Mortalidad de médicos por COVID-19 de acuerdo con su especialidad en la primera y segunda ola de la pandemia en el Perú

Introducción : El COVID-19 es una enfermedad infecciosa, declarada pandemia por la OMS en marzo 2020. Ha causado millones de muertes, incluidos médicos en el mundo. El objetivo fue determinar las características de la mortalidad de médicos por COVID-19 y la tasa de mortalidad específica por especialidad durante la pandemia del COVID-19 en el Perú. Material y métodos: Estudio descriptivo que evalúo la totalidad de médicos fallecidos reportados por el Colegio Médico del Perú hasta noviembre 2021 y que cumplieron con tener su certificado de defunción. Se definió tres grupos: médicos especialistas con alto (EMACC) y bajo contacto (EMBCC) con pacientes COVID-19 y médicos sin especialidad. Resultados: La edad >60 años y tener el sexo masculino en los EMACC mostraron un p=0,003 y 0,016 respectivamente. El 69,4% de médicos fallecieron en Lima y donde más fallecieron fue Hospital Rebagliati Martins (21%). La mayor tasa de mortalidad específica por especialidad (TME) fue 29,7 y 25,0 en epidemiología y administración de salud respectivamente. En la ciudad de Lima, fallecieron 69,4% de médicos, principalmente el grupo de EMBCC. Conclusión: Los médicos varones y >60 años son los que murieron con mayor frecuencia, sobre todo en la ciudad de Lima y en el grupo de EMACC. Las mayores tasas de mortalidad por el COVID-19 ha sido en el grupo de EMBCC.

Introduction: COVID-19 is an infectious disease declared a pandemic by the WHO in March 2020. It has caused millions of deaths, including among doctors in the world. The objective was to determine the characteristics of physician mortality from COVID-19 and the specific mortality rate by specialty during the COVID-19 pandemic in Peru. Material and methods: Descriptive study that evaluated all deceased physicians reported by the Medical College of Peru until November 2021 and who complied with having their death certificate. Three groups were defined: specialist physicians with high (EMACC) and low (EMBCC) contact with COVID-19 patients and physicians without a specialty. Results: Age >60 years and males in the EMACC showed p=0.003 and 0.016, respectively. 69.4% of doctors died in Lima, and most died at Rebagliati Martins Hospital (21%). The highest specialty-specific mortality rate was 29.7 and 25.0 in epidemiology and health administration, respectively. In Lima, 69.4% of physicians died, mainly in the EMBCC group. Conclusion: Male physicians >60 years old are the ones who die more frequently, especially in the city of Lima and in the EMACC group. The highest mortality rates from COVID-19 were in the EMBCC group.

[Correlation between serum ferritin, erythrocyte and hemoglobin indices in infants living at 3400 m altitude]. / Correlación entre ferritina sérica, índices eritrocitarios y hemoglobina en lactantes que viven a 3400 m de altitud.

Anemia (An) is a public health problem in South America, with iron deficiency (ID) as the main cause. In high-altitude cities, hypobaric hypoxia causes an increase in hemoglobin (Hb) levels in residents. For the diagnosis of An, Hb is measured, which is modified after erythrocyte indices (EI) measurements. There is evidence that there is an overestimation of the prevalence of An at high altitudes. OBJECTIVE: To correlate serum ferritin (SF) with Hb and EI, and to determine the Hb cut-off point for predicting ID in 6-month-old infants at 3400 m of altitude. SUBJECTS AND METHOD: 128 infants aged 6 months at 3400 m altitude were evaluated. The SF was considered an independent variable. IE and Hb were the dependent variables. The An in the infant was defined with an Hb < 13.4 g/dl. The DH was defined by FS <12 ug/dL. Data were processed in SPSS® version 25. Spearman correlation was used for bivariate analysis. The ROC curve was constructed to determine the Hb cut-off point for ID. RESULTS: The highest correlation of SF was observed with mean corpuscular hemoglobin (MCH), rho = 0.449 (p < 0.001), and mean corpuscular volume (MCV) rho= 0.423 (p < 0.001). The Hb cut-off point according to SF, defining ID was 12.15 g/dL (ROC curve: 0.704; 95% CI: 0.597-0.811; p < 0.001). CONCLUSION: MCV and MCH showed a better correlation with SF. The cubic and logarithmic models were the ones that best represented these relationships, respectively. Hb < 12.15 g/dL allows diagnosing ID in 6-month-old infants at 3400 m altitude.

