German Malaga | Universidad Peruana Cayetano Heredia (original) (raw)
Papers by German Malaga
MDM Policy & Practice, 2017
Global Heart, 2015
The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Here... more The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia, was created in 2009 with support from the United States National Heart, Lung, and Blood Institute (NHLBI). The vision of CRONICAS is to build a globally recognised Centre of Excellence conducting quality and innovative research and generating high-impact evidence for health. The Centre'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 organisation: it benefits from past experiences, including past mistakes, and improves upon them, and thus challenges traditional research approaches. This ethos and environment is key to fostering innovation in research. A CENTRE OF EXCELLENCE IN PERU Established in Peru, the CRONICAS Centre of Excellence in Chronic Diseases is based at Universidad Peruana Cayetano Heredia and was founded to close the research and capacity building gap in relation to non-communicable diseases (NCDs) in Peru. In Peru, the field of Miranda et al.
Trials, Jan 6, 2009
Randomized clinical trials (RCTs) stopped early for benefit often receive great attention and aff... more Randomized clinical trials (RCTs) stopped early for benefit often receive great attention and affect clinical practice, but pose interpretational challenges for clinicians, researchers, and policy makers. Because the decision to stop the trial may arise from catching the treatment effect at a random high, truncated RCTs (tRCTs) may overestimate the true treatment effect. The Study Of Trial Policy Of Interim Truncation (STOPIT-1), which systematically reviewed the epidemiology and reporting quality of tRCTs, found that such trials are becoming more common, but that reporting of stopping rules and decisions were often deficient. Most importantly, treatment effects were often implausibly large and inversely related to the number of the events accrued. The aim of STOPIT-2 is to determine the magnitude and determinants of possible bias introduced by stopping RCTs early for benefit. We will use sensitive strategies to search for systematic reviews addressing the same clinical question as ...
PLoS ONE, 2014
Aim: We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuro... more Aim: We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a lowmiddle income country setting. Methods: Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (,10 vs. 10years),glycaemiccontrol(HbA1c,710 years), glycaemic control (HbA1c ,7% vs. 10years),glycaemiccontrol(HbA1c,77%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios. Results: DPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07-1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02-1.93) in patients with $10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p,0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p,0.001), pain perception (p,0.001) and vibration perception (p,0.001). Conclusion: DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin
JAMA, 2010
LTHOUGH RANDOMIZED CONtrolled trials (RCTs) generally provide credible evidence of treatment effe... more LTHOUGH RANDOMIZED CONtrolled trials (RCTs) generally provide credible evidence of treatment effects, multiple problems may emerge when investigators terminate a trial earlier than planned, 1 especially when the decision to terminate the trial is based on the finding of an apparently beneficial treatment effect. Bias may arise because large random fluctuations of the estimated treatment effect can occur, particularly early in the progress of a trial. 2 When investigators stop a trial based on an apparently beneficial treatment effect, their results may therefore provide misleading estimates of the benefit. 3,4 Statistical modeling suggests that RCTs stopped early for benefit (truncated RCTs) will systematically overestimate treatment effects, 5 and empirical data demonstrate that truncated RCTs often show implausibly large treatment effects. 6 Empiricalevidenceaddressingthemagnitudeofbiasfromstoppingearly,andfactors that may influence the magnitude of the bias, remain limited and the appropriate interpretation of truncated RCTs a matter of controversy. 6-11 We therefore undertook a systematic review to determine the treatment effect from truncated RCTs compared with meta-analyses of RCTs addressing the same research questionthatwerenotstoppedearly(nontrun-cated RCTs) and to explore factors associated with overestimates of effect. METHODS A prior report provides a detailed description of the design and methods of See also Patient Page.
Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen, Jan 20, 2017
Peru has achieved sustained development in the last two decades. However, despite this achievemen... more Peru has achieved sustained development in the last two decades. However, despite this achievement, it has not been matched with improvements in the quality of education and health; investment in both sectors is among the lowest in the region. This situation perpetuates huge gaps in infrastructure and also conditions a poor literacy level of the population specifically in health. Currently, there is a fragmented model of patient care, in which the systems are exclusive of each other. They do not cooperate or communicate with each other; and if there is no vertical communication within the system, preventing referral of patients directly from the basic level to the complex level of care when needed. In addition, there has been no progress in the development of an empathetic, respectful or person-centered clinical practice; instead, economic, social and educational differences perpetuate a paternalistic clinical practice. The task of orienting medical training towards the development ...
