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Alarcón-Yaquetto DE, Rueda-Torres L, Bailon N, Barreto PV, Málaga G. Accuracy of HemoCue301 portable hemoglobin analyzer for anemia screening in capillary blood from women of reproductive age in a deprived region of Northern Peru: An on-field study. PLoS One 2023; 18:e0293984. [PMID: 37963155 PMCID: PMC10645325 DOI: 10.1371/journal.pone.0293984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE We aim to assess the accuracy and effectiveness of the HemoCue 301, a point-of-care (POC) device for measuring hemoglobin levels, and detecting anemia among individuals living in Tumbes, a rural, underserved area in Northern Peru. METHODS Baseline analysis of a clinical trial aimed at assessing the effect of multi-fortified bread (NCT05103709). Adult women with capillary blood HemoCue 301 readings below 12 g/dL were recruited in coastal city of Tumbes, Peru. A total of 306 women took part of the study, venous blood samples were taken and analyzed with an automated hematology analyzer. Serum samples were used to measure ferritin, serum iron and C reactive protein. RESULTS Capillary blood measured by the Hemocue 301 has a bias of 0.36 ± 0.93 g/dL respect to the automated Hb. More than 50% of women with normal ferritin values were classified as anemics according to the HemoCue 301. Automated Hb cut-off of 10.8 g/dL [AUC 0.82 (0.77-0.88)] had a specificity of 0.817 and a sensitivity 0.711 while with the HemoCue 301 cut-off of 11.1 g/dL [AUC 0.71 (0.62-0.79)] had a specificity of 0.697 and a sensitivity 0.688. The performance of the automated Hb cut-off was significantly better than the HemoCue (p<0.001). CONCLUSION Caution must be taken when using POC devices, especially with values around the threshold. Cut-off values found in our study could be used as surrogate means when no confirmatory tests are available. Clinical outcomes should be prioritized when diagnosing iron deficiency anemia in women of reproductive age to ensure proper diagnosis.
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Affiliation(s)
| | - Lenin Rueda-Torres
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Nataly Bailon
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Germán Málaga
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Perú
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Torres-Nolasco MF, Ruiz EF, Tarazona-Meza C, Lazo-Porras M, Málaga G. Analysis of medical appointments for patients with overweight and obesity in a public hospital of Lima, Peru: a cross-sectional study of audio-recorded consultations. J Int Med Res 2022; 50:3000605221104770. [PMID: 35701880 PMCID: PMC9208051 DOI: 10.1177/03000605221104770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To describe the content of overweight and obesity counseling performed in a public Peruvian hospital. Methods We audio-recorded 40 visits of patients with overweight or obesity from the internal medicine, cardiology, endocrinology, and family medicine services at Cayetano Heredia Hospital. Fragments of the recordings in which counseling was performed were transcribed and codified. We established a checklist to score each counseling session and performed descriptive analyses. Results Complete counseling (including weight, nutrition, and physical activity) was performed in 32.5% of consultations. The average time spent in counseling was 1.72 minutes. Counseling on weight loss was performed in 65% of consultations, nutrition in 65%, and physical activity in 35%. On average, 8 of 26 checklist items were fulfilled per appointment. Weight loss goals were established in 15% of visits. The most frequent diet recommendations were eating more fruits and vegetables (32.5%) and eating fewer carbohydrates (30.0%). Suggested physical activities were walking (10.0%), running (7.5%), and playing any sport (7.5%). Conclusions Complete counseling was only addressed in one-third of the appointments, and most counseling was superficial without considering therapeutic goals. This suggests the need to include lifestyle counseling in consultations, regardless of the medical specialty or patient’s background condition.
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Affiliation(s)
| | - Eloy F Ruiz
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carla Tarazona-Meza
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Universidad Científica del Sur, Lima, Peru
| | - María Lazo-Porras
- Division of Tropical and Humanitarian Medicine, University of Geneva & Geneve University Hospitals, Geneve, Switzerland.,CONEVID Unidad de Conocimiento y Evidencia, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Germán Málaga
- CONEVID Unidad de Conocimiento y Evidencia, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
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3
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Alarcón-Yaquetto DE, de Ferrari A, Málaga G. The road to patient-centred care in Peru: The difficulties and opportunities to achieve participatory health care. Z Evid Fortbild Qual Gesundhwes 2022; 171:113-116. [PMID: 35610135 DOI: 10.1016/j.zefq.2022.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Patient-centred care (PCC) is a pillar of quality health services, where decision-making power is shared between the clinician and the patient. Although, this approach could be adopted with easiness in high income settings or in countries with unified health systems, in settings such as Peru, where universal access and other structural problems remain a challenge, the practice of PCC is not a priority. In Peru, research on PCC has been conducted for almost two decades, but this has not generated a need for development in academia, decision makers, health personnel or patients. Here, we give an overview of the road that PCC research has taken in Peru and the challenges that remain to translate it into clinical practice.
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Affiliation(s)
| | - Aldo de Ferrari
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia. Lima, Peru
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4
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Muñoz Del Carpio-Toia A, Begazo Muñoz Del Carpio L, Mayta-Tristan P, Alarcón-Yaquetto DE, Málaga G. Workplace Violence Against Physicians Treating COVID-19 Patients in Peru: A Cross-Sectional Study. Jt Comm J Qual Patient Saf 2021; 47:637-645. [PMID: 34257040 PMCID: PMC8200256 DOI: 10.1016/j.jcjq.2021.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The COVID-19 pandemic is an unprecedented challenge to health systems that has revealed shortcomings and increased unmet demands. Such situations might exacerbate workplace violence (WPV) against physicians, as has been reported in several parts of the world. METHODS To identify the frequency and characteristics of WPV suffered by physicians attending COVID-19 patients in Peru, a descriptive, cross-sectional study was conducted with an online survey of 200 physicians. RESULTS Of the survey respondents, 84.5% had suffered some type of WPV; 97.6% of these suffered nonphysical violence. Suffering more than one incident of violence was reported by 75.7% of respondents. The primary aggressor was a patient's family member or caregiver. Violence occurred most frequently in critical areas inside the health service facility, such as COVID-19 triage, tents, and hospital units, although it also occurred during teleconsultations. Multiple shortcomings of the health services were perceived as the main trigger of violence. Being a female physician (odds ratio [OR] = 2.48, 95% confidence interval [CI] = 1.06-5.83) and working in a COVID-19 ICU (OR = 5.84, 95% CI = 1.60-21.28) were the main factors associated with WPV. CONCLUSION Violence against physicians attending COVID-19 patients in Peru is common. The perceived factors that contribute most to violence are linked to deficiencies in health services.
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Huayanay-Espinoza IE, Guerra-Castañon F, Reyes-Diaz M, Lazo-Porras M, de la Cruz-Luque C, Herrera DA, Málaga G. Quality of life and self-efficacy in patients with type 2 diabetes mellitus in a Peruvian public hospital. Medwave 2021; 21:e8133. [PMID: 33830978 DOI: 10.5867/medwave.2021.02.8132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 12/12/2020] [Indexed: 11/27/2022] Open
Abstract
Quality of life and self-efficacy assessments are increasingly applied in research with type 2 diabetes mellitus patients due to the impact of the disease on their lives. This study aimed to describe the quality of life and self-efficacy in type 2 diabetes mellitus patients and describe the association of quality of life and self-efficacy with demographic, metabolic, and clinical variables. This is a secondary data analysis from a cross-sectional study: Metabolic control in patients with type 2 diabetes mellitus in a public hospital in Peru: a cross-sectional study in a low-middle income country. Data were obtained by standardized interviews and evaluation of medical records. The evaluation tools used were the Diabetes 39 questionnaire (D-39) to measure the quality of life and the General Self-Efficacy scale (GSE) for self-efficacy. The median scores of the D-39 and GSE were 34.6 and 34, respectively. The D-39 dimension with the highest score was anxiety and concern. Better quality of life was associated with being older than 65 years old, not having complications, and the absence of depression. No significant association was found between self-efficacy and the quality of life score. Results suggest patients with type 2 diabetes mellitus have a poor quality of life. Patient-centered strategies for type 2 diabetes mellitus care must consider these psychosocial factors to improve disease control and quality of life.
