for Research and Evaluation II (AGREE-II). Durante el 2016 se realizaron búsquedas bibliográficas en Pubmed, EMBASE y biblioteca Cochrane, para actualizar siete preguntas clínicas de la GPC preseleccionada, y para responder una pregunta de novo. En reuniones de trabajo periódicas, el GEG-Local revisó la evidencia y formuló las recomendaciones y flujogramas usando la metodología Grading of commendations Assessment, Development, and Evaluation (GRADE). Finalmente, la GPC fue aprobada con Resolución N° 32-IETSI-ESSALUD-2016. Resultados. La presente GPC abordó ocho preguntas clínicas. En base a dichas preguntas se formularon 22 recomendaciones (tres recomendaciones fuertes y 19 recomendaciones condicionales) y cuatro flujogramas. Conclusión. Este artículo es el resumen de la GPC de EsSalud, en la cual se valoró la evidencia científica disponible sobre diagnóstico y tratamiento de hemofilia.

Introduction. Hemophilia is a rare congenital bleeding disorder; which requires interdisciplinary, complex, and often expensive management. The objective of this clinical practice guideline (CPG) is to provide evidence-based clinical recommendations for the evaluation and management of patients with hemophilia in the Peruvian Social Security (EsSalud). Methods. A local elaboration group (GEG-Local) was established, conformed by specialists in hematology and methodologists. The GEG-Local formulated 8 clinical questions to be answered by this CPG. We searched for and selected hemophilia CPGs that answered the questions posed and obtained a score higher than 60% in domains 1 and 3 of the Appraisal of Guidelines for Research and Evaluation II (AGREE-II). During 2016, bibliographic searches were conducted in Pubmed, EMBASE and the Cochrane library, to update 7 clinical questions of the preselected CPG, and to answer a question de novo. In regular work meetings, the GEG-Local reviewed the evidence and formulated the recommendations and flowcharts using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Finally, the CPG was approved with Resolution No. 32-IETSI-ESSALUD-2016. Results. This CPG addressed 8 clinical questions. Based on these questions, 22 recommendations were formulated (three strong recommendations and 19 weak recommendations) and four flowcharts. Conclusion. This article is the summary of the EsSalud CPG, in which the available scientific evidence on the diagnosis and treatment of hemophilia was assessed.

COLOCACIÓN DE IMPLANTE DENTAL CON RELLENO ÓSEO BIOGRAFT-G® EN HUESO CON TRAUMA DENTOALVEOLAR. REPORTE DE CASO / PLACEMENT OF DENTAL IMPLANTS WITH OSSEOUS FILLER (BIOGRAFT-G®) IN BONE WITH DENTAL ALVEOLAR TRAUMA. CASE REPORT

En la actualidad, para el odontólogo resulta un gran desafío poder restaurar la apariencia natural y la anatomía de dientes perdidos. En este trabajo se realiza el reporte de un caso clínico donde se restituye el incisivo central superior derecho, a causa de traumatismo dentomaxilofacial, por un implante Leader® combinado con el relleno óseo Biograft-G®. Se trata de una paciente de 19 años atendida en la consulta multidisciplinaria del Centro Nacional de Estomatología, La Habana, Cuba. La paciente portaba prótesis inmediata a causa de la pérdida del diente 11 por fractura de corona y raíz, con defecto óseo vestibular. A la paciente le ocurría fractura frecuente de la prótesis, viéndose afectada desde el punto de vista estético, social, psicoafectivo y funcional. Después de una evaluación multidisciplinaria y el consentimiento de la paciente, se procedió a la cirugía mediante la técnica de colgajo, colocación de implante Leader® y relleno con Biograft-G® para regenerar el defecto óseo, devolver contorno vestibular y lograr una rehabilitación definitiva. Con este tratamiento, la paciente obtuvo los resultados estéticos y funcionales deseados.

