Binding Potassium to Improve Treatment With Renin-Angiotensin-Aldosterone System Inhibitors: Results From Multiple One-Stage Pairwise and Network Meta-Analyses of Clinical Trials.

This manuscript presents findings from the first dichotomous data pooling analysis on clinical trials (CT) regarding the effectiveness of binding potassium. The results emanated from pairwise and network meta-analyses aiming evaluation of response to commercial potassium-binding polymers, that is, to achieve and maintain normal serum potassium (n = 1,722), and the association between this response and an optimal dosing of renin-angiotensin-aldosterone system inhibitors (RAASi) needing individuals affected by heart failure (HF) or resistant hypertension, who may be consuming other hyperkalemia-inducing drugs (HKID) (e.g., ß-blockers, heparin, etc.), and frequently are affected by chronic kidney disease (CKD) (n = 1,044): According to the surface under the cumulative ranking area (SUCRA), sodium zirconium cyclosilicate (SZC) (SUCRA >0.78), patiromer (SUCRA >0.58) and sodium polystyrene sulfonate (SPS) (SUCRA <0.39) were different concerning their capacity to achieve normokalemia (serum potassium level (sK+) 3.5-5.0 mEq/L) or acceptable kalemia (sK+ ≤ 5.1 mEq/L) in individuals with hyperkalemia (sK+ >5.1 mEq/L), and, when normokalemia is achieved, patiromer 16.8-25.2 g/day (SUCRA = 0.94) and patiromer 8.4-16.8 g/day (SUCRA = 0.41) can allow to increase the dose of spironolactone up to 50 mg/day in subjects affected by heart failure (HF) or with resistant hypertension needing treatment with other RAASi. The potential of zirconium cyclosilicate should be explored further, as no data exists to assess properly its capacity to optimize dosing of RAASi, contrarily as it occurs with patiromer. More research is also necessary to discern between benefits of binding potassium among all type of hyperkalemic patients, for example, patients with DM who may need treatment for proteinuria, patients with early hypertension, etc. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020185614, CRD42020185558, CRD42020191430.

The Inhibition of Complement System in Formal and Emerging Indications: Results from Parallel One-Stage Pairwise and Network Meta-Analyses of Clinical Trials and Real-Life Data Studies.

This manuscript presents quantitative findings on the actual effectiveness of terminal complement component 5 (C5) inhibitors and complement component 1 (C1) esterase inhibitors through their formal and common "off-label" (compassionate) indications. The results emanated from pairwise and network meta-analyses to present evidence until September 2019. Clinical trials (CT) and real-life non-randomized studies of the effects of interventions (NRSI) are consistent on the benefits of C5 inhibitors and of the absence of effects of C1 esterase inhibitors (n = 7484): Mathematically, eculizumab (surface under the cumulative ranking area (SUCRA) >0.6) and ravulizumab (SUCRA ≥ 0.7) were similar in terms of their protective effect on hemolysis in paroxysmal nocturnal hemoglobinuria (PNH), thrombotic microangiopathy (TMA) in atypical hemolytic uremic syndrome (aHUS), and acute kidney injury (AKI) in aHUS, in comparison to pre-/off-treatment state and/or placebo (SUCRA < 0.01), and eculizumab was efficacious on thrombotic events in PNH (odds ratio (OR)/95% confidence interval (95% CI) in CT and real-life NRSI, 0.07/0.03 to 0.19, 0.24/0.17 to 0.33) and chronic kidney disease (CKD) occurrence/progression in PNH (0.31/0.10 to 0.97, 0.66/0.44 to 0.98). In addition, meta-analysis on clinical trials shows that eculizumab mitigates a refractory generalized myasthenia gravis (rgMG) crisis (0.29/0.13 to 0.61) and prevents new acute antibody-mediated rejection (AMR) episodes in kidney transplant recipients (0.25/0.13 to 0.49). The update of findings from this meta-analysis will be useful to promote a better use of complement inhibitors, and to achieve personalization of treatments with this class of drugs.

Angiotensin-Converting Enzyme (ACE) genetic variation and longevity in Peruvian older people: a cross-sectional study.

