Weight variation over time and its relevance among multidrug-resistant tuberculosis patients

Objectives: We aimed to assess the variation in patient body weight over time according to the treatment outcome among multidrug-resistant tuberculosis (MDR-TB) cases. Methods: This was a retrospective cohort study. The data of patients commencing MDR-TB therapy were analyzed. Data were collected from different public TB treatment facilities located in peri-urban areas to the south of Lima, Peru. The outcome was patient body weight (kilograms) from treatment commencement, measured monthly. A random effects model was fitted using robust standard errors to calculate 95% confidence intervals. Results: Of a total of 1242 TB cases, 243 (19.6%) were MDR-TB. Only 201 cases were included in the analysis; 127 (63.2%) were males and the mean patient age was 33.6 (standard deviation 16.2) years. Weight changes over time among the patients who were cured differed from changes in those who died during therapy (p < 0.001). Weight curve divergence was important at the end of the third, fourth, and fifth treatment months: on average, the weight difference was 2.18 kg (p < 0.001), 3.27 kg (p = 0.007), and 3.58 kg (p = 0.03), respectively, when cured patients were compared to those who died. Conclusions: Our results show that weight variation during treatment can be a useful surrogate for the treatment outcome, specifically death during therapy. MDR-TB patients with weight loss should be followed more closely, as they are at greater risk of death.
Authors: Chung Delgado, Kocfa; Revilla Montag, Alejandro; Guillén Bravo, Sonia; Bernabe Ortiz, Antonio
Source: International Journal of Infectious Diseases

URL: http://hdl.handle.net/10757/326115

Use of automated external defibrillator in Peruvian out-of-hospital environment: improving emergency response in Latin America;

This case report relates out-ofhospital care to a patient with risk factors treated in the out-of-hospital services after cardiac arrest and ventricular fibrillation. The patient was treated according to the standards of basic life support and advanced cardiovascular life support; by applying an automated external defibrillator (AED) with favorable outcome and successful recovery of the patient from his risk of life condition. This is the first documented report with a favorable outcome in Peru, in out-ofhospital services and stresses the desirability of adopting policies for public access to early defibrillation.
Authors:Lister, Pablo; Loret de Mola, Christian; Arroyo, Elena; Solórzano, José; Escalante Kanashiro, Raffo; Matos Iberico, Giuliana
Source: Rev. bras. ter. intensiva
URL: http://hdl.handle.net/10757/324709

Medical residency in Peru: A view beyond the real demand

Señor Editor: La problemática de los recursos humanos en salud es un área que viene cobrando mayor relevancia en la agenda nacional de Perú, donde inclusive se ha identificado como una de las prioridades nacionales de investigación en salud . Dentro de los aspectos a considerar se encuentra la escasez de profesionales de la salud y la calidad de su formación, siendo un tópico particular de interés lo concerniente a los médicos especialistas. En ese sentido, un reciente documento técnico del Ministerio de Salud da cuenta de la necesidad de este tipo de profesionales.

Si bien lo expuesto en dicho texto permite tener una visión global del asunto y servir de base para la formulación de estrategias nacionales que busquen mejorar esa situación; una institución educativa (Universidad Privada Antenor Orrego), ha tomado el citado documento para justificar la creación de nuevas plazas de segunda especialidad y realizar convocatorias extraordinarias bajo el argumento de estar enmarcados en el proceso de descentralización y la necesidad de especialistas en su región, sin considerar que este proceso no debería contradecir el principio Constitucional de la "Unicidad del Estado", es decir que los Gobiernos Regionales no deberían hacer estas convocatorias, generando controversia en la comunidad médica .
Autor: Herrera Añazco, Percy
Fuente: Acta méd. peruana
URL:  http://hdl.handle.net/10757/324729

Eosinophilic and linphocitic colitis: diferent histological manifestations of a same process in a patients with chronic diarrhea

Objetivos: 1) Determinar la prevalencia de incremento de eosinófilos en mucosa colónica en pacientes con colitis linfocítica (CL). 2) Determinar la coexistencia de colitis eosinofílica (CE) en pacientes con CL. Materiales y métodos: Las biopsias colónicas de pacientes adultos con diarrea crónica diagnosticados como CL en el hospital Daniel A. Carrión durante octubre 2009 a marzo 2012 fueron revisadas de forma independiente por 2 patólogos. Microscópicamente, se investigó y cuantificó la presencia de eosinófilos en mucosa colónica. Resultados: Se incluyeron 68 casos de CL, de los cuales 76,5% tuvieron eosinófilos elevados en la mucosa colónica y en 51,4% se pudo hacer el diagnóstico de CE según los criterios establecidos. Conclusión: Tres de cuatro pacientes con CL presentan eosinófilos elevados y 1 de cada 2 pacientes con CL cumple criterios para CE.; Objectives: 1) To determine the prevalence of increased number of eosinophils in colonic mucosa of patients with lymphocytic colitis (LC). 2) To determine the coexistence of eosinophilic colitis (EC) in patients with lymphocytic colitis. Materials and methods: slides of adult patients with cronic diarrhea with diagnosis of LC were reviewed between October 2009 and March 2012. The number of eosinophils was quantified. Results: Sixty eight patients with LC were included. Elevated eosinophils were found in 76.5 and in 51.4% a diagnosis of EC was established. Conclusion: 3 out of 4 patients with LC had elevated eosinophils and 1 of 2 patients with LC had criteria for EC.
Autor: Arévalo, Fernando; Aragón, Violeta; Montes, Pedro; Perez Narrea, Teresa; Monge, Eduardo
Fuente: Rev. gastroenterol. Perú
URL: http://hdl.handle.net/10757/324707

An assessment of the use of a new method for teaching and the learning surgical management of unilateral cleft lip, in plastic surgery residents

 Introduction: A common problem during medical training in surgical areas like plastic surgery, is the absence of proper methods to obtain the necessary surgical skills to address the different pathologies related to this field. The medical training is performed in educational hospitals in Lima, however the methods are limited to the observation or assistance and don't let to the doctor obtain adequate competences to repair surgically this pathology once they finish their training. Material and Methods:This is a descriptive study for the development of the used methodology and a co relational study to evaluate the results obtained with the methodology. This is a quasi experimental study. It is used to third year plastic surgery training surgeons from San Marcos University of Lima and has been done in children with complete unilateral cleft lip attended in Regional Hospitals from Ministry of Health between 2010 and 2011. Results:We haven't seen significant differences between the non-cleft side and cleft side in these parameters: lip height, lip width and vermilion height. We have seen significant differences between the non-cleft side and cleft side in relation with the nasal base width. Conclusions: This developed methodology to teach and learn the upper double rotational advancement technique used in this study is efficient to obtain good results in the surgical management of unilateral cleft lip with our technique by third year training residents in plastic surgery.
Authors: Rossell Perry, Percy; Gavino-Gutierrez, Arquímedes M.
Source  Acta méd. peruana
URL: http://hdl.handle.net/10757/324706