Today is a challenge to restore the natural appearance and anatomy of extracted teeth. In this paper we present a clinical case in which the right upper central incisor is restored, due to the presence of a dentomaxillofacial trauma, through a Leader® implant combined with Biograft-G® bone filler. The patient is a 19 year woman treated in the multidisciplinary consultation of the National Center of Stomatology, Havana, Cuba. The patient had an immediate prosthesis due to a fracture of the crown and root, with vestibular bone defect. The patient frequently fractured the prosthesis, which affected her in terms of aesthetics, social, psychological and functional incorporation. After a multidisciplinary evaluation and the patient's consent, the surgery was performed using the flap technique, the placement of the Leader® implant and the filling with Biograft-G® to regenerate the bone defect, to recover the vestibular contour and to achieve a definitive rehabilitation. With this treatment, the patient obtained the desired aesthetic and functional results.

Human papillomavirus vaccine efficacy in the prevention of anogenital warts: systematic review and meta-analysis / Eficacia de la vacuna contra el virus del papiloma humano en la prevención de verrugas anogenitales: revisión sistemática y metanálisis

Abstract: Objective: To review evidence on the efficacy of HPV vaccines in the prevention of non-cancer lesions (anogenital warts [AGW], recurrent laryngeal papillomatosis and oral papillomatosis). Materials and methods: We conducted a systematic review of randomized trials. We performed random effect models and effects were reported as relative risks (RR) and their confidence intervals (95%CI) following both intention to treat (ITT) and per protocol (PP) analyses. Results: We included six studies (n=27 078). One study was rated as high risk of bias. One study could not be included in the meta-analysis because it provided combined results. We found that quadrivalent vaccine reduced the risk of AGW by 62% (RR: 0.38, 95%CI:0.32-0.45, I2:0%) in the ITT analysis and by 95% (RR: 0.05, 95%CI:0.01-0.25, I2:66%) in the PP analysis. Subgroup analyses of studies in women or with low-risk of bias provided similar results. Conclusion: HPV quadrivalent vaccine is efficacious in preventing AGW in men and women.

Resumen: Objetivo: Revisar la evidencia sobre la eficacia de las vacunas contra el virus del papiloma humano en la prevención de lesiones no oncológicas (verrugas anogenitales [VAG], papilomatosis recurrente respiratoria y papilomatosis oral). Material y métodos: Realizamos una revisión sistemática de ensayos clínicos aleatorizados. Empleamos modelos de efectos aleatorios, calculando riesgos relativos (RR) y sus intervalos de confianza al 95% (IC95%), utilizando el análisis por intención a tratar (ITT) y por protocolo (PP). Resultados: Seleccionamos seis estudios (n=27 078). Un estudio tuvo alto riesgo de sesgo y otro no fue incluido en el metanálisis. La vacuna cuadrivalente reduce el riesgo de VAG en 62% (RR: 0,38; IC95%:0,32-0,45; I2:0%) en el análisis ITT y en 95% (RR: 0,05; IC95%:0,01-0,25; I2:66%) en el análisis PP. Los análisis de subgrupos (mujeres y estudios con bajo riesgo de sesgo) proporcionaron resultados similares. Conclusión. La vacuna cuadrivalente es eficaz en la prevención de VAG en hombres y mujeres.

Diabetes mellitus y nefropatía diabética en el Perú / Diabetes mellitus and diabetic nephropathy in Peru