Background: Some studies have suggested that the insertion(I)/deletion(D) polymorphism of the Angiotensin-Converting Enzyme (ACE) gene may be associated with human longevity, especially in centenarians. However, this association is still controversial. Besides, there have been no studies in Peruvians.Aim: To describe the age distribution of the ACE polymorphism in a convenience sample of Peruvian older people.Subjects and methods: This was a cross-sectional study in 104 Geriatric Day Hospital patients in Lima, Perú. The ACE polymorphism was determined in all patients. For the purpose of association with age, the sample was divided into four categories: young (< 65), youngest-old (65-74), middle-old (75-84) and oldest-old (85 or more).Results: The distribution of genotype frequencies was consistent with a population in Hardy-Weinberg equilibrium (p = 0.62). The number (%) of D/D, I/D and I/I genotypes in the young was 2 (14.3%), 3 (21.4%) and 9 (64.3%), respectively; in youngest-old: 4 (11.4%), 15 (42.9%) and 16 (45.7%); in middle-old: 6 (12.2%), 20 (40.8%) and 23 (46.9%); and in oldest-old: 0 (0.0%), 4 (66.7%) and 2 (33.3%). A chi-square analysis showed no significant differences in genotype distribution between age groups (p = 0.647).Conclusion: No significant age differences were found in the distribution of the ACE polymorphism in this sample. Further studies with greater statistical power are recommended.

Diabetes mellitus e hipertensión arterial como factor de riesgo de mortalidad en pacientes con Covid-19 / Diabetes mellitus and arterial hypertension as a risk factor of mortality in patients with Covid-19

Objetivo. identificar la posible asociación de diabetes mellitus e hipertensión arterial como factores de riesgo de mortalidad en pacientes con COVID-19. Material y métodos: estudio de cohorte prospectivo, incluye a 1947 pacientes con 30 o más años de edad, atenciones realizadas entre marzo y agosto del 2020; pacientes con diagnóstico clínico y laboratorial de COVID-19; se excluyeron pacientes con inconsistencias en la información registrada, fallecidos en primeras 24 horas o estuvieron muertos al ingreso. Se incluyeron variable periodo de atención, edad, sexo, diabetes mellitus, hipertensión arterial, estancia hospitalaria, frecuencia respiratoria, frecuencia cardiaca, saturación de oxígeno y temperatura; para el análisis se utilizó la prueba chi cuadrado de Pearson, Odds Ratio y prueba T de student para muestras no emparejadas (p <0,05). Resultados: 73% de los fallecidos de sexo masculino (p<0.001), mayor frecuencia entre los 60 ­ 79 años de edad (54,8%, p<0,001); diabetes como comorbilidad en 17% de los casos (p=0,019) e hipertensión arterial en 24% (p<0,001). Las variables sexo (OR 1,5) y las comorbilidades diabetes (OR 1,4) e hipertensión arterial (OR 1,9) representan factores de riesgo de mortalidad. Conclusiones: la diabetes mellitus e hipertensión arterial, para la población en estudio, se identificaron como factor de riesgo de mortalidad frente al COVID-19

Objetive. to identify the possible association of diabetes mellitus and arterial hypertension as risk factorsformortalityinpatientswithCOVID-19. Material and methods: prospective cohort study, includes 1947 patients aged 30 or over, care performed between March and August 2020; patients with clinical and laboratory diagnosis of COVID-19; Patients with inconsistencies in the information recorded, who died in the first 24 hours or were dead on admission, were excluded. Variable period of care, age, sex, diabetes mellitus, arterial hypertension, hospital stay, respiratory rate, heart rate, oxygen saturation and temperature were included; Pearson's chi-square test, Odds Ratio and Student's Ttest for unpaired samples (p <0.05) were used for the analysis. Results: 73% of male deaths (p <0.001), the highest frequency was between 60-79 years of age (54.8%, p <0.001); diabetes as comorbidity in 17% of cases (p=0.019) and hypertension in 24% (p <0.001). The variables sex (OR 1.5) and the comorbidities diabetes (OR 1.4) and arterial hypertension (OR 1.9) represent risk factors for mortality. Conclusions: diabetes mellitus and arterial hypertension, for the study population, were identified as a risk factor for mortality against COVID-19

Análisis de asociación entre polimorfismos (rs941798 y rs914458) del gen PTPN1 y diabetes tipo 2 en familias de Lima-Perú / Analysis of the association between PTPN1 gene polymorphisms (rs941798 and rs914458) and type 2 diabetes in families from Lima ­ Peru