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Affiliation(s)
- Irma Elizabeth Huayanay-Espinoza
- Unidad de Conocimiento y Evidencia (CONEVID), Faculty of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru. ORCID: 0000-0002-1910-1501
| | - Felix Guerra-Castañon
- Unidad de Conocimiento y Evidencia (CONEVID), Faculty of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru. ORCID: 0000-0003-1721-4673
| | - Michael Reyes-Diaz
- Unidad de Conocimiento y Evidencia (CONEVID), Faculty of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru. ORCID: 0000-0003-0202-2572
| | - María Lazo-Porras
- Unidad de Conocimiento y Evidencia (CONEVID), Faculty of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru. Dirección: Av. Honorio, Delgado 430, San Martín de Porres 15102, Peru. Mail: . ORCID: 0000-0003-0062-5476
| | - Celso de la Cruz-Luque
- Unidad de Conocimiento y Evidencia (CONEVID), Faculty of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru. ORCID: 0000-0002-2808-3421
| | - Diego Adrianzen Herrera
- Unidad de Conocimiento y Evidencia (CONEVID), Faculty of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Montefiore Medical Center, New York, United States. ORCID: 0000-0003-0168-2165
| | - Germán Málaga
- Unidad de Conocimiento y Evidencia (CONEVID), Faculty of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Faculty of Medicine Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Internal Medicine, Hospital Cayetano Heredia, Lima, Peru. ORCID: 0000-0002-7828-300X
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6
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Llanos-Torres KH, Pérez-Orozco R, Málaga G. Nosocomial infections in emergency observation units and their association with overcrowding and ventilation. Rev Peru Med Exp Salud Publica 2021; 37:721-725. [PMID: 33566914 DOI: 10.17843/rpmesp.2020.374.5192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/29/2020] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to measure the frequency of nosocomial infections in the internal medicine observation units of the emergency services in two level III hospitals in Lima. A 5-day prevalence study was carried out on patients admitted after a 72 hours observation period, in whom community-based infections were ruled out. Data was obtained from clinical records. Additionally, overcrowding and ventilation in the hospitalization rooms were evaluated. The frequency of nosocomial infections in the emergency services was found to be 8.1%, four times what was reported as period prevalence in Peru. The associated risk factors were prolonged length of stay and lack of proper ventilation in the hospital environment. Inadequate ventilation triples the risk of nosocomial infections.
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Affiliation(s)
- Kevin H Llanos-Torres
- Facultad de Medicina «Alberto Hurtado», Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Rocío Pérez-Orozco
- Facultad de Medicina «Alberto Hurtado», Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Germán Málaga
- CONEVID Unidad de Conocimiento y Evidencia, Facultad de Medicina «Alberto Hurtado», Universidad Peruana Cayetano Heredia, Lima, Perú.,Hospital Cayetano Heredia, Lima, Perú
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7
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Mejía F, Medina C, Cornejo E, Morello E, Vásquez S, Alave J, Schwalb A, Málaga G. Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru. PLoS One 2020; 15:e0244171. [PMID: 33370364 PMCID: PMC7769479 DOI: 10.1371/journal.pone.0244171] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/06/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Peru is among the top ten countries with the highest number of coronavirus disease 2019 (COVID-19) cases worldwide. The aim of the study was to describe the clinical features of hospitalized adult patients with COVID-19 and to determine the prognostic factors associated with in-hospital mortality. METHODS We conducted a retrospective cohort study among adult patients with COVID-19 admitted to Hospital Cayetano Heredia; a tertiary care hospital in Lima, Peru. The primary outcome was in-hospital mortality. Multivariate Cox proportional hazards regression was used to identify factors independently associated with in-hospital mortality. RESULTS A total of 369 patients (median age 59 years [IQR:49-68]; 241 (65.31%) male) were included. Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) values of less than 90% on admission correlated with mortality, presenting 1.86 (95%CI: 1.02-3.39), 4.44 (95%CI: 2.46-8.02) and 7.74 (95%CI: 4.54-13.19) times greater risk of death for SaO2 of 89-85%, 84-80% and <80%, respectively, when compared to patients with SaO2 >90%. Additionally, age >60 years was associated with 1.88 times greater mortality. CONCLUSIONS Oxygen saturation below 90% on admission is a strong predictor of in-hospital mortality in patients with COVID-19. In settings with limited resources, efforts to reduce mortality in COVID-19 should focus on early identification of hypoxemia and timely access to hospital care.
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Affiliation(s)
- Fernando Mejía
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Carlos Medina
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
| | - Enrique Cornejo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
| | | | | | - Jorge Alave
- Hospital Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Unión, Lima, Peru
| | - Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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8
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Pesantes MA, Lazo-Porras M, Cárdenas MK, Diez-Canseco F, Tanaka-Zafra JH, Carrillo-Larco RM, Bernabé-Ortiz A, Málaga G, Miranda JJ. [Healthcare challenges for people with diabetes during the national state of emergency due to COVID-19 in Lima, Peru: primary healthcare recommendations]. Rev Peru Med Exp Salud Publica 2020; 37:541-546. [PMID: 33295559 DOI: 10.17843/rpmesp.2020.373.5980] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/08/2020] [Indexed: 03/07/2024] Open
Abstract
Patients diagnosed with type 2 diabetes mellitus, who then become infected with SARS-CoV-2, are at greater risk of developing complications from COVID-19, which may even lead to death. Diabetes is a chronic condition that requires continuous contact with healthcare facilities; therefore, this type of patients should have regular access to medicines, tests and appointments with healthcare personnel. In Peru, care and treatment continuity have been affected since the national state of emergency due to COVID-19 began; because many healthcare facilities suspended outpatient consultations. The strategies presented in this study were developed by different Peruvian health providers in the pandemic context to ensure care continuity for people with diabetes. This article provides recommendations to strengthen primary healthcare, because it is the first level of healthcare contact for patients with diabetes.
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Affiliation(s)
- M Amalia Pesantes
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Maria Lazo-Porras
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
- Departamento de Medicina Tropical y Humanitaria, Hospital Universitario de Ginebra y Universidad de Ginebra, Ginebra, Suiza
| | - Maria Kathia Cárdenas
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Francisco Diez-Canseco
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jessica Hanae Tanaka-Zafra
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Rodrigo M Carrillo-Larco
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Londres, Reino Unido
| | - Antonio Bernabé-Ortiz
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Germán Málaga
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
- Hospital Cayetano Heredia, Lima, Perú
| | - J Jaime Miranda
- CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú
- The George Institute for Global Health, University of New South Wales, Sidney, Australia
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9
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Muñoz del Carpio Toia A, Begazo- Muñoz del Carpio L, Díaz San Román B, Rodríguez Flores A, Mendoza Vicuña G, Málaga G. Burnout y calidad de vida profesional en operadores de justicia que atienden violencia familiar. Rev Peru Med Exp Salud Publica 2020; 37:589-590. [DOI: 10.17843/rpmesp.2020.373.5276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/24/2020] [Indexed: 11/06/2022] Open
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10
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Alves-de Farias L, Galvão-Silva D, Reyes-Cancino C, Málaga G. Encefalitis por el virus de herpes simple tipo 2 en un paciente adulto sano: un caso inusual. Rev Peru Med Exp Salud Publica 2020; 37:566-570. [DOI: 10.17843/rpmesp.2020.373.4752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 06/17/2020] [Indexed: 11/06/2022] Open
Abstract
La infección neurológica por el virus del herpes simple tipo 2 (VHS-2) es responsable de una morbimortalidad significativa que debe ser diagnosticada y tratada lo antes posible. Clásicamente se caracteriza por la tríada de fiebre, cefalea y cambios de comportamiento. La asociación de los síntomas, los resultados de las pruebas de laboratorio y las imágenes son fundamentales para el diagnóstico precoz y el tratamiento inmediato de esta patología, a fin de prevenir que su progresión sea fatal. Presentamos el caso de un paciente varón de 45 años con diagnóstico de encefalitis por VHS-2 después del uso crónico de corticoides. La infección neurológica por VHS-2 en pacientes adultos previamente sanos después del uso crónico de corticoides es extremadamente infrecuente y la asociación no había sido descrita previamente.
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11
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Málaga G, Gayoso D, Vásquez N. Empathy in medical students of a private university in Lima, Peru: A descriptive study. Medwave 2020; 20:e7905. [PMID: 32469857 DOI: 10.5867/medwave.2020.04.7905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/03/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Medical empathy is a characteristic that allows us to understand the subjective experiences and the perspective of the patient. Empathy can improve the clinical outcomes of our clinical actions. However, it is not easy to teach this ability in a medical school program. Objective We aimed to identify the level of empathy and related factors in students enrolled in medicine in 2019. Methods We conducted a cross-sectional, descriptive study. We used a questionnaire with sociodemographic questions, and Jefferson's Medical Empathy Scale to measure the variables. Results We surveyed 189 medical students. The mean score was 118,01 (range: 20 to 140), standard deviation, 11,61; median, 120; and a Cronbach's alpha coefficient of 0,76. We found that the year of the enrollment is inversely related to the level of empathy (p = 0,0095), that the female sex has a higher level of empathy (p = 0,0123) and that practicing a religious denomination is related to a higher level of empathy (p = 0,0001). Conclusion Medical students have an above-average level of empathy when compared to other local studies. We describe higher levels of empathy according to sex, and religious beliefs, and an inverse relation to the year of enrollment.