Revista Médica Herediana, 2010
Se describe el caso de una mujer de 37 anos, procedente de la ciudad de Lima, con cuadro clínico ... more Se describe el caso de una mujer de 37 anos, procedente de la ciudad de Lima, con cuadro clínico caracterizado por artralgias, sensación de alza térmica no cuantificada, presencia de nódulos eritematosos en miembros inferiores y de pápulas eritematosas en la región dorsal de los dedos de las manos. En la Rx de tórax y en la TAC se encontró linfoadenopatia mediastinal. La biopsia ganglionar fue compatible con sarcoidosis ganglionar. (Rev Med Hered 2010;21:51-55)
Revista Medica Herediana, Apr 1, 1996
Revista Peruana de Medicina Experimental y Salud Pública
BMC Infectious Diseases
Background To evaluate the effectiveness and safety of the World Health Organization antibiotic r... more 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 paucibacil...
Revista Peruana de Medicina Experimental y Salud Pública
Revista Peruana de Medicina Experimental y Salud Pública
American Heart Journal
Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and ... more 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. 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. 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). 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.
The lancet. Diabetes & endocrinology, Jan 26, 2018
Myocardial injury after non-cardiac surgery (MINS) is the most common perioperative cardiovascula... more Myocardial injury after non-cardiac surgery (MINS) is the most common perioperative cardiovascular complication and is independently associated with 30-day mortality. We aimed to assess the association between preoperative glucose concentration and postoperative MINS and mortality. The VISION study is a prospective cohort study done at 12 centres in eight countries. Patients aged 45 years or older who required at least one overnight hospital admission for non-cardiac surgery were enrolled from Aug 6, 2007, to Jan 11, 2011. In the GlucoVISION analysis, we assessed the relations between preoperative casual or fasting glucose concentration and MINS within 3 days after surgery using logistic regression, and 30-day mortality using Cox proportional regression, in people with and without diabetes. 11 954 patients were included in this analysis, of whom 2809 (23%) had diabetes. Within the first three postoperative days, MINS occurred in 813 (7%) patients. 249 (2%) patients died by day 30. M...
Revista peruana de medicina experimental y salud publica
This non-systematic bibliographic review examines the published Peruvian medical literature on ar... more This non-systematic bibliographic review examines the published Peruvian medical literature on arterial hypertension (HTN) as of December 2016. The results were divided into three thematic areas: self-knowledge, adherence to treatment, and control. We identified 197 articles, although only 15 were used for the analysis. Despite improvement in recent years, we found that the level of self-knowledge about HTN is poor. The level is better in urban areas, but is generally worse than in other Latin American cities. Moreover, despite improvement, HTN control is insufficient and worse than in other Latin American countries. Finally, adherence to treatment may be worse in the provinces.
BMC public health, Mar 14, 2018
Childhood obesity is emerging as a major public health problem worldwide. To date, most studies o... more Childhood obesity is emerging as a major public health problem worldwide. To date, most studies of obesity and overweight in Peru are focused on adults, with few of them involving children, a population at a critical stage of development. The trend in overweight and obesity prevalence in Peruvian children under the age of five has not yet been determined. Thus, the objective of the present study is to evaluate the prevalence rates of overweight and obesity between 2010 and 2015 in children under the age of five, stratified by geographical areas in Peru. Data were obtained from the Nutritional Status Information System of Peru. The total number of children evaluated was 14,155,914. For the Geographic Information Systems (GIS), the program Geo Da 1.8® was used to ascertain the spatial distribution of prevalence rates and was mapped for children under five. To assess the degree of spatial dependence, exploratory spatial data analysis was performed using the Moran's I statistic and ...
![Research paper thumbnail of [Frequency and risk factors for bacteremia caused by extendedspectrum beta-lactamase-producing enterobacteriaceae in patients of a public hospital in Lima, Peru]](https://attachments.academia-assets.com/67486808/thumbnails/1.jpg)
](Revista peruana de medicina experimental y salud publica
A cross-sectional study was conducted aimed at determining the frequency and the risk factors for... more A cross-sectional study was conducted aimed at determining the frequency and the risk factors for bacteremia caused by extended-spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae in patients hospitalized in a public hospital in Lima. The study included patients over 14 years of age, with positive blood cultures during their hospitalization in Hospital Nacional Cayetano Heredia in 2016. Patients were classified according to the isolated bacterium (ESBL-producing or not). Bacteremia was caused by ESBL-producing Enterobacteriacea in 50.6% of the cases; 55.8% and 32.6% by E. Coli and K. pneumoniae, respectively. No differences were found regarding co-morbidity, or prior antibiotic use (62.8% of bacteremia due to ESBLproducing strains and 57% in the non-producing strains [p=0.595]). Half of the bacteremia cases due to Enterobacteriaceae in hospitalized patients are produced by ESBL-producing Enterobacteriaceae and, of these, 40% are acquired in the community.