Objetivo: Analizar la asociación de los polimorfismos de un solo nucleótido (SNP) rs941798 y rs914458 del gen PTPN1 con la diabetes tipo 2 en familias peruanas de Lima. Materiales y métodos: Veintitrés tríos familiares fueron captados en el Hospital Nacional Arzobispo Loayza. Se extrajeron muestras de sangre periférica para obtener el ADN y luego las frecuencias alélicas y genotípicas de los SNP. La genotipificación de los SNP se realizó mediante secuenciación. El análisis de asociación basado en familias entre los SNP y la diabetes tipo 2 se realizó con el programa FBAT. Resultados: Se observaron los 3 genotipos posibles para cada SNP, rs941798 (A>G) y rs914458 (G>C). Las pruebas de asociación basada en familias a nivel alélico mostraron al alelo A del SNP rs941798 asociado a la diabetes tipo 2 (p = 0.023) bajo uno de los modelos evaluados; no obstante, tras la corrección de Bonferroni para comparaciones múltiples, esta asociación se perdió. No se evidenció asociación entre los SNP y la enfermedad en ningún nivel (alélico, genotípico o haplotípico). Conclusiones: No se encontraron evidencias de asociación significativa entre los SNP rs941798 y rs914458 del gen PTPN1 con la DT2 en familias peruanas de Lima, en ninguno de los niveles estudiados (alélico, genotípico y haplotípico).

Objective: To analyze the association that PTPN1 gene single nucleotide polymorphisms (SNPs) rs941798 and rs914458 have with type 2 diabetes in Peruvian families from Lima. Materials and methods: Twenty-three (23) families consisting of three members each were recruited at the Hospital Nacional Arzobispo Loayza. Peripheral blood samples were collected to obtain the DNA, and then the allele and genotype frequencies of the SNPs. SNP genotyping was performed using the sequencing method. The family-based analysis of the association between SNPs and type 2 diabetes was conducted using the family-based association test (FBAT) program. Results: Three (3) possible genotypes were observed for each SNP, i.e. rs941798 (A>G) and rs914458 (G>C). In one of the assessed models, the family-based association tests showed at the allele level that allele A of SNP rs941798 is associated with type 2 diabetes (p = 0.023). However, after using the Bonferroni correction for multiple comparisons, this association was lost. No association was demonstrated between the SNPs and the disease at any level (allele, genotype or haplotype). Conclusions: No evidence of significant association was found between PTPN1 gene SNPs rs941798 and rs914458 and type 2 diabetes at the studied levels (allele, genotype or haplotype) in Peruvian families from Lima.

Cholesterol-Lowering Treatment in Chronic Kidney Disease: Multistage Pairwise and Network Meta-Analyses.

Pairwise and network meta-analyses on the relationship between the efficacy of the use of statins with or without ezetimibe and reductions in low-density lipoprotein cholesterol (LDLc) and C-reactive protein (CRP) in patients with chronic kidney disease (CKD) are presented. In the pairwise meta-analysis, statins with or without ezetimibe were shown to be efficacious in reducing major adverse cardiovascular events (MACE) in patients with CKD and an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m2, in the context of both primary prevention [odds ratio (OR)/95% confidence interval (95% CI)/I2/number of studies (n): 0.50/0.40-0.64/0%/6] and primary/secondary prevention (0.66/0.57-0.76/57%/18). However, in the Bayesian network meta-analysis, compared to the placebo, only atorvastatin 80 mg daily and atorvastatin and rosuvastatin at doses equivalent to simvastatin 20 mg daily reduced the odds of MACEs in this patient population. The network meta-analysis for LDLc and CRP treatment objectives also showed that, regardless of eGFR and excluding dialysis patients, the number of MACEs decreased in patients with CKD, with reductions in both LDLc and CRP of less than 50% (surface under the cumulative ranking (SUCRA)/heterogeneity (vague)/n: 0.77/0.14/3). The evaluation of the benefits of drugs may lead to individualized therapy for CKD patients: Cholesterol-lowering treatment for CKD patients with high levels of both LDLc and CRP is suggested.