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Affiliation(s)
- Germán Málaga
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Diego Gayoso
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Nikole Vásquez
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
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12
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Lazo-Porras M, Prutsky GJ, Barrionuevo P, Tapia JC, Ugarte-Gil C, Ponce OJ, Acuña-Villaorduña A, Domecq JP, De la Cruz-Luque C, Prokop LJ, Málaga G. World Health Organization (WHO) antibiotic regimen against other regimens for the treatment of leprosy: a systematic review and meta-analysis. BMC Infect Dis 2020; 20:62. [PMID: 31959113 PMCID: PMC6971933 DOI: 10.1186/s12879-019-4665-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/01/2019] [Accepted: 11/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness and safety of the World Health Organization antibiotic regimen for the treatment of paucibacillary (PB) and multibacillary (MB) leprosy compared to other available regimens. METHODS We performed a search from 1982 to July 2018 without language restriction. We included randomized controlled trials, quasi-randomized trials, and comparative observational studies (cohorts and case-control studies) that enrolled patients of any age with PB or MB leprosy that were treated with any of the leprosy antibiotic regimens established by the WHO in 1982 and used any other antimicrobial regimen as a controller. Primary efficacy outcomes included: complete clinical cure, clinical improvement of the lesions, relapse rate, treatment failure. Data were pooled using a random effects model to estimate the treatment effects reported as relative risk (RR) with 95% confidence intervals (CI). RESULTS We found 25 eligible studies, 11 evaluated patients with paucibacillary leprosy, while 13 evaluated patients with MB leprosy and 1 evaluated patients of both groups. Diverse regimen treatments and outcomes were studied. Complete cure at 6 months of multidrug therapy (MDT) in comparison to rifampin-ofloxacin-minocycline (ROM) found RR of 1.06 (95% CI 0.88-1.27) in five studies. Whereas six studies compare the same outcome at different follow up periods between 6 months and 5 years, according to the analysis ROM was not better than MDT (RR of 1.01 (95% CI 0.78-1.31)) in PB leprosy. CONCLUSION Not better treatment than the implemented by the WHO was found. Diverse outcome and treatment regimens were studied, more statements to standardized the measurements of outcomes are needed.
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Affiliation(s)
- Maria Lazo-Porras
- CONEVID Unidad de Conocimiento y Evidencia, School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.,Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Gabriela J Prutsky
- CONEVID Unidad de Conocimiento y Evidencia, School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.,Department of Pediatrics, Mayo Clinic Health System, Mankato, MN, USA
| | - Patricia Barrionuevo
- CONEVID Unidad de Conocimiento y Evidencia, School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
| | - Jose Carlos Tapia
- CONEVID Unidad de Conocimiento y Evidencia, School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.,Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cesar Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Oscar J Ponce
- CONEVID Unidad de Conocimiento y Evidencia, School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru
| | - Ana Acuña-Villaorduña
- CONEVID Unidad de Conocimiento y Evidencia, School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.,Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Pablo Domecq
- CONEVID Unidad de Conocimiento y Evidencia, School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.,Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Celso De la Cruz-Luque
- CONEVID Unidad de Conocimiento y Evidencia, School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.,Cardiology division, Jackson Memorial Hospital, Miami, Florida, USA
| | - Larry J Prokop
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN, USA
| | - Germán Málaga
- CONEVID Unidad de Conocimiento y Evidencia, School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru. .,School of Medicine "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru.
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13
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Herrera-Añazco P, Taype-Rondan A, Ortiz PJ, Málaga G, Del Carpio-Toia AM, Alvarez-Valdivia MG, Juárez-Huanca C, Ciudad-Fernandez L, Bruner-Meléndez R, Samaniego-Mojica W, Perez-Rafael E. Use of medicinal plants in patients with chronic kidney disease from Peru. Complement Ther Med 2019; 47:102215. [PMID: 31780000 DOI: 10.1016/j.ctim.2019.102215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/21/2019] [Accepted: 10/10/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe the use of medicinal plants in patients with chronic kidney disease (CKD) in public healthcare centers in Peru. METHODS A cross-sectional study was conducted in patients with CKD in healthcare centers of three Peruvian regions: Lima, Arequipa, and Ucayali. A structured questionnaire which included socio-demographic data, medical antecedents and characteristics of the use of medicinal plants was used. Prevalence ratios (PR) and 95 % confidence intervals (95% CI) were calculated using crude Poisson regressions with robust variances. RESULTS A total of 599 patients with CKD were evaluated, of which 300 (50.1%) reported the use of medicinal plants (160 [30.3%] used these plants for CKD), 379 reported that medicinal plants were not harmful, while 166 (27.8%) stopped using allopathic medicine to use medicinal plants only. In the adjusted analysis, the frequency of the use of medicinal plants for CKD was similar between Lima and Arequipa but was lower in Ucayali than in Lima (PR: 0.32, 95% CI: 0.14 - 0.76). In addition, a higher frequency of the use of medicinal plants for CKD was observed in patients with more advanced stages of CKD (PR: 1.55, 95% CI: 1.06-2.26) and in patients who were aware they had CKD (PR: 2.79 95% CI: 1.39-5.63). CONCLUSIONS Half of the patients used medicinal plants and about one-third used it for CKD. This use was lower in Ucayali and higher in both the patients who knew they had CKD and those with more advanced stages of the disease. Given these results, physicians should ask and inform regarding medicinal plants consumption to their CKD patients.
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Affiliation(s)
- Percy Herrera-Añazco
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.
| | - Alvaro Taype-Rondan
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Pedro J Ortiz
- Instituto de Gerontología, Facultad de Medicina -Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Germán Málaga
- Conevid, Escuela de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Agueda Muñoz Del Carpio-Toia
- Universidad Católica de Santa María, Escuela de Medicina Humana, Vicerrectorado de Investigación, Arequipa, Peru
| | - M G Alvarez-Valdivia
- Universidad Católica de Santa María, Escuela de Medicina Humana, Vicerrectorado de Investigación, Arequipa, Peru
| | - C Juárez-Huanca
- Universidad Católica de Santa María, Escuela de Medicina Humana, Vicerrectorado de Investigación, Arequipa, Peru
| | - L Ciudad-Fernandez
- Instituto de Gerontología, Facultad de Medicina -Universidad Peruana Cayetano Heredia, Lima, Peru; Facultad de Medicina - Universidad Nacional de Ucayali, Ucayali, Peru
| | - R Bruner-Meléndez
- Facultad de Medicina - Universidad Nacional de Ucayali, Ucayali, Peru
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14
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Rosas-Chavez G, Romero-Visurraga CA, Ramirez-Guardia E, Málaga G. [The degree of health literacy and treatment compliance in patients with high blood pressure in a national hospital in Lima, Peru]. Rev Peru Med Exp Salud Publica 2019; 36:214-221. [PMID: 31460632 DOI: 10.17843/rpmesp.2019.362.4279] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/08/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES. To assess the level of health literacy and treatment compliance in high-blood pressure patients attending an outpatient clinic in a hospital in Lima, Peru. MATERIALS AND METHODS. A cross-sectional study was conducted in 276 patients, who filled out a questionnaire with general characteristics, the SAHLSA-50 Test, and the Morisky-Green Test. The Chi-square test was used to assess the association between independent variables with treatment compliance and health literacy. RESULTS. We found a 36% of inadequate health literacy and 15% treatment compliance. No association was found between these variables (p=0.155). There was an association between being a head of household (p=0.033) and having a partner (p=0.044) with the degree of health literacy. CONCLUSIONS. The percentage of health literacy was similar to that of Peruvian and Latin American studies, and the degree of treatment compliance was one of the lowest reported. No significant association was found between these two variables.
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Affiliation(s)
| | | | | | - Germán Málaga
- Servicio de Medicina Interna, Hospital Cayetano Heredia. Lima, Perú
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15
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Machline-Carrion MJ, Santucci EV, Damiani LP, Bahit MC, Málaga G, Pontes-Neto OM, Martins SCO, Zétola VF, Normilio-Silva K, Rodrigues de Freitas G, Gorgulho A, De Salles A, Pacheco da Silva BG, Santos JY, de Andrade Jesuíno I, Bueno PRT, Cavalcanti AB, Guimarães HP, Xian Y, Bettger JP, Lopes RD, Peterson ED, Berwanger O. Effect of a Quality Improvement Intervention on Adherence to Therapies for Patients With Acute Ischemic Stroke and Transient Ischemic Attack: A Cluster Randomized Clinical Trial. JAMA Neurol 2019; 76:932-941. [PMID: 31058947 DOI: 10.1001/jamaneurol.2019.1012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging, especially in low- and middle-income countries. Objective To assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for care of patients with AIS and TIA. Design, Setting and Participants This 2-arm cluster-randomized clinical trial assessed 45 hospitals and 2336 patients with AIS and TIA for eligibility before randomization. Eligible hospitals were able to provide care for patients with AIS and TIA in Brazil, Argentina, and Peru. Recruitment started September 12, 2016, and ended February 26, 2018; follow-up ended June 29, 2018. Data were analyzed using the intention-to-treat principle. Interventions The multifaceted quality improvement intervention included case management, reminders, a roadmap and checklist for the therapeutic plan, educational materials, and periodic audit and feedback reports to each intervention cluster. Main Outcomes and Measures The primary outcome was a composite adherence score for AIS and TIA performance measures. Secondary outcomes included an all-or-none composite end point of performance measures, the individual process measure components of the composite end points, and clinical outcomes at 90 days after admission (stroke recurrence, death, and disability measured by the modified Rankin scale). Results A total of 36 hospitals and 1624 patients underwent randomization. Nineteen hospitals were randomized to the quality improvement intervention and 17 to routine care. The overall mean (SD) age of patients enrolled in the study was 69.4 (13.5) years, and 913 (56.2%) were men. Overall mean (SD) composite adherence score for the 10 performance measures in the intervention group hospitals compared with control group hospitals was 85.3% (20.1%) vs 77.8% (18.4%) (mean difference, 4.2%; 95% CI, -3.8% to 12.2%). As a secondary end point, 402 of 817 patients (49.2%) at intervention hospitals received all the therapies that they were eligible for vs 203 of 807 (25.2%) in the control hospitals (odds ratio, 2.59; 95% CI, 1.22-5.53; P = .01). Conclusions and Relevance A multifaceted quality improvement intervention did not result in a significant increase in composite adherence score for evidence-based therapies in patients with AIS or TIA. However, when using an all-or-none approach, the intervention resulted in improved adherence to evidence-based therapies. Trial Registration ClinicalTrials.gov identifier: NCT02223273.