Pequeño y grande para edad gestacional como factor de riesgo para morbilidad y mortalidad neonatal a término en altura / Small and large for gestational age condition as a risk factor for neonatal morbidity and mortality at term newborns at altitude

Introducción: El crecimiento fetal en altura es menor en comparación al nivel del mar, debido a la hipoxia hipobárica existente. Consecuentemente hay menores medidas antropométricas neonatales. No hay información acerca de la capacidad de predicción de morbimortalidad neonatal usando los criterios de Lubchenco y Battaglia con la tabla creada a 3400 m de altura (TANA). Material y Métodos: Estudio de casos y controles. Usamos la información de 16 000 neonatos a término del Hospital Nacional Adolfo Guevara Velazco en Cusco, desde enero del 2003 a junio del 2012. Evaluamos el percentil 3, 10, 90 y 97 (P3, P10, P90 y P97) de los pesos e índice ponderal al nacer (IP). Neonatos con antropometría menor al P3 y P10 fueron considerados pequeños (PEG) y los mayores al P90 y P97 grandes para edad gestacional (GEG). Estos fueron considerados los casos, mientras aquellos con medidas entre estos intervalos fueron los controles (adecuados para edad gestacional). Resultados: La prevalencia de PEG (P10) fue 9,6% y 10,7% de GEG (P90). El P3 del peso al nacer (PN) incrementa el riesgo de ocurrencia en 3,2 y 10,7 veces de morbilidad y mortalidad neonatal, respectivamente. Similarmente, pronostica la mayor estancia hospitalaria (6,2 días). Conclusiones: Aplicando los criterios de Lubchenco y Battaglia, así como P3 y P97 del PN e IP utilizando la TANA, determinamos que el P3 del PN define el mayor riesgo para morbilidad y mortalidad neonatal a término a 3400 m de altura.

Background:The fetus growth at high altitude is less than at sea level due to hypobaric hypoxia. Consequently, there are small neonatal anthropometric measurements. Therefore, there is no information about predicting neonatal morbi-mortality using Battaglia and Lubchenco criteria by neonatal curve created at 3400-m altitude (TANA). : It was a case-control study. Material and MethodsWe used the information of 16000 term infants from the Adolfo Guevara Velazco National Hospital in Cusco, from January 1, 2003, to June 30, 2012. We evaluated the 3rd, 10th, 90th, and 97th percentile (P3, P10, P90, and P97) of newborns weight and ponderal index (PI). Neonatal anthropometry less than P3 or P10 (SGA) and higher than P90 or P97 (LGA) were the cases, and those with measurements between these intervals were the controls (AGA). SGA(P10) prevalence Results: was 9.6% and 10.7% of LGA(P90). The P3 of the birth weight (BW) increases the risk of occurrence of neonatal morbidity and mortality in 3.2 and 10.7 times, respectively. Similarly, it prognosticates longer hospital stay(6.2days). Conclusions: Applying the Lubchenco and Battaglia criteria and P3 and P97 of the BW and PI using the TANA, we determined that the P3 of the BW defines the highest risk for neonatal morbidity and mortality at term newborns at 3400-m altitude

Maternal Altitude-Corrected Hemoglobin and at Term Neonatal Anthropometry at 3400 m of Altitude.

Villamonte-Calanche, Wilfredo, Nelly Lam-Figueroa, Maria Jerí-Palomino, Cleto De-La-Torre, and Alexandra A. Villamonte-Jerí. Maternal altitude-corrected hemoglobin and at term neonatal anthropometry at 3400 m of altitude. High Alt Med Biol. 21:287-291, 2020. Introduction: Fetal growth is prominent in the last trimester of pregnancy. The development of the fetus depends on the nutrient consumption and oxygen delivery of the pregnant woman. Therefore, maternal anemia has an inverse relationship with fetal growth. Consequently, the newborn has lower anthropometric measurements. Residing in places of a high altitude increases the level of hemoglobin (Hb); as a result, the World Health Organization (WHO) recommends adjusting the value of Hb in maternal blood at 3400-m altitude by reducing 2.4 g/dL to obtain the corrected Hb (HbCorr). Objective: To determine if the relationship of maternal HbCorr for high altitude is related to term neonatal anthropometry at 3400-m altitude. Material and Methods: We performed a retrospective cohort study and evaluated the neonatal anthropometric variables (weight, ponderal index, head circumference [HC], and HC for birthweight index) in 308 exposed pregnant women (HbCorr <11 g/dL) and 600 unexposed pregnant women (HbCorr ≥11 g/dL). We obtained absolute relative frequencies and measures of central tendency. Besides, we compared the qualitative and quantitative variables using the chi-square and the Student t or the Mann-Whitney or Kruskal-Wallis U test, if applicable. We also performed linear regression. Results: Of anemic pregnant women, 68.2% were mild, while only 1% were severe. There was no relationship between HbCorr and neonatal anthropometry, and none of the anemic pregnant women showed a statistical difference in the neonatal anthropometric measures evaluated compared to the unexposed women. Conclusion: There is no relationship between HbCorr and neonatal anthropometry at 3400-m altitude.