Concentración de adiponectina posterior a reducción de masa corporal en un grupo de mujeres obesas premenopáusicas en Lima, Perú / Adiponectin concentration after a body mass reduction in a group of premenopausal obese women living in Lima, Peru

Objetivo: Investigar el cambio en la concentración de adiponectina circulante en plasma en 23 mujeres obesas premenopáusicas de la ciudad de Lima luego de la reducción de la masa corporal como resultado de un programa de actividad física aeróbica y una dieta baja en calorías.Materiales y métodos: Se llevó a cabo un estudio analítico y cuasi-experimental con el grupo de mujeres obesas. Adicionalmente, 24 mujeres se consideraron como control o de referencia de la concentración de adiponectina y otros marcadores bioquímicos. La cuantificación de adiponectina se realizó mediante la prueba de ELISA. La concentración de glucosa en ayunas en sangre, colesterol, lipoproteína de alta densidad y triglicéridos fueron cuantificados mediante análisis clínicos de rutina.Resultados: Antes del programa el grupo control mostró altos valores de adiponectina (mediana: 8,54 µg/mL; rango: 6,14 µg/mL a 13,49 µg/mL) en comparación con el grupo obesidad (mediana: 7,03 µg/mL, rango: 3;77 µg/mL a 17,23 µg/mL); sin embargo, la diferencia no fue estadísticamente significativa (P = 0.0563). Luego de la finalización del programa se observó que el grupo obesidad presentó una reducción estadísticamente significativa del índice de masa corporal (P = 5.98e-08) y de la circunferencia abdominal (P = 1.55e-08) así como un incremento estadísticamente significativo de los niveles de adiponectina (mediana, 8.79 µg/mL; rango, 5.50 µg/mL a 19.37 µg/mL) (P = 0.0127). Conclusiones: Basándonos en los resultados, concluimos que en mujeres obesas premenopáusicas la concentración de adiponectina se incrementa cuando la masa corporal se reduce como resultado de actividad física aeróbica y una dieta baja en calorías.

Objective: To investigate the changes in the plasma-circulating adiponectin concentration in 23 premenopausal obese women living in Lima after a body mass reduction as a result of an aerobic physical activity program and a low-calorie diet.Materials and methods: An analytical and quasi-experimental study was conducted in a group of obese women. In addition, another 24 women were considered as control or reference group for comparing their adiponectin concentration and other biochemical markers. The quantification of adiponectin was carried out using the ELISA test. Fasting blood glucose concentration, cholesterol, high-density lipoprotein and triglycerides levels were quantified by routine clinical analysis.Results: Before beginning the program, the control group showed high adiponectin levels (median, 8.54 µg/mL; range, 6.14 µg/mL to 13.49 µg/mL) compared to the obesity group (median, 7.03 µg/mL; range, 3.77 µg/mL to 17.23 µg/mL). However, the difference was not statistically significant (P = 0.0563). Once the program was finished, the obesity group showed a statistically significant reduction in the body mass index (P = 5.98e-08) and abdominal circumference (P = 1.55e-08), and a statistically significant increase in the adiponectin levels (median, 8.79 µg/mL; range, 5.50 µg/mL to 19.37 µg/mL) (P = 0.0127). Conclusions: Based on the results, we conclude that the adiponectin concentration in premenopausal obese women increases when the body mass is reduced as a result of aerobic physical activity and a low-calorie diet.

[Educational environment in a Peruvian medical school. A negative trend over the academic years]. / Ambiente educativo en una facultad de medicina peruana: una tendencia negativa a lo largo de los años académicos.

BACKGROUND: Educational environment refers to the material resources and interpersonal relationships of an educational institution. AIM: To describe the educational environment of a Peruvian medical school and to explore a possible association between curricular years and the educational environment. MATERIAL AND METHODS: A cross-sectional study was conducted using the Dundee Ready Education Environment Measure (DREEM) to evaluate the educational environment of a Peruvian medical school. Data collection consisted in online surveys completed voluntarily by 1st through 6th year medical students between April and October 2015. RESULTS: The questionnaire was completed by 828 of 2,421 (34.2%) students. The mean DREEM score was 117 ± 25.6 of a maximum of 200. A poorer perception of the educational environment was associated with later years in the curriculum, when analysis was adjusted for gender, age and academic status (p < 0.001). CONCLUSIONS: The educational environment of this medical school scored positively (> 100 points). However, it was evident that medical students in later curricular years had a more negative perception of the educational environment compared to those in earlier academic years.

Ambiente educativo en una facultad de medicina peruana: una tendencia negativa a lo largo de los años académicos / Educational environment in a Peruvian medical school: a negative trend over the academic years

Background: Educational environment refers to the material resources and interpersonal relationships of an educational institution. Aim: To describe the educational environment of a Peruvian medical school and to explore a possible association between curricular years and the educational environment. Material and Methods: A cross-sectional study was conducted using the Dundee Ready Education Environment Measure (DREEM) to evaluate the educational environment of a Peruvian medical school. Data collection consisted in online surveys completed voluntarily by 1st through 6th year medical students between April and October 2015. Results: The questionnaire was completed by 828 of 2,421 (34.2%) students. The mean DREEM score was 117 ± 25.6 of a maximum of 200. A poorer perception of the educational environment was associated with later years in the curriculum, when analysis was adjusted for gender, age and academic status (p < 0.001). Conclusions: The educational environment of this medical school scored positively (> 100 points). However, it was evident that medical students in later curricular years had a more negative perception of the educational environment compared to those in earlier academic years.