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Affiliation(s)
| | | | | | - M Cecilia Bahit
- Fundacion Instituto de Neurología Cognitiva Rosario, Grupo Argentino Colaborativo en Investigación Clínica, Rosario, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ying Xian
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Janet Prvu Bettger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.,Brazilian Clinical Research Institute, São Paulo, Brazil
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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16
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Machline-Carrion MJ, Santucci EV, Damiani LP, Bahit C, Málaga G, Pontes-Neto OM, Martins SCO, Zétola VF, Normilio-Silva K, de Freitas GR, Gorgulho A, De Salles A, da Silva BGP, Santos JY, de Andrade Jesuíno I, Bueno PRT, Cavalcanti AB, Guimarães HP, Xian Y, Bettger JP, Lopes RD, Peterson ED, Berwanger O. An international cluster-randomized quality improvement trial to increase the adherence to evidence-based therapies for acute ischemic stroke and transient ischemic attack patients: Rationale and design of the BRIDGE STROKE Trial. Am Heart J 2019; 207:49-57. [PMID: 30415083 DOI: 10.1016/j.ahj.2018.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/21/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and transient ischemic attack (TIA) is challenging especially in low- and middle-income countries. OBJECTIVES The aim of this study is to assess the effect of a multifaceted quality improvement intervention on adherence to evidence-based therapies for AIS and TIA patients care. DESIGN We designed a pragmatic, 2-arm cluster-randomized trial involving 36 clusters and 1624 patients from Brazil, Argentina, and Peru. Hospitals are randomized to receive a multifaceted quality improvement intervention (intervention group) or to routine care (control group). The BRIDGE Stroke multifaceted quality improvement intervention includes case management, reminders, health care providers' educational materials (including treatment algorithms), interactive workshops, and audit and feedback reports. Primary outcome is a composite adherence score to AIS and TIA performance measures. Secondary outcomes include an "all or none" composite end point to performance measures, the individual components of the composite end points, and clinical outcomes at 90 days following admission (stroke recurrence, death, and disability measured by the modified Rankin scale). SUMMARY The BRIDGE Stroke Trial is an international pragmatic evaluation of a multifaceted quality improvement intervention. If effective, this intervention could be potentially extended widely to improve the quality of care and outcomes of patients with AIS or TIA.
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17
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Falconí Sarmiento A, Nolasco Mejia M, Bedoya Rozas A, Amaro Giraldo C, Málaga G. Frecuencia y factores de riesgo para bacteriemia por enterobacterias productoras de betalactamasa de espectro extendido en pacientes de un hospital público de Lima, Perú. Rev Peru Med Exp Salud Publica 2018; 35:62-67. [DOI: 10.17843/rpmesp.2018.351.3601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 02/28/2018] [Indexed: 11/06/2022] Open
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18
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Málaga G, Cuba-Fuentes S, Romero-Albino Z. Implementation of a community-based breast cancer management programme. Lancet Oncol 2018; 19:e3. [DOI: 10.1016/s1470-2045(17)30858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 11/27/2022]
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19
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Herrera-Añazco P, Valenzuela-Rodríguez G, Pacheco-Mendoza J, Málaga G. Scientific production of Vice Chancellors for Research in Peruvian universities with a medical school. Medwave 2017; 17:e7074. [PMID: 29053664 DOI: 10.5867/medwave.2017.08.7074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/03/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To determine the scientific production of Research Vice-chancellors at Peruvian universities that have medical schools, as well as their academic degrees as an indirect way to evaluate their suitability for the position they hold. METHODS We searched all Peruvian universities that register medical schools. Of these, the scientific production of the universities registered in SCOPUS was identified in September of the 2016. The scientific production of the vice chancellors of investigation of these faculties of medicine was determined through the search of its scientific publications registered in SCOPUS and those reported in the National Registry of Researchers in Science and Technology. Academic degrees were obtained from the database of the National Superintendence of Higher University Education. RESULTS The sample included 28 research vice chancellors. Only 4/28 had any publications. The average number of articles published by the vice chancellors of research was 1.71, the number of citations 23.1 on average and the H index 0.64. Besides, 22 Vice-chancellors of research had the degree of doctor, four had the degree of bachelor and two the degree of master. CONCLUSIONS The scientific production of research vice chancellors is poor. The required academic grade requirement for the position is not met in all cases. It is likely that, having no research experience, his leadership in directing a university's research policies may be questioned.
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Affiliation(s)
- Percy Herrera-Añazco
- Servicio de Nefrología, Hospital Nacional Dos de Mayo, Lima, Perú; Vicerectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Perú. Address: Jirón Los Eucaliptos 158, Santa Isabel, Carabayllo, Lima, Perú.
| | | | | | - Germán Málaga
- Departamento de Medicina, Hospital Nacional Cayetano Heredia, Lima, Perú; Departamento de Clínicas Médicas, Universidad Peruana Cayetano Heredia, Lima, Perú
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20
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Herrera-Añazco P, Pacheco-Mendoza J, Valenzuela-Rodriguez G, Málaga G. Autoconocimiento, adherencia al tratamiento y control de la hipertensión arterial en el Perú: una revisión narrativa. Rev Peru Med Exp Salud Publica 2017; 34:497-504. [DOI: 10.17843/rpmesp.2017.343.2622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/20/2017] [Indexed: 11/06/2022] Open
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21
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Serrano V, Larrea-Mantilla L, Rodríguez-Gutiérrez R, Spencer-Bonilla G, Málaga G, Hargraves I, Montori VM. [Shared decision making in patients with diabetes mellitus]. Rev Med Chil 2017; 145:641-649. [PMID: 28898341 DOI: 10.4067/s0034-98872017000500012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/12/2016] [Indexed: 11/17/2022]
Abstract
Patients with diabetes mellitus often have several medical problems and carry a burden imposed by their illness and treatment. Health care often ignores the values, preferences and context of patients, leading to treatments that do not fit into patients overwhelmed lives. Shared Decision Making (SDM) emerges as a way to answer the question: Whats best for the patient?. SDM promotes an empathic conversation between patients and clinicians that integrates the best evidence available with their values, preferences and context. We discuss three SDM approaches for patients with diabetes: one focused on sharing information, another on making choices, and a third one on helping patients and clinicians to talk about how to address the problems of living with diabetes and its comorbidities. Despite the benefits demonstrated in studies conducted in the U.S. and Europe, the implementation of SDM continues to be a challenge. In Latin America, healthcare and socio-economic conditions render the implementation of SDM more challenging. Research aimed to respond to this challenge is necessary. Meanwhile, clinicians can practice SDM by sharing evidence-based information, giving voice to patients values and preferences in making choices, and creating empathic conversations aimed at decisions aligned with patients context, dreams, goals, and life expectations.