Anthropometric reference curves for term neonates born at 3400 meters above sea level.

OBJECTIVE: To describe the 3rd, 10th, 50th, 90th, and 97th percentile of weight, length, ponderal index (PI), head circumference (HC), and head circumference for birthweight index (HCBWI). METHODS: Descriptive, retrospective, and transverse study performed in the Adolfo Guevara Velazco National Hospital (AGVNH) at 3400 m above sea level between January 2005 and December 2010. The main inclusion criteria were singleton pregnancy, term gestational age, and absence of fetal structural anomalies. RESULTS: Of a total of 10,903 newborns evaluated, 7635 met inclusion criteria. Using the findings from the above population, polynomial models were constructed for the 3rd, 10th, 50th, 90th, and 97th percentiles of weight, length, HC, PI, and HCBWI. CONCLUSIONS: Reference curves were developed for the 3rd, 10th, 50th, 90th, and 97th percentile for weight, height, head circumference (HC), ponderal index (PI), and HCBWI for term newborns according to sex born at 3400 m above sea level.

Disrespect and abuse during childbirth in fourteen hospitals in nine cities of Peru.

OBJECTIVE: To assess the prevalence of disrespect and abuse during childbirth and its associated factors in Peru. METHODS: In an observational cross-sectional study, women were surveyed within 48 hours of live delivery at 14 hospitals located in nine Peruvian cities between April and July 2016. The survey was based on seven categories of disrespect and abuse proposed by Bowser and Hill. To evaluate factors associated with each category, prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using adjusted Poisson models with robust variances. RESULTS: Among 1528 participants, 1488 (97.4%) had experienced at least one category of disrespect and abuse. Frequency of abandonment of care was increased with cesarean delivery (PR 1.27, 95% CI 1.03-1.57) but decreased in the jungle region (PR 0.27, 0.14-0.53). Discrimination was associated with the jungle region (PR 5.67, 2.32-13.88). Physical abuse was less frequent with cesarean than vaginal delivery (PR 0.23, 0.11-0.49). The prevalences of abandonment of care (PR 0.42, 0.29-0.60), non-consented care (PR 0.70, 0.57-0.85), discrimination (PR 0.40, 0.19-0.85), and non-confidential care (PR 0.71, 0.55-0.93) were decreased among women who had been referred. CONCLUSION: Nearly all participants reported having experienced at least one category of disrespect and abuse during childbirth care, which was associated with type of delivery, being referred, and geographic region.

Antropometría neonatal a término en una población rural y urbana a 3 400 metros de altura / Antropometria de recém-nascidos a termo em uma população da zona rural e da zona urbana a uma altitude de 3 400 metros / Anthropometry in at-term neonates in a rural and an urban population at 3 400 meters altitude

Objetivo. Averiguar si hay diferencias en las medidas antropométricas de neonatos a término en una población rural y urbana a 3 400 m de altura. Material y métodos. Estudio descriptivo poblacional de neonatos a término sin enfermedades en el Hospital Nacional Adolfo Guevara Velasco del Cusco (HNAGV) y el Centro de Salud de Huanoquite (CSH), entre 2005 y 2010. Se calcularon medidas de tendencia central, las medias se compararon con la prueba t de Student, el modelo final se ajustó por sexo neonatal y se calcularon las odds ratios (OR) y sus IC95% para estimar la fuerza de la asociación entre tener un neonato pequeño para la edad gestacional (PEG) según el P10 del peso y del índice ponderal (IP) en los recién nacidos de madres que viven en el distrito de Huanoquite y cuyo parto fue atendido en el CSH. Resultados. En el HNAGV y el CSH se estudiaron 372 y 368 los neonatos, respectivamente. Las medias de la edad materna fueron 31,7 y 27,0 años, las gestaciones previas, 2,4 y 3,4, los abortos, 0,4 y 0,0, los hijos nacidos vivos, 1,0 y 2,3 (p < 0,001), y el peso, la talla y el IP, 3 311,8 g, 49,5 cm, 2,73 y 3 008,9 g, 48,4 cm, 2,66, respectivamente (p < 0,001). Tras ajustar por sexo, el peso, la talla y el IP por categoría edad gestacional para los dos centros fueron: (37-38 semanas) 3 185,1 g, 49,18 cm, 2,67, y 3 009,8 g, 48,5 cm, 2,64; (39-40 semanas) 3 385,9 g, 49,9, 2,73, y 3 051,8 g, 48,6 cm, 2,66; (41-42 semanas) 3 461, 6 g, 50,2 cm, 2,73, y 3 072,2 g, 49,1 cm, y 2,6, respectivamente (p < 0,001). La OR de nacer PEG en el CSH fue 3,52 (2,4-5,1) según el peso y 2,05 (1,3-3,1) según el IP respecto a nacer en el HNAGV. Conclusión. El peso, la talla y el IP de los neonatos del CSH fueron menores que los del HNAGV y las OR de tener un neonato PEG fueron 3,52 según el peso y 2,05 según el IP, respectivamente.