Objetivo: describir la producción científica peruana que sobre diabetes mellitus 2 (DM) y nefropatía diabética (NFD) se ha escrito en la literatura médica. Material y métodos: Se realizó una revisión bibliográfica no sistemática de la producción científica que sobre DM y NFD en población peruana y que ha sido publicada en revistas médicas nacionales e internacionales hasta febrero de 2015. Se consultaron las bases de datos Medline, Web of Science, Scopus, SciELO y Google Scholar. Los resultados se dividieron a priori en cinco áreas temáticas: prevalencia de DM, manejo clínico de los pacientes diabéticos, diagnóstico de la NFD, factores de riesgo para albuminuria, y evaluación temprana de la NFD. Resultados: Se encontraron 22 artículos. La prevalencia de la DM varía dependiendo la definición y población estudiada siendo mayor en la costa que en la sierra (4,3% vs. 2,1%). El 40% de los pacientes diabéticos en hospitales públicos de Lima tiene HBA1C > 7%. Así mismo, el control de los pacientes DM en Perú es deficiente comparado con sus pares latinoamericanos. El ôscreeningõ de la NFD es infrecuente, solo 8,9% de los pacientes tiene albuminuria en sus evaluaciones en hospitales a nivel nacional. Se encontraron factores modificables asociados a la albuminuria en pacientes con NFD tales como glicemia (OR 1,19 IC 95%: 1,05-1,34), hipertensión arterial (OR 0,48 IC 95%: 0,33-0,70) y estadios de enfermedad renal crónica OR 1,93 (p=0.007). Existen hospitales donde la atención nefrológica en pacientes con NFD es mayormente en condiciones de emergencia. Conclusiones: Los resultados de estos artículos mostraron que existen aspectos perfectibles en el ôscreeningõ y manejo de ambas enfermedades así como escasez de estudios sobre el tema en Perú.

Objectives: to describe the scientific literature production in Peru about type 2 diabetes mellitus (DM) and diabetic nephropathy (DN). Methods: A non-systematic review of the scientific production about DM and DN in peruvian population and has been published in national and international medical journals until february 2015 was conducted. We used the databases Medline, Web of Science, Scopus, SciELO and Google Scholar. The results were divided a priori into 5 areas: Prevalence DM 2, clinical management of the diabetic patient, diagnosis of DN, risk factors for albuminuria, and early assessment of DN. Results: We found 22 items. The prevalence of DM varies depending on the definition and study population and was higher on the coast than in the highlands (4.3% vs. 2.1%). In public hospitals in Lima, 40% of diabetic patients have HbA1c> 7%. Likewise, the control of DM patients in Peru is poor compared with their Latin American counterparts. The ôscreeningõ of the NFD is uncommon, only 8.9% of patients have albuminuria in their assessments in hospitals nationwide. Modifiable factors associated with albuminuria in patients with DN were found such as glucose (OR 1.19 95% CI 1.05 to 1.34), hypertension (OR 0.48 95% CI 0.33 to 0.70) and stages of chronic kidney disease OR: 93 (p = 0.007). There are hospitals where nephrology care in patients with DN is mostly under emergency conditions. Conclusions: The results of these articles reflect that there are aspects in the screening and management of both diseases that can be improved and scarcity of studies on the subject in Peru.

Percepção dos médicos sobre a formação adquirida durante a especialização em Nefrologia no Peru / Perception of physicians about medical education received during their Nephrology residency training in Peru

ResumoIntrodução:No Peru, existem diferentes locais e currículos de ensino para a formação de especialistas em Nefrologia.Objetivo:Avaliar a percepção dos médicos que frequentam esse tipo de formação.Métodos:Análise descritivo-transversal sobre médicos que estavam nos últimos dois anos de formação em Nefrologia em fevereiro de 2012 e os que se formaram nos anos 2010 e 2011, em nível nacional. Utilizou-se um questionário autoaplicável desenvolvido com base em normas internacionais, juntamente com a Sociedade Peruana de Nefrologia. Este questionário explorou as seguintes áreas: ensino, treinamento clínico, procedimentos, rotações externas, pesquisa e percepção global.Resultados:Foram obtidas 40 respostas de um total de 49 médicos. 82,5% tinham tutores, 22,5% deles disseram que o apoio destes era deficiente. 27,5% descreveram a sua formação teórica como deficiente. A formação prática, é percebida como aceitável, no entanto sugerem melhoras na formação em diálise peritoneal, transplante renal e análise de biópsias. Um 90% tem rotações externas nacionais e 65% relataram ter uma rotação internacional. Quando se avaliou seu desempenho na área de pesquisas, 77,5% o considerou deficiente. Além disso, 82,5% acreditam que a residência deve durar quatro anos. No entanto, 60% informaram que sua residência é boa. Existe uma diminuição da percepção positiva dos aspectos estudados entre os residentes com relação aos graduados.Conclusão:A formação geral na especialização em Nefrologia é considerada boa para os residentes; no entanto, a área de tutoria, as atividades acadêmicas e de pesquisa são deficientes.