[Psychometric analysis of a questionnaire to measure the educational environment in a sample of medical students in Peru]. / Análisis psicométrico de un cuestionario para medir el ambiente educativo en una muestra de estudiantes de medicina en Perú.

The objective of the study was to determine the psychometric properties of the Dundee Ready Education Environment Measure (DREEM) questionnaire in students of a Peruvian medical school. Participants were first-to-sixth-year students, invited to participate through a web platform. In the analysis the alpha coefficient of Cronbach was used to evaluate internal consistency. In addition, a confirmatory factorial analysis was performed to evaluate the construct validity of the subscales of the DREEM. The adjustment quality indexes used were: Root Mean Square Error Approximation (RMSEA), the Index of Benchmarking (CFI), Tucker-Lewis Index (TLI), and the Standardized Root Mean Residual (SRMR). The results showed that the social self-perception dimension had an alpha of Cronbach of less than 0.70. In addition, the quality indices did not support the five-dimensional structure of the DREEM. In conclusion, the DREEM questionnaire did not perform optimally in this Peruvian sample.

El objetivo del estudio fue determinar las propiedades psicométricas del cuestionario Dundee Ready Education Environment Measure (DREEM) en estudiantes de una facultad de Medicina peruana. Los participantes fueron los alumnos de primero a sexto año, invitados a participar mediante una plataforma web. En el análisis se utilizó el coeficiente alfa de Cronbach para evaluar consistencia interna. Además, se realizó un análisis factorial confirmatorio para evaluar la validez de constructo de las subescalas del DREEM. Los índices de bondad de ajuste utilizados fueron: error cuadrático medio de aproximación (RMSEA), el índice de ajuste comparativo (CFI), índice Tucker-Lewis (TLI) y el residuo estandarizado cuadrático medio (SRMR). Los resultados mostraron que la dimensión Autopercepción Social tuvo un alfa de Cronbach menor a 0,70. Además, los índices de bondad no apoyaron la estructura de cinco dimensiones del DREEM. Como conclusión, el cuestionario DREEM no tuvo un desempeño óptimo en esta muestra peruana.

Análisis psicométrico de un cuestionario para medir el ambiente educativo en una muestra de estudiantes de medicina en Perú / Psychometric analysis of a questionnaire to measure the educational environment in a sample of medical students in Peru

RESUMEN El objetivo del estudio fue determinar las propiedades psicométricas del cuestionario Dundee Ready Education Environment Measure (DREEM) en estudiantes de una facultad de Medicina peruana. Los participantes fueron los alumnos de primero a sexto año, invitados a participar mediante una plataforma web. En el análisis se utilizó el coeficiente alfa de Cronbach para evaluar consistencia interna. Además, se realizó un análisis factorial confirmatorio para evaluar la validez de constructo de las subescalas del DREEM. Los índices de bondad de ajuste utilizados fueron: error cuadrático medio de aproximación (RMSEA), el índice de ajuste comparativo (CFI), índice Tucker-Lewis (TLI) y el residuo estandarizado cuadrático medio (SRMR). Los resultados mostraron que la dimensión Autopercepción Social tuvo un alfa de Cronbach menor a 0,70. Además, los índices de bondad no apoyaron la estructura de cinco dimensiones del DREEM. Como conclusión, el cuestionario DREEM no tuvo un desempeño óptimo en esta muestra peruana.

ABSTRACT The objective of the study was to determine the psychometric properties of the Dundee Ready Education Environment Measure (DREEM) questionnaire in students of a Peruvian medical school. Participants were first-to-sixth-year students, invited to participate through a web platform. In the analysis the alpha coefficient of Cronbach was used to evaluate internal consistency. In addition, a confirmatory factorial analysis was performed to evaluate the construct validity of the subscales of the DREEM. The adjustment quality indexes used were: Root Mean Square Error Approximation (RMSEA), the Index of Benchmarking (CFI), Tucker-Lewis Index (TLI), and the Standardized Root Mean Residual (SRMR). The results showed that the social self-perception dimension had an alpha of Cronbach of less than 0.70. In addition, the quality indices did not support the five-dimensional structure of the DREEM. In conclusion, the DREEM questionnaire did not perform optimally in this Peruvian sample.