Canadian journal of surgery. Journal canadien de chirurgie, Jun 1, 2018
Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is stro... more Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is strongly associated with 30-day mortality; however, it remains mostly undetected without systematic troponin T monitoring. We evaluated the cost and consequences of postoperative troponin T monitoring to detect MINS. We conducted a model-based cost-consequence analysis to compare the impact of routine troponin T monitoring versus standard care (troponin T measurement triggered by ischemic symptoms) on the incidence of MINS detection. Model inputs were based on Canadian patients enrolled in the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study, which enrolled patients aged 45 years or older undergoing inpatient noncardiac surgery. We conducted probability analyses with 10 000 iterations and extensive sensitivity analyses. The data were based on 6021 patients (48% men, mean age 65 [standard deviation 12] yr). The 30-day mortality rate for MINS was 9.6%. We determi...
BMJ open, Jan 6, 2018
Covert stroke after non-cardiac surgery may have substantial impact on duration and quality of li... more Covert stroke after non-cardiac surgery may have substantial impact on duration and quality of life. In non-surgical patients, covert stroke is more common than overt stroke and is associated with an increased risk of cognitive decline and dementia. Little is known about covert stroke after non-cardiac surgery.NeuroVISION is a multicentre, international, prospective cohort study that will characterise the association between perioperative acute covert stroke and postoperative cognitive function. We are recruiting study participants from 12 tertiary care hospitals in 10 countries on 5 continents. We are enrolling patients ≥65 years of age, requiring hospital admission after non-cardiac surgery, who have an anticipated length of hospital stay of at least 2 days after elective non-cardiac surgery that occurs under general or neuraxial anaesthesia. Patients are recruited before elective non-cardiac surgery, and their cognitive function is measured using the Montreal Cognitive Assessment...
MDM Policy & Practice, 2017
Global Heart, 2015
The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Here... more The CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia, was created in 2009 with support from the United States National Heart, Lung, and Blood Institute (NHLBI). The vision of CRONICAS is to build a globally recognised Centre of Excellence conducting quality and innovative research and generating high-impact evidence for health. The Centre'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 organisation: it benefits from past experiences, including past mistakes, and improves upon them, and thus challenges traditional research approaches. This ethos and environment is key to fostering innovation in research. A CENTRE OF EXCELLENCE IN PERU Established in Peru, the CRONICAS Centre of Excellence in Chronic Diseases is based at Universidad Peruana Cayetano Heredia and was founded to close the research and capacity building gap in relation to non-communicable diseases (NCDs) in Peru. In Peru, the field of Miranda et al.
Trials, Jan 6, 2009
Randomized clinical trials (RCTs) stopped early for benefit often receive great attention and aff... more Randomized clinical trials (RCTs) stopped early for benefit often receive great attention and affect clinical practice, but pose interpretational challenges for clinicians, researchers, and policy makers. Because the decision to stop the trial may arise from catching the treatment effect at a random high, truncated RCTs (tRCTs) may overestimate the true treatment effect. The Study Of Trial Policy Of Interim Truncation (STOPIT-1), which systematically reviewed the epidemiology and reporting quality of tRCTs, found that such trials are becoming more common, but that reporting of stopping rules and decisions were often deficient. Most importantly, treatment effects were often implausibly large and inversely related to the number of the events accrued. The aim of STOPIT-2 is to determine the magnitude and determinants of possible bias introduced by stopping RCTs early for benefit. We will use sensitive strategies to search for systematic reviews addressing the same clinical question as ...
