[Do the morning peak in blood pressure, age and gender affect the need to change hypertension treatment because of inefficacy?]. / Influyen el pico matutino de la presión arterial, la edad y el sexo en la necesidad de cambio de tratamiento antihipertensivo por ineficacia?

OBJECTIVE: To evaluate if the timing coincidence of morning rise of arterial blood pressure (BP) and morning turn of clinic BP measurement in our primary healthcare center implies an increased risk of switching antihypertensive drugs because of inefficacy with respect to afternoon staff turn. We also describe age and sex differences. DESIGNAND SETTING: A historical cohort study. We recorded all changes of antihypertensive drugs because of inefficacy of patients of 7 urban primary care clinics during the period from october 1997 to september 1999. MEASUREMENTS: We compared the incidence of changes per 1000 months of prescription of morning and afternoon turns, men and women, older and younger patients than 75 and 65 years old. RESULTS: The mean age of 1152 patients was 69.5 years old. The relation men:women in morning and afternoon turns was similar. Relative risk of switching in morning/afternoon turns was 0.82 (95% CI, 0.61-1.10). Sex and age did not affect the results. If the turn was not considered, younger patients and men had increased risk of being switched. Male adults (< 65 years old) relative risk against female was 1.62 (95% CI, 1.07-2.47). Older patients than 65 year had the RR inverted: RR men/women: 0.78 (95% CI, 0.51-1.21). CONCLUSION: Morning rise of BP did not provoque an increased risk of switching antihypertensive drugs in morning turn with respect to afternoon turn. Male adults had increased risk of switching with respect to women. Older women than 65 years old had more risk than men to be changed.

¿Influyen el pico matutino de la presión arterial, la edad y el sexo en la necesidad de cambio de tratamiento antihipertensivo por ineficacia? / Have morning rise of arterial blood pressure, age and gender any influence on antihypertensive drug switching of because of inefficacy?

Objetivo. Comprobar si la coincidencia del horario de toma de presión arterial (PA) del turno de mañana con el pico matutino de PA supone una necesidad mayor de cambio de fármacos hipotensores por ineficacia respecto al turno de tarde. Analizamos también la influencia de la edad y el género en los cambios de tratamiento globales por ineficacia. Diseño. Estudio de cohorte histórico. Emplazamiento. Siete consultas médicas urbanas de atención primaria. Participantes. Todos los pacientes registrados como hipertensos. Mediciones principales. Revisión de las historias clínicas, registrando los cambios de fármacos hipotensores por ineficacia entre octubre de 1997 y septiembre de 1999. Se comparó la incidencia de cambios por mil meses de prescripción entre el turno de mañana y tarde, entre varones y mujeres y entre mayores y menores de 75 y 65 años. Resultados. La edad media de los 1.152 pacientes fue de 69,5 años, con una distribución por sexo similar en los grupos de mañana y tarde. El riesgo relativo (RR) de cambio del turno de mañana respecto al de tarde fue de 0,82 (IC del 95 por ciento, 0,61-1,10) sin influir la edad y el sexo. Independientemente del turno, los pacientes más jóvenes y los varones tenían más probabilidad de cambiarles el tratamiento. El riesgo era mayor en adultos varones menores de 65 años respecto a mujeres: RR, 1,62 (IC del 95 por ciento, 1,07-2,47). En mayores de 65 años el riesgo se invertía con más cambios en mujeres: RR, 0,78 (IC del 95 por ciento, 0,51-1,21).Conclusiones. El pico matutino de PA no provoca más cambios de tratamiento por ineficacia en los pacientes atendidos en el turno de mañana. En nuestra población se cambia el tratamiento antihipertensivo por ineficacia con más frecuencia a los varones menores de 65 años que a las mujeres, y en mayores de 65 años esta proporción se invierte (AU)

[Colorectal cancer: its clinical picture and survival]. / Cáncer colorectal: cuadro clínico y sobrevida.

Retrospectively collected information on 77 patients who had undergone resection for colorectal cancer at Belén Hospital, Trujillo, Perú, from 1966 to 1993, was analyzed to establish their clinical features and the importance of both clinical and pathological factors affecting outcome. Common presenting features in right colon cancer were abdominal pain, pallor, and palpable mass; in left colon cancer were symptoms of obstruction, and in rectal carcinoma predominated bleeding. The diagnostic accuracy of barium enema (n = 25) and proctosigmoidoscopy (n = 18) was 72 and 100% respectively. In 54.5% (n = 42) curative resection and in 45.5% (n = 35) palliative resection was performed The surgical procedures performed were right hemicolectomy (n = 29), transverse colectomy (n = 6), left hemicolectomy (n = 11), sigmoid resection (n = 14), low anterior resection (n = 5), and abdominoperineal resection of the rectum (n = 12). The total perioperative mortality rate was 18%. The 5 year survival rate in this series was 28% (53% for curative resection and 0% for palliative resection). An univariate analysis of survival time using long-rank test revealed that presence of bowel obstruction or perforation, macroscopic appearance, tumor size, depth of invasion, lymph node status, number of lymph node metastasis, distant metastasis, and clinical stage had and individual prognostic significance. Age, sex, length of disease, serum hemoglobin level, blood transfusions, location of tumor, histologic type, and tumor grade did not affect the prognosis. Improvement in the survival probably depends on development of better adjuvant therapy in association with surgery.