AbstractIntroduction:In Peru there are different hospitals and university programs for training of specialists in nephrology.Objective:To assess the perception of physicians who attend such programs.Methods:We carried out a descriptive cross-sectional national-level study in physicians who were in the last two years of nephrology training during February 2012 and who had graduated from it in 2010 and 2011. A self-applied questionnaire was developed along with the Peruvian Society of Nephrology based on international standards. The questionnaire evaluated: mentoring, clinical training, procedures, external rotations, research and global perception.Results:Forty doctors were surveyed nationwide. 82.5% had tutors, 22.5% of them said their support was poor. A 27.5% described their theoretical formation as deficient. The practical training was perceived as acceptable globally; however, improvements in training on peritoneal dialysis and reading kidney transplant biopsies are necessary. A 90% have national external rotations and 65% reported to have an international rotation. In the assessment of research, 77.5% thought this is deficient. In addition, 82.5% believed that residency should last four years. However, 60% reported that their residency training was good. There is a decrease in the positive perception of the aspects studied among residents regarding graduates.Conclusion:The overall perception of nephrology residency training was considered good; however, areas of tutoring, and academic and research activities on average were deficient.

Factores asociados a mortalidad intrahospitalaria de una población en hemodiálisis en el Perú / Factors associated with in hospital deaths in a hemodialysis population in Peru

Determinar los factores asociados a la mortalidad durante la primera hospitalización de una población incidente en hemodiálisis. Materiales y métodos. Estudio observacional y retrospectivo de pacientes que ingresaron al Hospital Nacional Dos de Mayo entre enero de 2012 y diciembre de 2013. Para el análisis de la supervivencia utilizamos el método de Kaplan-Meier. Se realizó un análisis de regresión logístico multivariado para evaluar los factores asociados a mortalidad intrahospitalaria. Resultados. Se estudiaron 216 pacientes con edad promedio de 56,9 ± 15,5 años. El 24% de los paciente (n=51) fallecieron durante la estancia hospitalaria. La tasa de mortalidad fue de 9,3 muertes/100 personas-semanas (IC 95%: 7,0 a 12,3). Se evidenció una tendencia a menor riesgo de fallecer en pacientes que tenían entre uno y seis meses con diagnóstico de enfermedad renal crónica (OR 0,84; IC 95%: 0,32 a 2,26), y en aquellos con más de seis meses comparado con aquellos que lo tenían hace menos de un mes (OR 0,55; IC 95%: 0,19 a 1,57). La atención previa por un nefrólogo no estuvo asociada a diferencias en la mortalidad menor (OR 1,14; IC 95%: 0,39 a 3,31). Conclusiones. Existe una deficiente atención previa entre los pacientes en hemodiálisis que forman parte de una inadecuada estructura de atención de salud y que está asociado a una alta mortalidad intrahospitalaria...