PLoS ONE, 2014
Aim: We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuro... more Aim: We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a lowmiddle income country setting. Methods: Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (,10 vs. 10years),glycaemiccontrol(HbA1c,710 years), glycaemic control (HbA1c ,7% vs. 10years),glycaemiccontrol(HbA1c,77%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios. Results: DPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07-1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02-1.93) in patients with $10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p,0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p,0.001), pain perception (p,0.001) and vibration perception (p,0.001). Conclusion: DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin
JAMA, 2010
LTHOUGH RANDOMIZED CONtrolled trials (RCTs) generally provide credible evidence of treatment effe... more LTHOUGH RANDOMIZED CONtrolled trials (RCTs) generally provide credible evidence of treatment effects, multiple problems may emerge when investigators terminate a trial earlier than planned, 1 especially when the decision to terminate the trial is based on the finding of an apparently beneficial treatment effect. Bias may arise because large random fluctuations of the estimated treatment effect can occur, particularly early in the progress of a trial. 2 When investigators stop a trial based on an apparently beneficial treatment effect, their results may therefore provide misleading estimates of the benefit. 3,4 Statistical modeling suggests that RCTs stopped early for benefit (truncated RCTs) will systematically overestimate treatment effects, 5 and empirical data demonstrate that truncated RCTs often show implausibly large treatment effects. 6 Empiricalevidenceaddressingthemagnitudeofbiasfromstoppingearly,andfactors that may influence the magnitude of the bias, remain limited and the appropriate interpretation of truncated RCTs a matter of controversy. 6-11 We therefore undertook a systematic review to determine the treatment effect from truncated RCTs compared with meta-analyses of RCTs addressing the same research questionthatwerenotstoppedearly(nontrun-cated RCTs) and to explore factors associated with overestimates of effect. METHODS A prior report provides a detailed description of the design and methods of See also Patient Page.
Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen, Jan 20, 2017
Peru has achieved sustained development in the last two decades. However, despite this achievemen... more Peru has achieved sustained development in the last two decades. However, despite this achievement, it has not been matched with improvements in the quality of education and health; investment in both sectors is among the lowest in the region. This situation perpetuates huge gaps in infrastructure and also conditions a poor literacy level of the population specifically in health. Currently, there is a fragmented model of patient care, in which the systems are exclusive of each other. They do not cooperate or communicate with each other; and if there is no vertical communication within the system, preventing referral of patients directly from the basic level to the complex level of care when needed. In addition, there has been no progress in the development of an empathetic, respectful or person-centered clinical practice; instead, economic, social and educational differences perpetuate a paternalistic clinical practice. The task of orienting medical training towards the development ...
Revista Médica Herediana, 2010
Se describe el caso de una mujer de 37 anos, procedente de la ciudad de Lima, con cuadro clínico ... more Se describe el caso de una mujer de 37 anos, procedente de la ciudad de Lima, con cuadro clínico caracterizado por artralgias, sensación de alza térmica no cuantificada, presencia de nódulos eritematosos en miembros inferiores y de pápulas eritematosas en la región dorsal de los dedos de las manos. En la Rx de tórax y en la TAC se encontró linfoadenopatia mediastinal. La biopsia ganglionar fue compatible con sarcoidosis ganglionar. (Rev Med Hered 2010;21:51-55)
Revista Medica Herediana, Apr 1, 1996
Revista Peruana de Medicina Experimental y Salud Pública
BMC Infectious Diseases
Background To evaluate the effectiveness and safety of the World Health Organization antibiotic r... more 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 paucibacil...
Revista Peruana de Medicina Experimental y Salud Pública
Revista Peruana de Medicina Experimental y Salud Pública
American Heart Journal
Translating evidence into clinical practice in the management of acute ischemic stroke (AIS) and ... more 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. 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. 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). 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.
The lancet. Diabetes & endocrinology, Jan 26, 2018
Myocardial injury after non-cardiac surgery (MINS) is the most common perioperative cardiovascula... more Myocardial injury after non-cardiac surgery (MINS) is the most common perioperative cardiovascular complication and is independently associated with 30-day mortality. We aimed to assess the association between preoperative glucose concentration and postoperative MINS and mortality. The VISION study is a prospective cohort study done at 12 centres in eight countries. Patients aged 45 years or older who required at least one overnight hospital admission for non-cardiac surgery were enrolled from Aug 6, 2007, to Jan 11, 2011. In the GlucoVISION analysis, we assessed the relations between preoperative casual or fasting glucose concentration and MINS within 3 days after surgery using logistic regression, and 30-day mortality using Cox proportional regression, in people with and without diabetes. 11 954 patients were included in this analysis, of whom 2809 (23%) had diabetes. Within the first three postoperative days, MINS occurred in 813 (7%) patients. 249 (2%) patients died by day 30. M...