[Safety of statins].

The discovery of statins, was a landmark in primary and secondary prevention of cardiovascular disease, where cholesterol plays a central pathophysiologic role. Currently there are 7 statins, which according to recent meta-analytic studies did not reveal significant differences in effectiveness measured by results of cardiovascular morbidity and mortality. This means that the selection of a particular statin, could be very important aspects of safety and cost. The two adverse reactions greater interest currently on statins are rhabdomyolysis and risk of type 2 diabetes mellitus; the first is an adverse reaction appeared almost from the birth of these drugs and caused the withdrawal of cerivastatin, while the second has been recently reported. Significant differences have been reported between different statins, in relation to the two mentioned adverse reactions.

[Nonsteroidal antiinflammatory drugs: gastrointestinal and cardiovascular and renal safety]. / Antiinflamatorios no esteroides: seguridad gastrointestinal, cardiovascular y renal.

The choice of a specific medication belonging to a drug class is under the criteria of efficacy, safety, cost and suitability. NSAIDs currently constitute one of the most consumed drugs in the world, so it is very important review of the safety aspects of this drug class. This review has the objective of analyze the safety of NSAIDs on 3 main criteria: gastrolesivity, cardiotoxicity and nephrotoxicity.

Asociación entre los microsatelites D4S2912, D4S230 Y D4S300I (API5. I) y diabetes tipo 2 en la población peruana / Association of microsatellites D4S912, D4S230 and D4S3001 (4P15.1) to type 2 diabetes in peruvian population

Determinar la asociación entre los microsatélites D4S2912, D4S230 y D4S3001 y diabetes tipo 2 (Dm2) en la población peruana. Material y método. En 99 diabéticos se analizaron los marcadores de los microsatélites D4S2912, D4S230 y D4S3001 y como controles: individuos sanos procedentes de lima, 120 para D4S2912, 129 para D4S230 y 133 para D4S3001. 5e procesó el a0n extraído de sangre endovenosa, amplificándose por la técnica de la reacción en cadena de la polimerasa (pcr) a los tres marcadores de la región 4p15.1. Finalmente, se analizó las frecuencias alélicas y genotípicas de los marcadores y determinó la homogeneidad genética de la población mediante la prueba de hardy-weinberg (h-w), continuándose con el estudio de asociación a dm2 en casos versus controles. Resultados. Se encontró en D4S2912 y D4S3001 ausencia de un alelo en el grupo control al compararlo con la población diabética. Al realizar el análisis de asociación utilizando el modelo de regresión logística condicional y la prueba de permutación de montecarlo, se observó asociación entre D4S3001 y población peruana con dm2. Conclusiones. esta investigación muestra al microsatélite D4S3001, localizado en la región cromosómica 4p15.1 como un marcador asociado a dm2 en la población peruana y que se encuentra en una región cromosómica que contendría un gen(es) que jugaría(n) un rol en la etiología de dm2...

To determine the association of microsatellite markers D4S2912, D4S230 and D4S3001 with diabetes type 2 (DM2) in the peruvian population. Material and methods. We analyzed the microsatellite markers D4S2912, D4S230 and D4S3001 in 99 diabetics and 120 healthy individuals to D4S2912, D4S230 and 129 to 133 for D4S3001 as controls from Lima. We processed the 0na extracted from blood intravenously, amplified by the technique of polymerase chain reaction (pcr) for the three markers in the region 4p15.1. Finally, we analyzed the polymorphisms of the markers and determined the genetic homogeneity of the population through proof of hardy-weinberg (hw), and continued in the study of association of DM2 in patients versus controls. Results. In D4S2912 and D4S3001 there was absence of an allele in the control group when compared with the diabetic population. When performing association analysis using conditional logistic regression model and the monte carlo permutation test, they showed an association between D4S3001 and peruvian population with DM2. Conclusions. this research shows the microsatellite D4S3001, located on chromosome 4p15.1 region as a marker associated with dm2 in the Peruvian population and is located in a chromosomal region that contain a gene(s) which would play a role in the etiology DM2...