To determine the factors associated with mortality during the first hospitalization of patients admitted to a hemodialysis unit. Materials and methods. Observational and retrospective study of patients admitted to ôDos de Mayoõ National Hospital between January 2012 and December 2013. For the survival analysis we used the Kaplan-Meier method. A multivariate logistic regression was performed to evaluate the factors associated with hospital mortality. Results. 216 patients with a mean age of 56.9 ± 15.5 years were studied. 24% of patients (n = 51) died during their hospital stay. The mortality rate was 9.3 deaths/100 person-weeks (95% CI: 7.0 to 12.3). We found a tendency of less risk of death in patients with between 1 and 6 months from chronic kidney disease diagnosis (OR 0.84, 95% CI: 0.32 to 2.26) and in those with more than six months from chronic kidney disease diagnosis compared with those who had less than a month from chronic kidney disease diagnosis (OR 0.55, 95% CI: 0.19 to 1.57). Previous care by a nephrologist was not associated with differences in lower mortality (OR 1.14, 95% CI: 0.39 to 3.31). Conclusions. There is poor prior care among hemodialysis patients that form part of an inadequate health care structure and this is associated with high inhospital mortality...

Revisión sistemática sobre la efectividad de intervenciones basadas en la comunidad en la disminución de la mortalidad neonatal / Systematic review of the efectiveness of community-based interventions to decrease neonatal mortality

Se evalúa la eficacia/efectividad de las intervenciones basadas en la comunidad, destinadas a disminuir la mortalidad neonatal. Se realizó una revisión sistemática de ensayos controlados aleatorizados, ensayos aleatorizados de comunidad y estudios de cohortes de intervenciones dirigidas a la mujer gestante, al neonato (hasta 28 días de nacido) o a ambos. Se evaluaron 34 estudios (n=844,989): 20 en mujeres gestantes (n=406,172); 6 en neonatos (n=24,994), y 8 en ambos grupos (n=413,823). El riesgo de sesgo fue generalmente bajo. Hubo heterogeneidad entre los tipos de intervenciones. Las intervenciones educación materna en salud y cuidado en casa de madres y neonatos estuvieron asociadas con disminución de mortalidad neonatal en la mitad de los seis estudios de cada grupo. La suplementación materna con multimicronutrientes, el cuidado de madre canguro y la suplementación materna prenatal con vitamina A no disminuyeron la mortalidad neonatal. Pocas intervenciones comunitarias heterogéneas han demostrado disminuir la mortalidad neonatal...

We evaluated the efficacy/effectiveness of community-based interventions to decrease neonatal mortality. A systematic review of randomized controlled trials, cluster randomized trials and cohort studies of interventions on pregnant women, neonates (up to 28 days after birth) or both was made. Thirty four studies were evaluated (n=844,989): 20 in pregnant women (n=406,172), 6 in neonates (n=24,994), and 8 in both (n=413,823). Risk of bias was generally low. There was heterogeneity among interventions. Interventions such as maternal health education and maternal and neonatal home care were associated to a decrease in neonatal mortality in half of the 6 studies of each group. Supplementation with multiple micronutrients, kangaroo mother care, and maternal supplementation with vitamin A did not decrease neonatal mortality. A few heterogeneous community-based interventions demonstrated a decrease in neonatal mortality...

Mortalidade dos pacientes com doença renal crônica em hemodiálise de manutenção em um hospital público do Peru / Mortality in patients with chronic kidney disease undergoing hemodialysis in a public hospital of Peru

Resumo Introdução: O Ministério da Saúde do Peru não tem um programa nacional de hemodiálise e os hospitais que oferecem este tipo de tratamento apresentam problemas de cobertura que podem resultar em aumento da mortalidade. Objetivo: Avaliar a mortalidade da população incidente em hemodiálise em um hospital de Lima. Métodos: Análise da população acima de 18 anos que iniciou o tratamento entre 1 de janeiro de 2012 e 31 de dezembro de 2013, com data de corte final do acompanhamento em 31 de março de 2014. Foi realizada regressão logística bivariada e multivariada dos fatores associados com a mortalidade e usadas as curvas de Kaplan-Meier para determinar a probabilidade de sobrevivência durante o acompanhamento. Resultados: Foram incluídos 235 pacientes para estudo, com idade média de 56,4 ± 15,8 anos. A mediana de acompanhamento foi 0,6 anos (IQR 0,3 a 1,5). A pesquisa mostra que 50% dos pacientes abandonaram o tratamento durante o estudo por falta de vagas ou recursos econômicos. No final do terceiro mês, a mortalidade foi 37,7% (IC 95% 29,3 a 48,5) e 49,5% (IC 95% 38,8 a 61,4) ao sétimo mês. A mortalidade foi menor quando o paciente tinha mais de seis meses com diagnóstico de doença insuficiência renal crônica (OR = 0,39 [IC 95% 0,12-1,27]) e quando o paciente ingressava à diálise programada (OR = 0,28 [IC 95% 0,01 a 2,28]). Conclusão: Metade dos pacientes foi a óbito no sétimo mês de seguimento. Ter ingressado com diálise programada e ter mais tempo de diagnóstico foi associado à menor mortalidade. .