Revista peruana de medicina experimental y salud publica
This non-systematic bibliographic review examines the published Peruvian medical literature on ar... more This non-systematic bibliographic review examines the published Peruvian medical literature on arterial hypertension (HTN) as of December 2016. The results were divided into three thematic areas: self-knowledge, adherence to treatment, and control. We identified 197 articles, although only 15 were used for the analysis. Despite improvement in recent years, we found that the level of self-knowledge about HTN is poor. The level is better in urban areas, but is generally worse than in other Latin American cities. Moreover, despite improvement, HTN control is insufficient and worse than in other Latin American countries. Finally, adherence to treatment may be worse in the provinces.
BMC public health, Mar 14, 2018
Childhood obesity is emerging as a major public health problem worldwide. To date, most studies o... more Childhood obesity is emerging as a major public health problem worldwide. To date, most studies of obesity and overweight in Peru are focused on adults, with few of them involving children, a population at a critical stage of development. The trend in overweight and obesity prevalence in Peruvian children under the age of five has not yet been determined. Thus, the objective of the present study is to evaluate the prevalence rates of overweight and obesity between 2010 and 2015 in children under the age of five, stratified by geographical areas in Peru. Data were obtained from the Nutritional Status Information System of Peru. The total number of children evaluated was 14,155,914. For the Geographic Information Systems (GIS), the program Geo Da 1.8® was used to ascertain the spatial distribution of prevalence rates and was mapped for children under five. To assess the degree of spatial dependence, exploratory spatial data analysis was performed using the Moran's I statistic and ...
Revista peruana de medicina experimental y salud publica
A cross-sectional study was conducted aimed at determining the frequency and the risk factors for... more A cross-sectional study was conducted aimed at determining the frequency and the risk factors for bacteremia caused by extended-spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae in patients hospitalized in a public hospital in Lima. The study included patients over 14 years of age, with positive blood cultures during their hospitalization in Hospital Nacional Cayetano Heredia in 2016. Patients were classified according to the isolated bacterium (ESBL-producing or not). Bacteremia was caused by ESBL-producing Enterobacteriacea in 50.6% of the cases; 55.8% and 32.6% by E. Coli and K. pneumoniae, respectively. No differences were found regarding co-morbidity, or prior antibiotic use (62.8% of bacteremia due to ESBLproducing strains and 57% in the non-producing strains [p=0.595]). Half of the bacteremia cases due to Enterobacteriaceae in hospitalized patients are produced by ESBL-producing Enterobacteriaceae and, of these, 40% are acquired in the community.
Canadian journal of surgery. Journal canadien de chirurgie, Jun 1, 2018
Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is stro... more Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is strongly associated with 30-day mortality; however, it remains mostly undetected without systematic troponin T monitoring. We evaluated the cost and consequences of postoperative troponin T monitoring to detect MINS. We conducted a model-based cost-consequence analysis to compare the impact of routine troponin T monitoring versus standard care (troponin T measurement triggered by ischemic symptoms) on the incidence of MINS detection. Model inputs were based on Canadian patients enrolled in the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study, which enrolled patients aged 45 years or older undergoing inpatient noncardiac surgery. We conducted probability analyses with 10 000 iterations and extensive sensitivity analyses. The data were based on 6021 patients (48% men, mean age 65 [standard deviation 12] yr). The 30-day mortality rate for MINS was 9.6%. We determi...
BMJ open, Jan 6, 2018
Covert stroke after non-cardiac surgery may have substantial impact on duration and quality of li... more Covert stroke after non-cardiac surgery may have substantial impact on duration and quality of life. In non-surgical patients, covert stroke is more common than overt stroke and is associated with an increased risk of cognitive decline and dementia. Little is known about covert stroke after non-cardiac surgery.NeuroVISION is a multicentre, international, prospective cohort study that will characterise the association between perioperative acute covert stroke and postoperative cognitive function. We are recruiting study participants from 12 tertiary care hospitals in 10 countries on 5 continents. We are enrolling patients ≥65 years of age, requiring hospital admission after non-cardiac surgery, who have an anticipated length of hospital stay of at least 2 days after elective non-cardiac surgery that occurs under general or neuraxial anaesthesia. Patients are recruited before elective non-cardiac surgery, and their cognitive function is measured using the Montreal Cognitive Assessment...