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Affiliation(s)
- Valentina Serrano
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Minnesota, USA
| | - Laura Larrea-Mantilla
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Minnesota, USA
| | - René Rodríguez-Gutiérrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Minnesota, USA
| | - Gabriela Spencer-Bonilla
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Minnesota, USA
| | - Germán Málaga
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Minnesota, USA
| | - Víctor M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Minnesota, USA
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22
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Málaga G, Romero ZO, Málaga AS, Cuba-Fuentes S. Shared decision making and the promise of a respectful and equitable healthcare system in Peru. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen 2017; 123-124:81-84. [PMID: 28539192 DOI: 10.1016/j.zefq.2017.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Germán Málaga
- Unidad Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú; Internal Medicine Attending, Hospital Cayetano Heredia, Lima, Perú.
| | - Zoila O Romero
- Unidad Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú; Family physician, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Ariana S Málaga
- Unidad Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Sofia Cuba-Fuentes
- Unidad Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú; Family physician, Universidad Peruana Cayetano Heredia, Lima, Perú
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23
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Bazo‐Alvarez JC, Quispe R, Pillay TD, Bernabé‐Ortiz A, Smeeth L, Checkley W, Gilman RH, Málaga G, Miranda JJ. Glycated haemoglobin (HbA 1c ) and fasting plasma glucose relationships in sea-level and high-altitude settings. Diabet Med 2017; 34:804-812. [PMID: 28196274 PMCID: PMC5432378 DOI: 10.1111/dme.13335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 12/28/2022]
Abstract
AIM Higher haemoglobin levels and differences in glucose metabolism have been reported among high-altitude residents, which may influence the diagnostic performance of HbA1c . This study explores the relationship between HbA1c and fasting plasma glucose (FPG) in populations living at sea level and at an altitude of > 3000 m. METHODS Data from 3613 Peruvian adults without a known diagnosis of diabetes from sea-level and high-altitude settings were evaluated. Linear, quadratic and cubic regression models were performed adjusting for potential confounders. Receiver operating characteristic (ROC) curves were constructed and concordance between HbA1c and FPG was assessed using a Kappa index. RESULTS At sea level and high altitude, means were 13.5 and 16.7 g/dl (P > 0.05) for haemoglobin level; 41 and 40 mmol/mol (5.9% and 5.8%; P < 0.01) for HbA1c ; and 5.8 and 5.1 mmol/l (105 and 91.3 mg/dl; P < 0.001) for FPG, respectively. The adjusted relationship between HbA1c and FPG was quadratic at sea level and linear at high altitude. Adjusted models showed that, to predict an HbA1c value of 48 mmol/mol (6.5%), the corresponding mean FPG values at sea level and high altitude were 6.6 and 14.8 mmol/l (120 and 266 mg/dl), respectively. An HbA1c cut-off of 48 mmol/mol (6.5%) had a sensitivity for high FPG of 87.3% (95% confidence interval (95% CI) 76.5 to 94.4) at sea level and 40.9% (95% CI 20.7 to 63.6) at high altitude. CONCLUSION The relationship between HbA1c and FPG is less clear at high altitude than at sea level. Caution is warranted when using HbA1c to diagnose diabetes mellitus in this setting.
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Affiliation(s)
- J. C. Bazo‐Alvarez
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | - R. Quispe
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | - T. D. Pillay
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- University College London Medical SchoolLondon School of Hygiene and Tropical MedicineLondonUK
| | - A. Bernabé‐Ortiz
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | - L. Smeeth
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - W. Checkley
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Division of Pulmonary and Critical CareJohns Hopkins UniversityBaltimoreMDUSA
| | - R. H. Gilman
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Área de Investigación y DesarrolloA.B. PRISMALimaPeru
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - G. Málaga
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Department of MedicineUniversidad Peruana Cayetano HerediaLimaPeru
| | - J. J. Miranda
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Department of MedicineUniversidad Peruana Cayetano HerediaLimaPeru
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Torres-Roman JS, Azañedo D, Ruiz EF, Avilez JL, Málaga G, Machicado C. Human papillomavirus-associated oropharyngeal cancer: Prioritizing preventive policies in males. Oral Oncol 2017; 69:129-130. [PMID: 28456477 DOI: 10.1016/j.oraloncology.2017.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Affiliation(s)
- J Smith Torres-Roman
- Faculty of Medicine, Universidad Nacional San Luis Gonzaga, Ica, Peru; CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Diego Azañedo
- Instituto de Investigación, Universidad Católica los Ángeles de Chimbote, Chimbote, Peru.
| | - Eloy F Ruiz
- CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - José L Avilez
- Faculty of Mathematics, University of Waterloo, Canada; CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Germán Málaga
- CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Claudia Machicado
- Laboratorios de Investigación y Desarrollo (LID), Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Peru.
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Miranda JJ, Moscoso MG, Yan LL, Diez-Canseco F, Málaga G, Garcia HH, Ovbiagele B. Addressing post-stroke care in rural areas with Peru as a case study. Placing emphasis on evidence-based pragmatism. J Neurol Sci 2017; 375:309-315. [PMID: 28320158 DOI: 10.1016/j.jns.2017.02.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/13/2017] [Indexed: 02/08/2023]
Abstract
Stroke is a major cause of death and disability, with most of its burden now affecting low- and middle-income countries (LMIC). People in rural areas of LMIC who have a stroke receive very little acute stroke care and local healthcare workers and family caregivers in these regions lack the necessary knowledge to assist them. Intriguingly, a recent rapid growth in cell-phone use and digital technology in rural areas has not yet been appropriately exploited for health care training and delivery purposes. What should be done in rural areas, at the community setting-level, where access to healthcare is limited remains a challenge. We review the evidence on improving post-stroke outcomes including lowering the risks of functional disability, stroke recurrence, and mortality, and propose some approaches, to target post-stroke care and rehabilitation, noting key challenges in designing suitable interventions and emphasizing the advantages mHealth and communication technologies can offer. In the article, we present the prevailing stroke care situation and technological opportunities in rural Peru as a case study. As such, by addressing major limitations in rural healthcare systems, we investigate the potential of task-shifting complemented with technology to utilize and strengthen both community-based informal caregivers and community healthcare workers.
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Affiliation(s)
- J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Miguel G Moscoso
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China; Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Germán Málaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Hector H Garcia
- Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru; Cysticercosis Unit, National Institute of Neurological Sciences, Lima, Peru.
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Castillo-Tokumori F, Irey-Salgado C, Málaga G. Worrisome high frequency of extended-spectrum beta-lactamase-producing Escherichia coli in community-acquired urinary tract infections: a case-control study. Int J Infect Dis 2016; 55:16-19. [PMID: 27979787 DOI: 10.1016/j.ijid.2016.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/02/2016] [Accepted: 12/05/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES There has been a sustained and dramatic increase in community-acquired urinary tract infections (CA-UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria over recent years. Despite this, no studies have been performed in low- or middle-income countries. The main objective of this case-control study was to describe ESBL CA-UTI and its risk factors. METHODS Outpatients with CA-UTI seen at the Hospital Cayetano Heredia during 2015 were identified. Patients were contacted by telephone. After consent had been obtained, a questionnaire concerning previously identified risk factors was applied. Univariate and multivariate analyses were conducted using Stata version 13. RESULTS The overall frequency of ESBL-producing Escherichia coli was 40.85%. Sixty-seven cases and 105 controls were included in this study. The following main risk factors were identified on multivariate analysis: previous antibiotic use (odds ratio (OR) 3.09), previous hospitalization (OR 2.92), and previous surgery (OR 2.75). Chronic corticosteroid use (OR 24.32, 95% confidence interval 2.39-246.92) was also identified as a risk factor. CONCLUSIONS ESBL E. coli accounted for more than 40% of CA-UTIs during 2015. A history of previous hospitalization, surgery, and antibiotic use should be considered when treating this type of infection. Action should be taken to confirm these worrisome results and avoid the major consequences for public health.
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Affiliation(s)
- Franco Castillo-Tokumori
- CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima, Peru
| | - Claudia Irey-Salgado
- CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima, Peru
| | - Germán Málaga
- CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Urb. Ingeniería, San Martín de Porres, Lima, Peru; Departamento de Medicina, Hospital Cayetano Heredia, San Martín de Porres, Lima, Peru.
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Huayanay-Espinoza IE, Guerra-Castañon F, Lazo-Porras M, Castaneda-Guarderas A, Thomas NJ, Garcia-Guarniz AL, Valdivia-Bustamante AA, Málaga G. Metabolic control in patients with type 2 diabetes mellitus in a public hospital in Peru: a cross-sectional study in a low-middle income country. PeerJ 2016; 4:e2577. [PMID: 27761351 PMCID: PMC5068371 DOI: 10.7717/peerj.2577] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/16/2016] [Indexed: 12/03/2022] Open
Abstract
Objective The objective of this study was to assess patients’ achievement of ADA (American Diabetes Association) guideline recommendations for glycosylated hemoglobin, lipid profile, and blood pressure in a type 2 diabetes mellitus (T2DM) outpatient clinic in a low-middle income country (LMIC) setting. Methods This is a descriptive cross-sectional study with 123 ambulatory T2DM patients who are being treated at a public hospital in Lima, Peru. Data was gathered via standardized interviews, clinical surveys, and anthropomorphic measurements for each patient. Blood samples were drawn in fasting state for measures of glucose, glycosylated hemoglobin (HbA1c), and lipid profile. Laboratory parameters and blood pressure were evaluated according to ADA recommendations. Results Of the 123 patients, 81 were women and the mean age was 61.8 years. Glycemic control was abnormal in 82 (68.33%) participants, and 45 (37.50%) were unable to control their blood pressure. Lipid profile was abnormal in 73 (60.83%) participants. Only nine (7.50%) participants fulfilled ADA recommendations for glycemic, blood pressure, and lipid control. Conclusions Amongst individuals with type 2 diabetes, there was poor attainment of the ADA recommendations (HbA1c, blood pressure and LDL-cholesterol) for ambulatory T2DM patients. Interventions are urgently needed in order to prevent long-term diabetic complications.