Objective: Ascertain whether there are differences in the anthropometric measurements of at-term neonates in a rural population and an urban population at 3 400 m altitude. Material and methods: Descriptive population study of healthy at-term neonates in the Adolfo Guevara Velasco National Hospital (HNAGV) in Cusco and in the Huanoquite Health Center (CSH), [both at 3 400 m altitude in Peru], between 2005 and 2010. Measures of central tendency were calculated, the averages were compared with a Student’s t-test, the final model was adjusted by neonatal sex, and the odds ratios (OR) and corresponding confidence intervals (CI95%) were calculated to estimate the strength of association between small for gestational age (SGA) infants (according to weight under P10 and ponderal index [PI]) in mothers who live in the Huanoquite district and those who gave birth in the CSH. Results: In the HNAGV and the CSH, 372 and 368 neonates were studied, respectively. The average maternal age was 31.7 and 27.0 years; previous pregnancies, 2.4 and 3.4; miscarriages, 0.4 and 0.0; live births, 1.0 and 2.3 (p<0.001); and weight, height and PI, 3 311.8 g, 49.5 cm, 2.73, and 3,008.9 g, 48.4 cm, 2.66, respectively (p<0.001). The weight, height, and PI for the two centers were, after adjusting for sex and by gestational age bracket: (37-38 weeks) 3,185.1 g, 49.18 cm, 2.67, and 3,009.8 g, 48.5 cm, 2.64; (39-40 weeks) 3 385.9 g, 49.9, 2.73, and 3 051.8 g, 48.6 cm, 2.66; (41-42 weeks) 3 461, 6 g, 50.2 cm, 2.73, and 3,072.2 g, 49.1 cm, and 2.6, respectively (p<0.001). The OR of SGA births in the CSH was 3.52 (2.4-5.1) according to weight and 2.05 (1.3-3.1) according to PI, compared to birth in the HNAGV. Conclusion: The weight, height, and PI of infants born in the CSH were lower than those born in the HNAGV, and the OR of SGA births was 3,52 according to weight and 2,05 according to PI, respectively.

Objetivo: Examinar se existem diferenças antropométricas em recém-nascidos a termo em uma população da zona rural e da zona urbana vivendo a uma altitude de 3.400 m. Materiais e métodos: Estudo descritivo populacional de recém-nascidos a termo sem doenças associadas realizado no Hospital Nacional Adolfo Guevara Velasco, em Cusco (HNAGV), e no Centro de Saúde, em Huanoquite (CSH), entre 2005 e 2010. Foram calculadas as medidas de tendência central e as médias comparadas com o teste t de Student. O modelo final foi ajustado por sexo do recém-nascido e calculados os odds ratios (OR) e seus respectivos intervalos de confiança de 95% (IC95%) para estimar a força da associação entre ser pequeno para idade gestacional (PIG) segundo o percentil 10 (P10) do peso e o índice ponderal (IP) nos recém-nascidos de mães que vivem no distrito de Huanoquite cujo parto foi assistido no CSH. Resultados: Foram estudados 372 e 368 recém-nascidos no HNAGV e no CSH, respectivamente. A idade média materna foi de 31,7 e 27,0 anos, as mães tiveram em média 2,4 e 3,4 gestações anteriores, 0,4 e 0,0 abortos, 1,0 e 2,3 nascidos vivos (p < 0,001) com peso, comprimento e IP foi de 3 311,8 g, 49,5 cm e 2,73 e 3 008,9 g, 48,4 cm e 2,66, respectivamente (p < 0,001). Após ajuste para o sexo, o peso, o comprimento e o IP por categoria de idade gestacional nos dois centros estudados foram: (37–38 semanas) 3 185,1 g, 49,18 cm e 2,67 e 3 009,8 g, 48,5 cm e 2,64; (39–40 semanas) 3 385,9 g, 49,9 e 2,73 e 3 051,8 g, 48,6 cm e 2,66; (41–42 semanas) 3 461,6 g, 50,2 cm e 2,73 e 3 072,2 g, 49,1 cm e 2,6, respectivamente (p < 0,001). Os OR dos recém-nascidos PIG no CSH foram de 3,52 (2,4–5,1) segundo o peso e 2,04 (1,3–3,1) segundo o IP ao nascimento no HNAGV. Conclusão: O peso, o comprimento e o IP dos recém-nascidos no CSH foram menores que os dos recém-nascidos no HNAGV e o OR de ser PIG foi de 3,52 segundo o peso e 2,05 segundo o IP, respectivamente.