Antiinflamatorios no esteroides: seguridad gastrointestinal, cardiovascular y renal / Nonsteroidal antiinflammatory drugs: gastrointestinal and cardiovascular and renal safety

La selección de un medicamento específico perteneciente a una clase farmacológica es bajo criterios de eficacia, seguridad, costo y conveniencia. Los Antiinflamatorios No Esteroideos (AINEs) actualmente se constituyen en uno de los medicamentos más consumidos en el mundo, por lo tanto es de gran importancia la revisión de los aspectos de seguridad de este grupo farmacológico. El presente trabajo tiene el objetivo de analizar bajo las evidencias disponibles hasta la actualidad, la seguridad de los AINES con 3 criterios principales: gastrolesividad, cardiotoxicidad y nefrotoxicidad.

The choice of a specific medication belonging to a drug class is under the criteria of efficacy, safety, cost and suitability. NSAIDs currently constitute one of the most consumed drugs in the world, so it is very important review of the safety aspects of this drug class. This review has the objective of analyze the safety of NSAIDs on 3 main criteria: gastrolesivity, cardiotoxicity and nephrotoxicity.

Análisis de asociación genética entre el SNP RS914458 del gen proteína tirosina fosfatasa no receptor tipo 1 (ptpn1) y diabetes tipo 2 en población peruana / Genetic association analysis between SNP rs914458 of protein tyrosine phosphatase, non-receptor type 1(ptpn1) gene and Type 2 Diabetes in Peruvian Population

Evaluar la posible asociación entre el SNP rs914458 (C>G) del gen PTPN1con la DM2 en una población de la zona urbana de Lima - Perú. Material y Métodos: El estudio incluyó un total de 216 personas de la zona urbana de Lima correspondientes a un grupo control (n = 123) y un grupo de pacientes diagnosticados con diabetes tipo 2 provenientes del Hospital A. Loayza (n = 93). La genotipificación del SNP se llevó a cabo mediante PCR y con un secuenciador ABI PRISM 310. El análisis de asociación se llevó a cabo con el uso de la herramienta web SNPStats para realizar cinco modelos de regresión logística. El efecto de la asociación genética se estableció con el valor de OR. Resultados: La frecuencia del MAF (alelo G) fue de 0.22 en el grupo de controles y en el grupo de pacientes. Ninguno de los modelos de regresión muestra valores de OR (considerando los CI) por encima o por debajo del valor de referencia. Conclusión: No se encontró asociación genética significativa entre el SNP rs914458 del gen PTPN1 y la DM2 para la población de la zona urbana de Lima - Perú...

Objective: Evaluate the association between SNP rs914458 (C>G) of PTPN1 gene with T2DM in a population from the urban area of Lima - Peru. Material and Methods: This study included a total of 216 subjects from the urban area of Lima. The number of subjects in control group was 123, and 93 patients diagnosed with type 2 diabetes from Hospital A. Loayza. SNP genotyping was performed by PCR and sequencing using ABI PRISM 310 DNA sequencer. The association analysis was carried out using the web tool SNPStats and five logistic regression models were performed. The effect of genetic association was established with the OR. Results: The frequency of MAF (allele G) was 0.22 in both control and patient groups. The OR values were not different from the reference values considering the respective confidence interval. Conclusion: No significant association was found between the SNP rs914458 and the PTPN1 gene with T2DM for the urban population of Lima - Peru...

Incidencia del síndrome metabólico en adolescentes de 12 a 17 años del distrito de AteûVitarte de Lima metropolitana junio-2005 / Metabolic syndrome incidence in young among 12 to 17 years of Ate-Vitarte district of Metropolitan Lima June-2005

El objetivo del presente estudio es determinar la presencia de síndrome metabólico, así como las características de presentación de sus criterios diagnósticos. Se incluyeron en el estudio a 100 alumnos del Colegio Nacional Fernando Belaunde Terry ubicado en el distrito de Ate û Vitarte, de ambos sexos y edades comprendidas entre 12 a 17 años, la selección de ellos fue al azar. A cada uno se le realizó pruebas antropométricas (peso, talla, diámetro de la cintura, diámetro de la cadera. Índice cintura / cadera, IMC) medida de la presión arterial y pruebas bioquímicas para determinar valores séricos de glucosa, triglicéridos, colesterol y HDL, previa aprobación por parte de los alumnos mediante la firma de un consentimiento informado. El tipo de estudio es observacional, descriptivo, transversal, que responde a una investigación exploratoria. Entre los resultados más resaltantes se indica que la presencia de Síndrome Metabólico es de 2%. El criterio que se presentó con mayor frecuencia fue el de la presión arterial. Se aprecia un predominio de la variable circunferencia de la cintura en el grupo etáreo de 16 a 17 años frente a los demás grupos. Pese a que el IMC no es un criterio diagnóstico para síndrome metabólico se encontró que un 15% presenta rangos de sobrepeso u obesidad, el cual es un importante factor de riesgo para desarrollar síndrome metabólico en el futuro. La prevención, mediante el cambio de estilo de vida (nutrición y sedentarismo) es el principal mecanismo para evitar que se desarrollen los criterios diagnósticos y demás factores de riesgo, así como de la modificación de los factores afectados, mejorando el pronóstico del paciente.