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Affiliation(s)
| | - Felix Guerra-Castañon
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia , Lima , Peru
| | - María Lazo-Porras
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ana Castaneda-Guarderas
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, United States; Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Ana-Lucia Garcia-Guarniz
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia , Lima , Peru
| | | | - Germán Málaga
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Faculty of Medicine "Alberto Hurtado," Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Internal Medicine, Hospital Cayetano Heredia, Lima, Peru
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Miranda JJ, Bernabé-Ortiz A, Diez-Canseco F, Málaga G, Cárdenas MK, Carrillo-Larco RM, Lazo-Porras M, Moscoso-Porras M, Pesantes MA, Ponce V, Araya R, Beran D, Busse P, Boggio O, Checkley W, García PJ, Huicho L, León-Velarde F, Lescano AG, Mohr DC, Pan W, Peiris D, Perel P, Rabadán-Diehl C, Rivera-Chira M, Sacksteder K, Smeeth L, Trujillo AJ, Wells JCK, Yan LL, García HH, Gilman RH. Towards sustainable partnerships in global health: the case of the CRONICAS Centre of Excellence in Chronic Diseases in Peru. Global Health 2016; 12:29. [PMID: 27255370 PMCID: PMC4890274 DOI: 10.1186/s12992-016-0170-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
Human capital requires opportunities to develop and capacity to overcome challenges, together with an enabling environment that fosters critical and disruptive innovation. Exploring such features is necessary to establish the foundation of solid long-term partnerships. In this paper we describe the experience of the CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia in Lima, Peru, as a case study for fostering meaningful and sustainable partnerships for international collaborative research. The CRONICAS Centre of Excellence in Chronic Diseases was established in 2009 with the following Mission: "We support the development of young researchers and collaboration with national and international institutions. Our motivation is to improve population's health through high quality research." The Centre's identity is embedded in its core values - generosity, innovation, integrity, and quality- and its trajectory is a result of various interactions between multiple individuals, collaborators, teams, and institutions, which together with the challenges confronted, enables us to make an objective assessment of the partnership we would like to pursue, nurture and support. We do not intend to provide a single example of a successful partnership, but in contrast, to highlight what can be translated into opportunities to be faced by research groups based in low- and middle-income countries, and how these encounters can provide a strong platform for fruitful and sustainable partnerships. In defiant contexts, partnerships require to be nurtured and sustained. Acknowledging that all partnerships are not and should not be the same, we also need to learn from the evolution of such relationships, its key successes, hurdles and failures to contribute to the promotion of a culture of global solidarity where mutual goals, mutual gains, as well as mutual responsibilities are the norm. In so doing, we will all contribute to instil a new culture where expectations, roles and interactions among individuals and their teams are horizontal, the true nature of partnerships.
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Affiliation(s)
- J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru.
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Germán Málaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Internal Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - María K Cárdenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Rodrigo M Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Miguel Moscoso-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - M Amalia Pesantes
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Vilarmina Ponce
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendáriz 497, Miraflores, Lima 18, Peru
| | - Ricardo Araya
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
- University of Geneva, Geneva, Switzerland
| | | | - Oscar Boggio
- Division of Non-Communicable Diseases, Dirección General de Salud de las Personas, Ministerio de Salud, Lima, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patricia J García
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Huicho
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Pediatrics, Instituto Nacional de Salud del Niño, Lima, Peru
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | - Andrés G Lescano
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Parasitology, and Public Health Training Program, USA Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - William Pan
- Division of Environmental Science and Policy, Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - David Peiris
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Pablo Perel
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- World Heart Federation, Geneva, Switzerland
| | - Cristina Rabadán-Diehl
- Office of Global Affairs, U.S. Department of Health & Human Services, Washington, DC, USA
| | | | - Katherine Sacksteder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio J Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, University College London, London, UK
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Héctor H García
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Center for Global Health - Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
- Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Robert H Gilman
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Asociación Benéfica PRISMA, Lima, Peru
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Neira-Sanchez ER, Málaga G. [Are the MINSA clinical practice guidelines for hypertension and type 2 diabetes mellitus reliable?]. Rev Peru Med Exp Salud Publica 2016; 33:377-379. [PMID: 27656943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/20/2016] [Indexed: 06/06/2023] Open
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Neira-Sanchez ER, Málaga G. ¿Son las guías de práctica clínica de hipertensión arterial y diabetes mellitus tipo 2 elaboradas por el MINSA, confiables? Rev Peru Med Exp Salud Publica 2016. [DOI: 10.17843/rpmesp.2016.332.2093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Lazo-Porras M, Bernabe-Ortiz A, Málaga G, Gilman RH, Acuña-Villaorduña A, Cardenas-Montero D, Smeeth L, Miranda JJ. Low HDL cholesterol as a cardiovascular risk factor in rural, urban, and rural-urban migrants: PERU MIGRANT cohort study. Atherosclerosis 2015; 246:36-43. [PMID: 26752691 PMCID: PMC4773291 DOI: 10.1016/j.atherosclerosis.2015.12.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/22/2015] [Accepted: 12/24/2015] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Whilst the relationship between lipids and cardiovascular mortality has been well studied and appears to be controversial, very little has been explored in the context of rural-to-urban migration in low-resource settings. OBJECTIVE Determine the profile and related factors for HDL-c patterns (isolated and non-isolated low HDL-c) in three population-based groups according to their migration status, and determine the effect of HDL-c patterns on the rates of cardiovascular outcomes (i.e. non-fatal stroke and non-fatal myocardial infarction) and mortality. METHODS Cross-sectional and 5-year longitudinal data from the PERU MIGRANT study, designed to assess the effect of migration on cardiovascular risk profiles and mortality in Peru. Two different analyses were performed: first, we estimated prevalence and associated factors with isolated and non-isolated low HDL-c at baseline. Second, using longitudinal information, relative risk ratios (RRR) of composite outcomes of mortality, non-fatal stroke and non-fatal myocardial infarction were calculated according to HDL-c levels at baseline. RESULTS Data from 988 participants, rural (n = 201), rural-to-urban migrants (n = 589), and urban (n = 199) groups, was analysed. Low HDL-c was present in 56.5% (95%CI: 53.4%-59.6%) without differences by study groups. Isolated low HDL-c was found in 36.5% (95%CI: 33.5-39.5%), with differences between study groups. In multivariable analysis, urban group (vs. rural), female gender, overweight and obesity were independently associated with isolated low HDL-c. Only female gender, overweight and obesity were associated with non-isolated low HDL-c. Longitudinal analyses showed that non-isolated low HDL-c increased the risk of negative cardiovascular outcomes (RRR = 3.46; 95%CI: 1.23-9.74). CONCLUSIONS Isolated low HDL-c was the most common dyslipidaemia in the study population and was more frequent in rural subjects. Non-isolated low HDL-c increased three-to fourfold the 5-year risk of cardiovascular outcomes.
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Affiliation(s)
- María Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Germán Málaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA; Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru
| | - Ana Acuña-Villaorduña
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Benziger CP, Bernabé-Ortiz A, Gilman RH, Checkley W, Smeeth L, Málaga G, Miranda JJ. Metabolic Abnormalities Are Common among South American Hispanics Subjects with Normal Weight or Excess Body Weight: The CRONICAS Cohort Study. PLoS One 2015; 10:e0138968. [PMID: 26599322 PMCID: PMC4658165 DOI: 10.1371/journal.pone.0138968] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023] Open
Abstract
Objective We aimed to characterize metabolic status by body mass index (BMI) status. Methods The CRONICAS longitudinal study was performed in an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings: Lima (Peru’s capital, costal urban, highly urbanized), urban and rural Puno (both high-altitude), and Tumbes (costal semirural). Data from the baseline study, conducted in 2010, was used. Individuals were classified by BMI as normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30 kg/m2), and as metabolically healthy (0–1 metabolic abnormality) or metabolically unhealthy (≥2 abnormalities). Abnormalities included individual components of the metabolic syndrome, high-sensitivity C-reactive protein, and insulin resistance. Results A total of 3088 (age 55.6±12.6 years, 51.3% females) had all measurements. Of these, 890 (28.8%), 1361 (44.1%) and 837 (27.1%) were normal weight, overweight and obese, respectively. Overall, 19.0% of normal weight in contrast to 54.9% of overweight and 77.7% of obese individuals had ≥3 risk factors (p<0.001). Among normal weight individuals, 43.1% were metabolically unhealthy, and age ≥65 years, female, and highest socioeconomic groups were more likely to have this pattern. In contrast, only 16.4% of overweight and 3.9% of obese individuals were metabolically healthy and, compared to Lima, the rural and urban sites in Puno were more likely to have a metabolically healthier profile. Conclusions Most Peruvians with overweight and obesity have additional risk factors for cardiovascular disease, as well as a majority of those with a healthy weight. Prevention programs aimed at individuals with a normal BMI, and those who are overweight and obese, are urgently needed, such as screening for elevated fasting cholesterol and glucose.