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

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

[Anthropometry in at-term neonates in a rural and an urban population at 3 400 meters altitudeAntropometria de recém-nascidos a termo em uma população da zona rural e da zona urbana a uma altitude de 3 400 metros]. / Antropometría neonatal a término en una población rural y urbana a 3 400 metros de altura.

OBJECTIVE: Ascertain whether there are differences in the anthropometric measurements of at-term neonates in a rural population and an urban population at 3 400 m altitude. MATERIAL AND METHODS: Descriptive population study of healthy at-term neonates in the Adolfo Guevara Velasco National Hospital (HNAGV) in Cusco and in the Huanoquite Health Center (CSH), [both at 3 400 m altitude in Peru], between 2005 and 2010. Measures of central tendency were calculated, the averages were compared with a Student's t-test, the final model was adjusted by neonatal sex, and the odds ratios (OR) and corresponding confidence intervals (CI95%) were calculated to estimate the strength of association between small for gestational age (SGA) infants (according to weight under P10 and ponderal index [PI]) in mothers who live in the Huanoquite district and those who gave birth in the CSH. RESULTS: In the HNAGV and the CSH, 372 and 368 neonates were studied, respectively. The average maternal age was 31.7 and 27.0 years; previous pregnancies, 2.4 and 3.4; miscarriages, 0.4 and 0.0; live births, 1.0 and 2.3 (p<0.001); and weight, height and PI, 3 311.8 g, 49.5 cm, 2.73, and 3,008.9 g, 48.4 cm, 2.66, respectively (p<0.001). The weight, height, and PI for the two centers were, after adjusting for sex and by gestational age bracket: (37-38 weeks) 3,185.1 g, 49.18 cm, 2.67, and 3,009.8 g, 48.5 cm, 2.64; (39-40 weeks) 3 385.9 g, 49.9, 2.73, and 3 051.8 g, 48.6 cm, 2.66; (41-42 weeks) 3 461, 6 g, 50.2 cm, 2.73, and 3,072.2 g, 49.1 cm, and 2.6, respectively (p<0.001). The OR of SGA births in the CSH was 3.52 (2.4-5.1) according to weight and 2.05 (1.3-3.1) according to PI, compared to birth in the HNAGV. CONCLUSION: The weight, height, and PI of infants born in the CSH were lower than those born in the HNAGV, and the OR of SGA births was 3,52 according to weight and 2,05 according to PI, respectively.

OBJETIVO: Examinar se existem diferenças antropométricas em recém-nascidos a termo em uma população da zona rural e da zona urbana vivendo a uma altitude de 3.400 m. MATERIAIS E MÉTODOS: Estudo descritivo populacional de recém-nascidos a termo sem doenças associadas realizado no Hospital Nacional Adolfo Guevara Velasco, em Cusco (HNAGV), e no Centro de Saúde, em Huanoquite (CSH), entre 2005 e 2010. Foram calculadas as medidas de tendência central e as médias comparadas com o teste t de Student. O modelo final foi ajustado por sexo do recém-nascido e calculados os odds ratios (OR) e seus respectivos intervalos de confiança de 95% (IC95%) para estimar a força da associação entre ser pequeno para idade gestacional (PIG) segundo o percentil 10 (P10) do peso e o índice ponderal (IP) nos recém-nascidos de mães que vivem no distrito de Huanoquite cujo parto foi assistido no CSH. RESULTADOS: Foram estudados 372 e 368 recém-nascidos no HNAGV e no CSH, respectivamente. A idade média materna foi de 31,7 e 27,0 anos, as mães tiveram em média 2,4 e 3,4 gestações anteriores, 0,4 e 0,0 abortos, 1,0 e 2,3 nascidos vivos (p < 0,001) com peso, comprimento e IP foi de 3 311,8 g, 49,5 cm e 2,73 e 3 008,9 g, 48,4 cm e 2,66, respectivamente (p < 0,001). Após ajuste para o sexo, o peso, o comprimento e o IP por categoria de idade gestacional nos dois centros estudados foram: (37­38 semanas) 3 185,1 g, 49,18 cm e 2,67 e 3 009,8 g, 48,5 cm e 2,64; (39­40 semanas) 3 385,9 g, 49,9 e 2,73 e 3 051,8 g, 48,6 cm e 2,66; (41­42 semanas) 3 461,6 g, 50,2 cm e 2,73 e 3 072,2 g, 49,1 cm e 2,6, respectivamente (p < 0,001). Os OR dos recém-nascidos PIG no CSH foram de 3,52 (2,4­5,1) segundo o peso e 2,04 (1,3­3,1) segundo o IP ao nascimento no HNAGV. CONCLUSÃO: O peso, o comprimento e o IP dos recém-nascidos no CSH foram menores que os dos recém-nascidos no HNAGV e o OR de ser PIG foi de 3,52 segundo o peso e 2,05 segundo o IP, respectivamente.