Abstract Introduction: The Peruvian Ministry of Health does not have a national program of hemodialysis and hospitals that offer it have coverage problems, which may result in increased mortality. Objective: We evaluated mortality of a population with incident hemodialysis in a Peruvian public hospital as well as its associated factors. Methods: Retrospective and descriptive study of a population over 18 years-old who started treatment between January 1, 2012 and December 31, 2013 with the final follow-up day on31 March 2014. We used bivariate and multivariate logistic regression models to evaluate factors associated with mortality and Kaplan Meier curves were used to determine the probability of survival. Results: We included 235 patients with a mean age of 56.4 ± 15.8 years. Median follow-up was 0.6 years (IQR 0.3 to 1.5). 50% of years withdrew from therapy during the study for lack of financial resources or space available. The third month mortality was 37.7% (95% CI 4.7 to 48.5) and 49.5% (95% CI 5.8 to 61.4) at 7 months. There was a trend towards lower mortality when patients had more than 6 months with a diagnosis of chronic kidney disease (CKD) (OR = 0.39 [95% CI 0.12 to 1.27]) and when the patient was admitted with scheduled dialysis (OR = 0.28 [95% CI 0.01 to 2.28]). Conclusion: Half of patients died within seven months of follow-up. Scheduled dialysis and having longer time with CKD diagnosis tend to be associated with lower mortality .

La mala calidad de sueño se asocia a una menor adherencia al tratamiento antirretroviral de gran actividad en pacientes peruanos con infección por VIH/SIDA / Poor quality of sleep associated with low adherence to highly active antiretroviral therapy in Peruvian patients with HIV/AIDS / A má qualidade do sono associada à menor aderência à terapia antirretroviral de alta atividade em pacientes peruanos com infecção pelo HIV/AIDS

Con el objetivo de evaluar si existe asociación entre la mala calidad de sueño y la adherencia al tratamiento antirretroviral de gran actividad (TARGA) en personas con infección por VIH/ SIDA; llevamos a cabo un estudio analítico de corte transversal que incluyó 389 pacientes peruanos en TARGA. La mala calidad de sueño fue medida con la Escala de Calidad de Sueño de Pittsburgh y la adherencia con el CEAT-VIH. Realizamos un modelo lineal generalizado de familia Poisson, con errores estándar robustos para estimar razones de prevalencia y su IC95%. A nivel crudo la mala calidad de sueño leve, moderada y severa se asoció a la adherencia inadecuada. Al ajustar por las variables asociadas en el análisis bivariado o por las variables teóricamente asociadas a la adherencia, sólo la mala calidad de sueño moderada/severa se mantuvo asociada (RP = 1,34; IC95%: 1,17-1,54 y RP = 1,34; IC95%: 1,16-1,57; respectivamente). Se concluye que la mala calidad de sueño moderada/severa se asocia de manera independiente con la adherencia al TARGA. La evaluación de la calidad de sueño podría por ende ser útil en la valoración integral de los pacientes con VIH.