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Affiliation(s)
- Catherine P. Benziger
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Cardiology, University of Washington, Seattle, WA, United States of America
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Asociación Benéfica PRISMA, Lima, Peru
| | - William Checkley
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
- Division of Pulmonary and Critical Care, School of Medicine Johns Hopkins University, Baltimore, MD, United States of America
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Germán Málaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- * E-mail:
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Lerner AG, Bernabé-Ortiz A, Ticse R, Hernandez A, Huaylinos Y, Pinto ME, Málaga G, Checkley W, Gilman RH, Miranda JJ. Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry. Diabet Med 2015; 32:1470-8. [PMID: 25761508 PMCID: PMC4567976 DOI: 10.1111/dme.12752] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 01/03/2023]
Abstract
AIM To determine if changes in pupillary response are useful as a screening tool for diabetes and to assess whether pupillometry is associated with cardiac autonomic neuropathy. METHODS We conducted a cross-sectional study with participants drawn from two settings: a hospital and a community site. At the community site, individuals with newly diagnosed diabetes as well as a random sample of control individuals without diabetes, confirmed by oral glucose tolerance test, were selected. Participants underwent an LED light stimulus test and eight pupillometry variables were measured. Outcomes were diabetes, defined by oral glucose tolerance test, and cardiac autonomic dysfunction, determined by a positive readout on two of four diagnostic tests: heart rate response to the Valsalva manoeuvre; orthostatic hypotension; 30:15 ratio; and expiration-to-inspiration ratio. The area under the curve, best threshold, sensitivity and specificity of each pupillometry variable was calculated. RESULTS Data from 384 people, 213 with diabetes, were analysed. The mean (±sd) age of the people with diabetes was 58.6 (±8.2) years and in the control subjects it was 56.1 (±8.6) years. When comparing individuals with and without diabetes, the amplitude of the pupil reaction had the highest area under the curve [0.69 (sensitivity: 78%; specificity: 55%)]. Cardiac autonomic neuropathy was present in 51 of the 138 people evaluated (37.0%; 95% CI 28.8-45.1). To diagnose cardiac autonomic neuropathy, two pupillometry variables had the highest area under the curve: baseline pupil radius [area under the curve: 0.71 (sensitivity: 51%; specificity: 84%)], and amplitude of the pupil reaction [area under the curve: 0.70 (sensitivity: 82%; specificity: 55%)]. CONCLUSIONS Pupillometry is an inexpensive technique to screen for diabetes and cardiac autonomic neuropathy, but it does not have sufficient accuracy for clinical use as a screening tool.
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Affiliation(s)
- Alana G. Lerner
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ray Ticse
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Arturo Hernandez
- Division of Ophtalmology, Department of Surgery, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Yvonne Huaylinos
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Miguel E. Pinto
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Endocrinology, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Germán Málaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Internal Medicine, Department of Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - William Checkley
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Robert H. Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Área de Investigación y Desarrollo, A.B. PRISMA, Lima, Peru
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Pesantes MA, Lazo-Porras M, Abu Dabrh AM, Ávila-Ramírez JR, Caycho M, Villamonte GY, Sánchez-Pérez GP, Málaga G, Bernabé-Ortiz A, Miranda JJ. Resilience in Vulnerable Populations With Type 2 Diabetes Mellitus and Hypertension: A Systematic Review and Meta-analysis. Can J Cardiol 2015; 31:1180-8. [PMID: 26239007 PMCID: PMC4556590 DOI: 10.1016/j.cjca.2015.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Patients with chronic conditions and limited access to health care experience stressful challenges resulting from the burden of managing both their conditions and their daily life demands. Resilience provides a mechanism of adapting to stressful experiences. We conducted a systematic review and meta-analysis to synthesize the evidence about interventions to enhance resiliency in managing hypertension or type 2 diabetes in vulnerable populations and to assess the efficacy of these interventions on clinical outcomes. METHODS We searched multiple databases from early inception through February 2015 including randomized controlled trials that enrolled patients with type 2 diabetes or hypertension. All interventions that targeted resilience in vulnerable populations were included. Data were synthesized to describe the characteristics and efficacy of resiliency interventions. We pooled the total effects by calculating standardized mean difference using the random-effects model. RESULTS The final search yielded 17 studies. All studies were conducted in the United States and generally targeted minority participants. Resiliency interventions used diverse strategies; discussion groups or workshops were the most common approach. CONCLUSIONS Interventions aimed at enhancing the resiliency of patients from vulnerable groups are diverse. Outcomes were not fully conclusive. There was some evidence that resiliency interventions had a positive effect on hemoglobin A1C levels but not blood pressure. The incorporation of resiliency-oriented interventions into the arsenal of preventing and managing chronic conditions appears to be an opportunity that remains to be better investigated and exploited, and there is need to pursue further understanding of the core components of any intervention that claims to enhance resilience.
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Affiliation(s)
- M Amalia Pesantes
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Abd Moain Abu Dabrh
- Knowledge and Evaluation Research (KER) Unit Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Jaime R Ávila-Ramírez
- Knowledge and Evaluation Research (KER) Unit Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - María Caycho
- Knowledge and Evaluation Research (KER) Unit Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Georgina Y Villamonte
- Knowledge and Evaluation Research (KER) Unit Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Grecia P Sánchez-Pérez
- Knowledge and Evaluation Research (KER) Unit Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Germán Málaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Manzaneda AJ, Lazo-Porras M, Málaga G. Actividad física en pacientes ambulatorios con diabetes mellitus 2 de un hospital nacional del Perú. Rev Peru Med Exp Salud Publica 2015. [DOI: 10.17843/rpmesp.2015.322.1626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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36
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Rivas-Nieto AC, Málaga G, Ruiz-Grosso P, Huayanay-Espinoza CA, Curioso WH. Uso y percepciones de las tecnologías de información y comunicación en pacientes con hipertensión arterial, dislipidemia o diabetes de un hospital nacional de Lima, Perú. Rev Peru Med Exp Salud Publica 2015. [DOI: 10.17843/rpmesp.2015.322.1621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Burroughs Pena MS, Bernabé-Ortiz A, Carrillo-Larco RM, Sánchez JF, Quispe R, Pillay TD, Málaga G, Gilman RH, Smeeth L, Miranda JJ. Migration, urbanisation and mortality: 5-year longitudinal analysis of the PERU MIGRANT study. J Epidemiol Community Health 2015; 69:715-8. [PMID: 25987723 DOI: 10.1136/jech-2015-205657] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/24/2015] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To compare all-cause and cause-specific mortality among 3 distinct groups: within-country, rural-to-urban migrants, and rural and urban dwellers in a longitudinal cohort in Peru. METHODS The PERU MIGRANT Study, a longitudinal cohort study, used an age-stratified and sex-stratified random sample of urban dwellers in a shanty town community in the capital city of Peru, rural dwellers in the Andes, and migrants from the Andes to the shanty town community. Participants underwent a questionnaire and anthropomorphic measurements at a baseline evaluation in 2007-2008 and at a follow-up visit in 2012-2013. Mortality was determined by death certificate or family interview. RESULTS Of the 989 participants evaluated at baseline, 928 (94%) were evaluated at follow-up (mean age 48 years; 53% female). The mean follow-up time was 5.1 years, totalling 4732.8 person-years. In a multivariable survival model, and relative to urban dwellers, migrant participants had lower all cause mortality (HR=0.30; 95% CI 0.12-0.78), and both the migrant (HR=0.07; 95% CI 0.01-0.41) and rural (HR=0.06; 95% CI 0.01-0.62) groups had lower cardiovascular mortality. CONCLUSIONS Cardiovascular mortality of migrants remains similar to that of the rural group, suggesting that rural-to-urban migrants do not appear to catch up with urban mortality in spite of having a more urban cardiovascular risk factor profile.
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Affiliation(s)
- Melissa S Burroughs Pena
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Duke University Research Institute, Duke University, Durham, North Carolina, USA
| | - Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo M Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan F Sánchez
- Department of Parasitology, U.S. Naval Medical Research Unit No.6 (NAMRU-6), Callao, Peru
| | - Renato Quispe
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Timesh D Pillay
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Medical School, University College London, London, UK
| | - Germán Málaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru
| | - Liam Smeeth
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Manzaneda AJ, Lazo-Porras M, Málaga G. [Physical activity in outpatients with type 2 diabetes in a National Hospital of Peru]. Rev Peru Med Exp Salud Publica 2015; 32:311-315. [PMID: 26338393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/18/2015] [Indexed: 06/05/2023] Open
Abstract
In order to determine the level of physical activity performed by outpatients with type 2 diabetes seen at a National Hospital in Lima, Peru, we surveyed 120 patients with the International Physical Activity Questionnaire (IPAQ). 66% were women, the mean age was 61.6 years, and 70% had poor glycemic control. 20% of the patients qualified as inactive, 68% as minimally active, and 12% had adequate physical activity. No relationship between physical activity, duration of disease, glycemic control, and body mass index was found. Age was negatively associated with physical activity. It is concluded that there are low levels of physical activity in patients with Type 2 diabetes and these are not focused on leisure activities that provide health benefits.