Antropometría neonatal a término en una población rural y urbana a 3 400 metros de altura / Anthropometry in at-term neonates in a rural and an urban population at 3 400 meters altitude / Antropometria de recém-nascidos a termo em uma população da zona rural e da zona urbana a uma altitude de 3 400 metros

RESUMEN Objetivo Averiguar si hay diferencias en las medidas antropométricas de neonatos a término en una población rural y urbana a 3 400 m de altura. Material y métodos Estudio descriptivo poblacional de neonatos a término sin enfermedades en el Hospital Nacional Adolfo Guevara Velasco del Cusco (HNAGV) y el Centro de Salud de Huanoquite (CSH), entre 2005 y 2010. Se calcularon medidas de tendencia central, las medias se compararon con la prueba t de Student, el modelo final se ajustó por sexo neonatal y se calcularon las odds ratios (OR) y sus IC95% para estimar la fuerza de la asociación entre tener un neonato pequeño para la edad gestacional (PEG) según el P10 del peso y del índice ponderal (IP) en los recién nacidos de madres que viven en el distrito de Huanoquite y cuyo parto fue atendido en el CSH. Resultados En el HNAGV y el CSH se estudiaron 372 y 368 los neonatos, respectivamente. Las medias de la edad materna fueron 31,7 y 27,0 años, las gestaciones previas, 2,4 y 3,4, los abortos, 0,4 y 0,0, los hijos nacidos vivos, 1,0 y 2,3 (p < 0,001), y el peso, la talla y el IP, 3 311,8 g, 49,5 cm, 2,73 y 3 008,9 g, 48,4 cm, 2,66, respectivamente (p < 0,001). Tras ajustar por sexo, el peso, la talla y el IP por categoría edad gestacional para los dos centros fueron: (37-38 semanas) 3 185,1 g, 49,18 cm, 2,67, y 3 009,8 g, 48,5 cm, 2,64; (39-40 semanas) 3 385,9 g, 49,9, 2,73, y 3 051,8 g, 48,6 cm, 2,66; (41-42 semanas) 3 461, 6 g, 50,2 cm, 2,73, y 3 072,2 g, 49,1 cm, y 2,6, respectivamente (p < 0,001). La OR de nacer PEG en el CSH fue 3,52 (2,4-5,1) según el peso y 2,05 (1,3-3,1) según el IP respecto a nacer en el HNAGV. Conclusión El peso, la talla y el IP de los neonatos del CSH fueron menores que los del HNAGV y las OR de tener un neonato PEG fueron 3,52 según el peso y 2,05 según el IP, respectivamente.

Objective Ascertain whether there are differences in the anthropometric measurements of at-term neonates in a rural population and an urban population at 3 400 m altitude. Material and methods Descriptive population study of healthy at-term neonates in the Adolfo Guevara Velasco National Hospital (HNAGV) in Cusco and in the Huanoquite Health Center (CSH), [both at 3 400 m altitude in Peru], between 2005 and 2010. Measures of central tendency were calculated, the averages were compared with a Student's t-test, the final model was adjusted by neonatal sex, and the odds ratios (OR) and corresponding confidence intervals (CI95%) were calculated to estimate the strength of association between small for gestational age (SGA) infants (according to weight under P10 and ponderal index [PI]) in mothers who live in the Huanoquite district and those who gave birth in the CSH. Results In the HNAGV and the CSH, 372 and 368 neonates were studied, respectively. The average maternal age was 31.7 and 27.0 years; previous pregnancies, 2.4 and 3.4; miscarriages, 0.4 and 0.0; live births, 1.0 and 2.3 (p<0.001); and weight, height and PI, 3 311.8 g, 49.5 cm, 2.73, and 3,008.9 g, 48.4 cm, 2.66, respectively (p<0.001). The weight, height, and PI for the two centers were, after adjusting for sex and by gestational age bracket: (37-38 weeks) 3,185.1 g, 49.18 cm, 2.67, and 3,009.8 g, 48.5 cm, 2.64; (39-40 weeks) 3 385.9 g, 49.9, 2.73, and 3 051.8 g, 48.6 cm, 2.66; (41-42 weeks) 3 461, 6 g, 50.2 cm, 2.73, and 3,072.2 g, 49.1 cm, and 2.6, respectively (p<0.001). The OR of SGA births in the CSH was 3.52 (2.4-5.1) according to weight and 2.05 (1.3-3.1) according to PI, compared to birth in the HNAGV. Conclusion The weight, height, and PI of infants born in the CSH were lower than those born in the HNAGV, and the OR of SGA births was 3,52 according to weight and 2,05 according to PI, respectively.