Estado de la resistencia a los antibióticos del Vibrio Cholerae en dos hospitales nacionales-Perú: 1991 a 1993 / State of the antibiotic resistance of Vibrio Cholerae in two national hospitals-Peru: from 1991 to 1993

Se estudiaron 53 cepas del Vibrio Cholerae aisladas de pacientes del Hospital Nacional Arzobispo Loayza y 34 procedentes de pacientes pediátricos del Hospital San Bartolomé, con la finalidad de establecer la Concentración Mínima Inhibitoria (CIM) para distintos antibióticos, mediante el método de doble dilución en Agar Muller Hinton. Se encontró que todas las cepas fueron resistentes al Cloramfenicol y a la Lincomicina; además en las cepas aisladas en niños, se halló resistencia a la Gentamicina, Sulfametoxazol y Trimetropin. En el grupo de adultos, la resistencia fue variable, destacando el 11.31% para ampicilina (CIM=0.75 mg/ml), el 13.2% para ácido nalidíxico (CIM=3.5 mg/ml) el 13.20% para penicilina (CIM=3.5 mg/ml) y el 32.1% para amoxicilina (CIM=3.5 mg/ml). En el grupo de cepas aisladas de niños se encontró un 8.82% resistentes a la tetraciclina y a la penicilina (CIM=0.125 y 3.65 UI/ml mg/ml respectivamente), el 5.88% correspondiente a la amoxicilina y ácido nalidíxico (CIM=2.75 mg/ml para ambos) y el 38.23% para ampicilina (CIM=0.75 mg/ml). En relación a los patrones de resistencia a antibiotipos, estos varían de R:3 a R:9; siendo los más frecuentes el R:5 (Cloramfenicol, Clindamicina, Lincomicina, Sulfametoxazol y Trimetropin) en adultos y R:4 (Clindamicina, Lincomicina, Gentamicina y Trimetropin) en niños. Estos resultados sugieren que el Vibrio Cholerae actuaría como posible reservorio de plásmidos de resistencia a antibióticos, lo que complicaría el tratamiento de enfermedades y al mismo tiempo la erradicación del Vibrio Cholerae de nuestro medio.

Fifty three strains of the Vibrio Cholerae were studied, isolated from patients from the National Hospital Arzobispo Loayza and 34 strains coming from pediatric patients from the Bartolome Hospital, with the goal of establishing the Minimun Inhibitory Concentration (MIC) for different antibiotics, by means of the method of double dilution in Agar Muller Hinton. It was found that all the strains were resistant to Cloramfenicol and Lincomicin; besides, at the isolated strains from children, was found a resistance to Gentamicin, Sulfametoxazol and Trimetropin. At the adult group the resistance was variable, being remarkable the 11.32% from ampicilina (MIC=0.75 ug/ml) the 13% for nalidixic acid (MIC=3.5 ug/ml). At the group of isolated strains from children, it was found an 8.82% resistant to tetraciclina and penicillin (MIC=0.152 and 3.65 UL/ml ug/ml respectively) the 5.88% belong to amoxilin and nalidix acid (MIC=2.75 ug/ml for both) and 38.23% for ampicilina (MIC=0.75 ug/ml). In relation to the patterns of resistance to anti-biotic types, these change from r:3 to r:9 being the more frequent ones the R:5 (Cloramfenicol, Clindamicina, Lincomicin, Sulfametoxazol and Trimetropin) in adults and R:4 (Clindamicina, Lincomicin, Gentamicin and Trimetropin) in children. These results suggest that the Vibrio Cholerae will act as a possible reservoir of plasmids of resistance to anti-biotics, and that would complicate the treatment of the illness, and at the same time, the ending of Vibrio Cholerae in our environment.

[Prognostic significance of age in resectable cancer of the stomach]. / Significancia pronóstica de la edad en el cáncer de estómago resecable.

From January 1, 1966 to December 31, 1991, 137 patients with carcinoma of the stomach underwent standard radical gastrectomy at Belen Hospital, Trujillo, Perú. The patients were classified into two groups--those with age < or = 40 years (n = 19) and those with age > 40 years (n = 118)--and we analyzed herein comparatively clinicopathologic features and five year survival rates using the Mantel Haenszel test. In patients aged 40 years and younger there was a significant increased in the number of patients with carcinomas present in the upper two-thirds of stomach (p < 0.01) and in undifferentiated type adenocarcinoma in histology (p < 0.01) compared with patients more than 40 years old. There were no statistically significant differences between these two groups of age with regard to sex, abdominal mass, size of tumor, type of cancer (early vs advanced carcinoma), Borrmann's criteria, depth of invasion (T), nodal involvement (N), clinical stage (UICC, 1987), type of operation, curability, operative death and five year actuarial survival (8.0 percent vs 6.0 percent, respectively) (p > 0.05). In this study, carcinomas in young people were found to have a higher incidence of undifferentiated forms pathologically and the majority occurred in the body and after gastric resection were similar in both groups of patients.