The objective of the present study is to determine the presence of metabolic syndrome, as well as the characteristics of presentation of its diagnostic criteria. One hundred students of the National School Fernando Belaunde Terry located in the district of AteûVitarte, of both sexes and ages between 12 to 17 years, were chosen at random. Anthropometric measurements were carried out in each of them (weight, size, diameter of the waist, diameter of the hip. Index waist / hip, IMC). Also, measurement of the arterial pressure and biochemical tests to determine seric values of glucose, triglycerides, cholesterol and HDL, were performed subject to approval on the part of the students by means of an informed consent. The type of study is observational, descriptive, transverse that responds to an exploratory investigation. Among the most significant results, we found Metabolic Syndrome in 2 % of students. The criterion that was frequently present was that of the arterial pressure. A predominance of the variable circumference of the waist in the group is appreciated in the age group from 16 to 17 years set against the other groups. Despite the fact that the IMC is not a diagnostic criterion for metabolic syndrome, 15% of students are overweight or obese, and this constitutes an important risk factor to develop metabolic syndrome in the future. Prevention, by means of the change of habits (nutrition and sedentary lifestyle) is the main mechanism to avoid developing the diagnostic criteria and other risk factors. Also, modification of the factors affected, improves the prognosis of the patient.

Variación y distribución genética de los SNP's 19, 43 y 63 del gen de susceptibilidad de diabetes tipo 2 Calpaina 10 (Capn10) en la población peruana / Variation and genetic distribution of SNP's 19, 43 y 63 of the susceptibility gene calpain 10 (Capn10) for the type 2 diabetes in the peruvian population

La diabetes tipo 2 es una enfermedad compleja que tiene un componente genético. Calpaina 10 (CAPN10) es un gen de susceptibilidad para este gen y está localizado en 2q37.3. Pacientes de algunas poblaciones de origen amerindio presentan las frecuencias alélicas de los SNP19, 43 y 63 del gen CAPN10, que sugiere una relación causal entre este gen y la biabetes tipo 2. El origen filogenético común, nos permite suponer que CAPN10 también sería un gen de susceptibilidad en la población peruana nativa y mestiza, lo cual nos motivó a investigar esta relación en nuestra población. Se obtuvieron resultados de la frecuencia alélica de los SNP19, 43 y 63 de CAPN10 en 129 controles normales de Lima, la mayoría de origen mestizo. Además de la prueba del equilibrio de Hardy-Weinberg (H-W) para determinar si la población tiene una distribución genéticamente homogénea en dichos marcadores. Se puede concluir que la prueba de H-W sugiere fuertemente que nuestra población control es adecuada para un estudio de asociación y desequilibrio de ligamiento en pruebas caso-control. Esto a su vez es la base para futuros estudios de asociación y desequilibrio de ligamiento, postulando a CAPN10 como gen de susceptibilidad de diabetes tipo 2 en la población peruana.

Type 2 diabetes is a complex genetic disorder, where the gene calpain 10 (CAPN10) located in 2q37.3, plays an important role. Allele frequencies of SNP19, 43 and 63 are present in affected Amerindian populations and might suggest a possible relationship between CAPN10 and type 2 diabetes. The fact that Amerindian populations has a common phyllogenetic origin was our main motivation for studying this possible relation, because it would suggest' that CAPN10 is a susceptibility gene for native and admixed Peruvian populations. Allelic frequencies of SNP19, 43 and 63 of calpain 10 was obtained of 129 normal controls from Lima, most of them admixed population. Hardy-Weinberg test (H-W) was used in order to determine if the population had a genetically homogenous distribution for the employed molecular markers. It can be concluded that the H-W test strongly suggests that the control population is adequate for an association and linkage disequilibrium in case-control studies. Furthermore, this would mean be thstart of future association and linkage disequilibrium studies where CAPN10 would be considered as a susceptibility gene for type 2 diabetes in Peruvian population.