Resumo Objetivo Examinar se existem diferenças antropométricas em recém-nascidos a termo em uma população da zona rural e da zona urbana vivendo a uma altitude de 3.400 m. Materiais e métodos Estudo descritivo populacional de recém-nascidos a termo sem doenças associadas realizado no Hospital Nacional Adolfo Guevara Velasco, em Cusco (HNAGV), e no Centro de Saúde, em Huanoquite (CSH), entre 2005 e 2010. Foram calculadas as medidas de tendência central e as médias comparadas com o teste t de Student. O modelo final foi ajustado por sexo do recém-nascido e calculados os odds ratios (OR) e seus respectivos intervalos de confiança de 95% (IC95%) para estimar a força da associação entre ser pequeno para idade gestacional (PIG) segundo o percentil 10 (P10) do peso e o índice ponderal (IP) nos recém-nascidos de mães que vivem no distrito de Huanoquite cujo parto foi assistido no CSH. Resultados Foram estudados 372 e 368 recém-nascidos no HNAGV e no CSH, respectivamente. A idade média materna foi de 31,7 e 27,0 anos, as mães tiveram em média 2,4 e 3,4 gestações anteriores, 0,4 e 0,0 abortos, 1,0 e 2,3 nascidos vivos (p < 0,001) com peso, comprimento e IP foi de 3 311,8 g, 49,5 cm e 2,73 e 3 008,9 g, 48,4 cm e 2,66, respectivamente (p < 0,001). Após ajuste para o sexo, o peso, o comprimento e o IP por categoria de idade gestacional nos dois centros estudados foram: (37-38 semanas) 3 185,1 g, 49,18 cm e 2,67 e 3 009,8 g, 48,5 cm e 2,64; (39-40 semanas) 3 385,9 g, 49,9 e 2,73 e 3 051,8 g, 48,6 cm e 2,66; (41-42 semanas) 3 461,6 g, 50,2 cm e 2,73 e 3 072,2 g, 49,1 cm e 2,6, respectivamente (p < 0,001). Os OR dos recém-nascidos PIG no CSH foram de 3,52 (2,4-5,1) segundo o peso e 2,04 (1,3-3,1) segundo o IP ao nascimento no HNAGV. Conclusão O peso, o comprimento e o IP dos recém-nascidos no CSH foram menores que os dos recém-nascidos no HNAGV e o OR de ser PIG foi de 3,52 segundo o peso e 2,05 segundo o IP, respectivamente.

Bacteriuria asintomática en la gestante de altura / Asymptomatic bacteriuria in pregnant women at high altitude

OBJETIVOS: Conocer la incidencia y los resultados neonatales de las gestantes con bacteriuria asintomática, en la altura. DISEÑO: Estudio prospectivo comparativo. LUGAR: Hospital Nacional Sureste de EsSalud. PARTICIPANTES: Trescientas mujeres con gestación única. INTERVENCIONES: A mujeres congestación única que acudieron a control prenatal, entre enero 2002 y diciembre 2004, se les tomó dos urocultivos, con la técnica del chorro medio. PRINCIPALES MEDIDAS DE RESULTADOS: Bacteriuria asintomática y resultados de los recién nacidos. RESULTADOS: La incidencia de bacteriuria asintomática fue17,7 por ciento, siendo el germen comúnmente hallado Escherichia coli (71,7 por ciento). Tuvo significación estadística el antecedente de parto pretérmino y realización del urocultivo en el primer trimestre (p menor que 0,05). No hubo diferencia significativa en la edad materna, vía del parto, peso, sexo, edad gestacional, Ápgar al primer y 5 minutos del recién nacido, relación entre peso del neonato y edad gestacional, reanimación, unidad de ingreso, motivo de ingreso a la unidad de cuidados intensivos del neonato y tiempo de hospitalización de los recién nacidos. CONCLUSIONES: En la altura, la incidencia de bacteriuria asintomática es elevada y semejante a la del nivel del mar. Las gestantes que tuvieron embarazos pretérmino previamente tuvieron con mayor frecuencia bacteriuria asintomática. Es recomendable tomar un urocultivo en el primer trimestre.