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

A fim de avaliar se a associação entre a má qualidade do sono e adesão à terapia antirretroviral (TARV) em pessoas com infecção pelo HIV/AIDS, realizamos um estudo analítico de corte transversal que incluiu 389 pacientes peruanos em TARV. A má qualidade do sono foi medida com a escala Índice de Qualidade de Sono de Pittsburgh (IQSP) e a aderência com o CEAT- (adaptação peruana). Foi realizado um modelo linear generalizado da família Poisson com padrão de erros robustos, para estimar as razões de prevalência e IC95%. No nível cru, a má qualidade do sono leve, moderada e grave foram associadas com adesão inadequada. Quando fizemos o ajuste para as variáveis associadas na análise bivariada ou variáveis teoricamente associadas à adesão, somente a má qualidade moderada/grave manteve-se associada (RP = 1,34; IC95%: 1,17-1,54 e RP = 1,34; IC95%: 1,16-1,57; respectivamente). Concluímos que a má qualidade do sono moderada/grave está independentemente associada com a adesão a TARV. Avaliar a qualidade do sono pode ser útil na avaliação global do paciente com HIV.

Baja adherencia al régimen de hemodiálisis en pacientes con enfermedad crónica renal en un hospital de referencia del Ministerio de Salud en Perú / Low adherence to hemodialysis regime in patients with chronic renal disease in a Peruvian Ministry of Health reference hospital

Introducción: La ausencia a una sesión mensual en un esquema de diálisis convencional puede incrementar la mortalidad en 30 por ciento. Objetivos: Describir la frecuencia y la percepción de las causas de falta de adherencia a diálisis en una población prevalente de un hospital público de referencia nacional en Perú. Diseño: Estudio descriptivo. Institución: Servicio de Nefrología, Hospital Nacional 2 de Mayo, Lima, Perú. Participantes: Pacientes con más de un año en diálisis Intervenciones: Se determinó el número de faltas y se aplicó un cuestionario para describir su percepción respecto a las causas de las faltas, validado por juicio de expertos. Principales medidas de resultados: Baja adherencia a diálisis definida como: pacientes con más de una falta al mes o más de 12 faltas, entre julio de 2012 y julio de 2013. Resultados: Se incluyó 54 pacientes, 27 eran varones, con una edad y tiempo de diálisis promedio de 57 ± 16,4 años y 40,6 ± 11,5 meses, respectivamente; 7/54 pacientes tenían educación superior. Hubo 504 faltas (5,45 por ciento). El segundo día de la programación semanal fue el día con mayor frecuencia de faltas (292), seguido del tercer día (145); 13/54 tuvieron baja adherencia. Las principales causas reportadas fueron: una residencia alejada (6/13), la sensación de bienestar (6/13), el contar con escasos recursos económicos para solventar el traslado (5/13). Conclusiones: Uno de cada cuatro pacientes tuvo baja adherencia. El residir lejos o que se sintiera bien fueron las principales causas de la baja adherencia...

Background: Failing to attend a monthly session within a scheme of conventional dialysis may increase mortality by 30 per cent. Objectives: To describe the frequency and perceived causes of non-adherence to dialysis in a Peruvian national reference public hospital. Design: Descriptive study. Setting: Nephrology department, Hospital Nacional 2 de Mayo, Lima, Peru. Participants: Patients with more than one year on dialysis. Interventions: The number of absences to appointed sessions was determined and a validated questionnaire was used to describe perceptions regarding the causes of absences. Main outcomes measures: Low adherence to dialysis defined as patients with more than one absence per month or more than 12 absences between July 2012 and July 2013. Results: The study included 54 patients, of which 27 were male. Average age was 57 ± 16.4 years and average time on dialysis was 40.6 ± 11.5 months. Only 7 patients had higher education. There were 504 absences (5.45 per cent). The second day of the weekly schedule was the day with more absences (292), followed by the third day (145). Overall 13 patients showed low adherence. Main causes of absence reported included a remote residence (6/13), feeling good (6/13), and insufficient financial resources to cover transportation costs (5/13). Conclusions: A quarter of patients had low adherence, and main factors were distance to health facility and wellbeing self-perception...