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Affiliation(s)
| | - María Lazo-Porras
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Germán Málaga
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
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Rivas-Nieto AC, Málaga G, Ruiz-Grosso P, Huayanay-Espinoza CA, Curioso WH. [Use and perceptions of information and communication technologies in patients with hypertension, dyslipidemia or diabetes in a national hospital in Lima, Peru]. Rev Peru Med Exp Salud Publica 2015; 32:283-288. [PMID: 26338388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/27/2015] [Indexed: 06/05/2023] Open
Abstract
This study aimed to determine the use and perceptions towards information and communication technologies (ICT) in 206 patients with arterial hypertension, dyslipidemia and diabetes, recruited from the outpatient clinic in a national hospital in Lima, Peru. 54.4% were older adults and 70.4% were women. The use of daily phone calls was 44.7%. Most had never used a computer (78.2%), email (84%) or the Internet (84%). Many have never sent (80.6%) or received (69.9%) a text message. 70% had at some time forgotten to take their medicine. 72.8% would like to be reminded to take their medication and 67.9% had a family member who could help them with access to ICT. Despite the low use of ICT in this population, there is willingness and expectation from the patients to participate in programs that implement them.
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Affiliation(s)
| | | | | | | | - Walter H Curioso
- Consejo Nacional de Ciencia, Tecnología e Innovación Tecnológica (CONCYTEC), Lima, Perú
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Miranda JJ, Bernabé-Ortiz A, Diez-Canseco F, Málaga G, Cardenas MK, Carrillo-Larco RM, Pesantes MA, Araya R, Boggio O, Checkley W, García PJ, León-Velarde F, Lescano AG, Montori V, Pan W, Rivera-Chira M, Sacksteder K, Smeeth L, García HH, Gilman RH. Building a platform for translational research in chronic noncommunicable diseases to address population health: lessons from NHLBI supported CRONICAS in Peru. Glob Heart 2015; 10:13-9. [PMID: 25754562 PMCID: PMC4356013 DOI: 10.1016/j.gheart.2014.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia, was created in 2009 with support from the U.S. National Heart, Lung, and Blood Institute (NHLBI). The vision of CRONICAS is to build a globally recognized center of excellence conducting quality and innovative research and generating high-impact evidence for health. The center's identity is embedded in its core values: generosity, innovation, integrity, and quality. This review has been structured to describe the development of the CRONICAS Centre, with a focus on highlighting the ongoing translational research projects and capacity-building strategies. The CRONICAS Centre of Excellence is not a risk-averse organization: it benefits from past experiences, including past mistakes, and improves upon them and thus challenges traditional research approaches. This ethos and environment are key to fostering innovation in research.
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Affiliation(s)
- J. Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru,School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco Diez-Canseco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Germán Málaga
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru,Division of Internal Medicine, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - María K. Cardenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo M. Carrillo-Larco
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M. Amalia Pesantes
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Araya
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Oscar Boggio
- Division of Non-Communicable Diseases, Dirección General de Salud de las Personas, Ministerio de Salud, Lima, Peru
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Patricia J. García
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Andrés G. Lescano
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru,Department of Parasitology, and Public Health Training Program, USA Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA,Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - William Pan
- Division of Environmental Science and Policy, Nicholas School of the Environment, Duke University, Durham, NC, USA
| | | | - Katherine Sacksteder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Program in Neuroscience and Cognitive Science, University of Maryland, Baltimore, MD, USA
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Héctor H. García
- School of Sciences, Universidad Peruana Cayetano Heredia, Lima, Peru,Centre for Global Health – Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru,Cysticercosis Unit, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Robert H. Gilman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Asociación Benéfica PRISMA, Lima, Peru
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Alvarado-Dulanto CMA, Lazo MDLÁ, Loza-Herrera JD, Málaga G. [One year prognosis after suffering the onset of cerebrovascular disease in patients from a public hospital in Lima, Peru]. Rev Peru Med Exp Salud Publica 2015; 32:98-103. [PMID: 26102112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/04/2015] [Indexed: 06/04/2023] Open
Abstract
In Latin America, there is almost nonexistense information about the prognosis of patients with stroke. We tried to find one- year vital and functional prognosis from patients with "first-ever stroke". We did a prospective cohort study, recruiting patients in the medicine service of a public hospital, and follow them up to one year after their first-ever stroke. We collected baseline data, such as previous medical history and information about their stroke. We found mortality proportions, differences among subgroups, and compared their actual and initial functionality. We included 101 patients, 20.8% of whom died during the follow-up, with higher mortality in people over 65 years old and those severely disabled after the stroke. The functionality did not improve after one year. One out of five patients with a first-ever stroke dies a year after it, with higher mortality in elders and in people with severe disability. We conclude it is mandatory to develop a follow-up and support program to prevent unfavorable outcomes in patients who suffer stroke.
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Affiliation(s)
- C Martín A Alvarado-Dulanto
- Unidad de Conocimiento y Evidencia (CONEVID), Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - María de los Ángeles Lazo
- Unidad de Conocimiento y Evidencia (CONEVID), Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Javier D Loza-Herrera
- Unidad de Conocimiento y Evidencia (CONEVID), Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Germán Málaga
- Unidad de Conocimiento y Evidencia (CONEVID), Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
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Málaga G. ¿Es posible una reforma del sector salud, prescindiendo del desarrollo académico y con personal de salud “multi-empleo”? Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2014.314.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Málaga G. [Is health sector reform possible without academic development of the health system and with "multifunction" health staff?]. Rev Peru Med Exp Salud Publica 2014; 31:803-804. [PMID: 25597738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 09/03/2014] [Indexed: 06/04/2023] Open
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Davalos LF, Málaga G. El accidente cerebrovascular en el Perú: una enfermedad prevalente olvidada y desatendida. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2014.312.73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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45
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Alva-Rodriguez D, de los Ángeles Lazo M, Loza-Herrera JD, Málaga G. [Three-month life prognosis and associated factors in patients with altered mental status admimtted to the emergency room of a national hospital in Peru]. Rev Peru Med Exp Salud Publica 2014; 31:480-486. [PMID: 25418646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 08/06/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES Determine the prognosis at three months and associated factors of patients with altered mental status (AMS). MATERIALS AND METHODS Cross-sectional study that included patients over 18 years of age admitted to the emergency room in a national hospital, with AMS, within twenty-four hours of onset and that required observation. The demographic, clinical and functional assessment information were taken from the medical record. A follow-up was made at three months by telephone. RESULTS The study included 290 patients, representing 4.1% of the total patients in the emergency room. Overall mortality was 24.2%, whereas in the subgroup of older adults was 28.1%; 19.3% in adults and 15.2% in young adults. The average age was 63.5 years and the elderly group constituted nearly two thirds of the population. 51% were males. The average hospital stay was 7 days. The most frequently associated causes were infectious diseases (44.1%), neurological (40.3%), respiratory (28.3%), metabolic (18.6%), and cardiovascular (17.2%) disorders. Mortality was associated with a) GCS levels <7 (OR 2.9, p<0.001) and b) functionality score of 5 on the modifi Rankin scale (OR 8.2, p=0.03). CONCLUSIONS AMS, present in 4% of emergency admissions, is associated with mortality in one in four people. The predominant cause infectious diseases. The commitment of the functionality was the main predictor of mortality.
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Affiliation(s)
| | | | - Javier D Loza-Herrera
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú
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Brito JP, Domecq JP, Prutsky G, Málaga G, Young L, Kargi AY. [Rhabdomyolysis and myopathy as the only manifestations of severe hypothyroidism secondary to Hashimoto's thyroiditis]. Rev Peru Med Exp Salud Publica 2014; 30:129-32. [PMID: 23612826 DOI: 10.1590/s1726-46342013000100024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/23/2013] [Indexed: 11/21/2022] Open
Abstract
Hashimoto's thyroiditis is the most frequent cause of hypothyroidism. In the regions with no iodine deficiency, it is more frequent in women and oftentimes has a familial association. The symptoms and signs of hypothyroidism are systemic and depend on the duration and intensity of the thyroid hormone deficiency. Neuromuscular manifestations are seldom the only symptoms and signs present. We present the case of a young patient with severe myopathy, where rhabdomyolysis was the sole manifestation of severe hypothyroidism secondary to Hashimoto's thyroiditis.
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Affiliation(s)
- Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN 55905, USA
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Davalos LF, Málaga G. [Stroke in Peru: a forgotten and unattended prevalent disease]. Rev Peru Med Exp Salud Publica 2014; 31:400-401. [PMID: 25123893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 05/28/2014] [Indexed: 06/03/2023] Open
Affiliation(s)
- Long F Davalos
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Germán Málaga
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Perú
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Bazo-Alvarez JC, Poterico J, Peralta-Alvarez F, Quispe R, Valle G, Gilman RH, Sánchez JF, Málaga G, Bernabé-Ortiz A, Miranda J. CARDIOVASCULAR DISEASES RISK SCORES: A COMPARISON OF THEIR PERFORMANCE IN A LOW AND MIDDLE INCOME COUNTRY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61382-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Vásquez-Kunze S, Málaga G. Las nuevas guías de hipertensión arterial y dislipidemia, más allá de la controversia, ¿son guías confiables? Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2014.311.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Guyatt GH, Málaga G. Dificultades en la interpretación de los resultados de la investigación biomédica relacionada con el manejo de pacientes con enfermedades crónicas no transmisibles. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2014.311.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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