OBJECTIVES: To determine the incidence and neonatal outcomes of asymptomatic bacteriuria in pregnant women at high altitude. DESIGN: Comparative and prospective study. SETTING: EsSalud’s Southeast national hospital. PARTICIPANTS: Three hundred pregnant womenwith singletons. INTERVENTIONS: Midstream urine samples for culture were taken from women who had prenatal control at our hospital from January 2002 through December 2004. MAIN OUTCOME MEASURES: Asymptomatic bacteriuria and neonatal outcome. RESULTS: The incidence of asymptomatic bacteriuria was 17,7 per cent. The most common uropathogen isolated was Escherichia coli (71,7 per cent). History of preterm delivery andurine culture in the first trimester showed statistical significance (p less than 0,05). Maternal age, route of delivery, weight, gender, gestational age, newborn’s Apgar during the first and fifth minute, relationship between newborn weight and gestational age, type of reanimation, admission unit, reason for neonatal internsive care unit admission, and time of hospitalization did not show statistical significance. CONCLUSIONS: The incidence of asymptomatic bacteriuria is high at high altitude and similar to that at sea level. Pregnant women with history of preterm delivery frequently showed asymptomatic bacteriuria. It seems better to take a urine culture during the first trimester than later.

Factores de riesgo del parto pretérmino. Instituto Materno Perinatal / Preterm delivery risk factors. Materno and Perinatal Institute

OBJETIVO: Determinar los factores de riesgo del parto pretérmino. Diseño: Estudio de casos y controles. MATERIAL y MÉTODOS: Se estudio 165 casos y 330 controles. LUGAR: Institute Materno Perinatal en el primer trimestre de 1996. RESULTADOS: La ausencia de control prenatal (OR= 14,4 y P< 0,01), nacida en la sierra (OR= 2,26; P < 0,01) y la selva (OR= 3,33; P= 0,01), procedente de distrito de clase social baja (OR= 2.52; P= 0,05), antecedente de partos pretérmino (OR= 1, 62; P < 0,05), diagnóstico de hemorragia del tercer trimestre (OR= 17,33 P < 0, 01), ruptura prematura de membranas (OR= 7,29; P< 0,01), sufrimiento fetal agudo (OD= 3, 63; P < 0,01), presentación podálica (OR= 2,89; P= 0,02), preeclampsia (OR= 1,92; P= 0,05) y embarazo gemelar (OR= 2,26; P= 0,09) mostraron ser factores de riesgo para el parto pretérmino. CONCLUSIÓN: La presencia de hemorragia del tercer trimestre, ruptura prematura de membranas, preeclampsia, sufrimiento fetal agudo y embarazo gemelar se relacionaron con el nacimiento de un pretérmino.

OBJETIVE: To determine the risk factors of preterm birth. DESIGN. Case control study. Setting: Maternal Perinatal Institute during the first trimester of 1996. MATERIAL AND METHODS: One hundred and sixty-five patients with preterm birth and 330 controls. RESULTS: The absence of prenatal control (OR= 14,4 and P < 0,01), born in the highland (OR= 2,26; P= 0, 001) and jungle (OR= 3,33; P= 0, 013), living in a poverty district (OR= 2,52; P= 0,05), previous preterm births (OR= 1,62; P< 0,05), obstetrical diagnosis of third trimester hemorrhage (OR= 17,33; P= 0, 00001), preterm rupture of membranes (OR= 7,29; P = 0,000001), acute fetal distress (OR= 3,63; P= 0, 005), breech presentation (OR=2,89; P= 0,021), preeclampsia (OR=1,92; P= 0,05) and twin pregnancy (OR= 2,26; P= 0, 09) were risk factors for preterm birth. CONCLUSIÓN: Third trimester hemorrhage, preterm rupture of membranes, acute fetal distress, preeclampsia and twin pregnancy were risk factors for preterm birth.

Diagnóstico prenatal y manejo de malformación pulmonar fetal / Prenatal diagnosis and management of pulmonary fetal malformation

La malformación adenomatosa quística (MAQ) es una rara lesión pulmonar fetal y se caracteriza por un crecimiento exagerado de los bronquiolos terminales, los cuales forman quistes. Describimos un caso de diagnóstico y manejo prenatal y postnatal de MAQ a 3,400 msnm (Cusco).

The cystic adenomatous malformation (CAM) is a rare fetal lung lesion. Its frequency is about 1 in 4000 births and is characterized by an overgrowth of terminal respiratory bronchioles that form cysts of various sizes. It can be associated with polyhydramnios and pulmonary hypoplasia. We describe here a case of prenatal diagnosis and management of CAM at 3400 m (Cusco).