Perception of physicians about medical education received during their Nephrology residency

Introduction: In Peru there are different hospitals and university programs for training of specialists in nephrology. Objective: To assess the perception of physicians who attend such programs. Methods: We carried out a descriptive cross-sectional national-level study in physicians who were in the last two years of nephrology training during February 2012 and who had graduated from it in 2010 and 2011. A self-applied questionnaire was developed along with the Peruvian Society of Nephrology based on international standards. The questionnaire evaluated: mentoring, clinical training, procedures, external rotations, research and global perception. Results: Forty doctors were surveyed nationwide. 82.5% had tutors, 22.5% of them said their support was poor. A 27.5% described their theoretical formation as deficient. The practical training was perceived as acceptable globally; however, improvements in training on peritoneal dialysis and reading kidney transplant biopsies are necessary. A 90% have national external rotations and 65% reported to have an international rotation. In the assessment of research, 77.5% thought this is deficient. In addition, 82.5% believed that residency should last four years. However, 60% reported that their residency training was good. There is a decrease in the positive perception of the aspects studied among residents regarding graduates. Conclusion: The overall perception of nephrology residency training was considered good; however, areas of tutoring, and academic and research activities on average were deficient.Revisión por pare

Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

[email protected] Randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs. Methods We performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence. Results Ten studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] =1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] =7%; 95%CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95 % CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology. Conclusions Intra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. We need further RCTs with better design and quality to evaluate the true efficacy of endovascular therapy.Revisión por pare

Effect of exercise on sleep quality and insomnia in middle-aged women: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE: We assessed the effects of programmed exercise (PE) on sleep quality and insomnia in middle-aged women (MAW). METHODS: Searches were conducted in five databases from inception through December 15, 2016 for randomized controlled trials (RCTs) evaluating the effects of PE versus a non-exercising control condition on sleep quality, sleep disturbance and/or insomnia in MAW. Interventions had to last at least 8 weeks. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and insomnia with the Insomnia Severity Index (ISI). Random effects models were used for meta-analyses. The effects on outcomes were expressed as mean differences (MDs) and their 95% confidence intervals (CI). RESULTS: Five publications reported data from four RCTs on PE effects during 12-16 weeks on sleep quality (n=4 studies reporting PSQI results) and/or insomnia (n=3 studies reporting ISI results), including 660 MAW. Low-moderate levels of exercise significantly lowered the PSQI score (MD=-1.34; 95% CI -2.67, 0.00; p=0.05) compared with controls. In a subgroup analysis, moderate PE (aerobic exercise) had a positive effect on sleep quality (PSQI score MD=-1.85; 95% CI -3.62, -0.07; p=0.04), while low levels of physical activity (yoga) did not have a significant effect (MD-0.46, 95% CI -1.79, 0.88, p=0.50). In three studies (two studies of yoga, one study of aerobic exercise), there was a non-significant reduction in the severity of insomnia measured with the ISI score (MD -1.44, 95% CI -3.28, 0. 44, p=0.13) compared with controls. Heterogeneity of effects among studies was moderate to high. CONCLUSION: In middle-aged women, programmed exercise improved sleep quality but had no significant effect on the severity of insomnia.Actividad Física y Deport

A systematic review of the relative efficacy and toxicity of treatment regimens for HIV-associated cerebral toxoplasmosis: is trimephoprim-sulfamethaxozole a real option?

Background: Pyrimethamine and sulfadiazine (P-S) combination is effective and considered the mainstay therapy for cerebral toxoplasmosis (CT). Alternative treatment regimens are available, but their relative efficacy and tolerability are not well known. Particularly, trimephoprim-sulfamethaxozole (TMP-SMX) shows potential advantages (i.e., tolerability, posology, parenteral formulation, cost, and accessibility) but its use is infrequent when P-S is available. Methods: We searched PubMed and 4 other databases to identify randomized controlled trials (RCTs) and cohort studies comparing different regimens for the treatment of HIV-associated CT. Two independent reviewers searched and identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models. Results: Nine studies were included (5 RCTs, 3 retrospective cohorts, 1 prospective cohort). Treatment with P-S has the same or better clinical efficacy than P-C or TMP-SMX in terms of partial or complete response clinical response (P-C vs P-S: RR 0.87, 95%CI 0.70-1.08; TMP-SMX vs P-S: RR 0.97, 95%CI 0.78-1.21) and radiological response (P-C vs P-S: RR 0.92, 95%CI 0.82-1.03). Safety profile in terms of skin rash (P-C vs P-S: RR 0.81, 95%CI 0.56-1.17; TMP-SMX vs P-S: RR 0.17, 95%CI 0.02-1.29), liver impairment (P-C vs P-S: RR 0.48, 95%CI 0.24-0.97) and drug discontinuation due to adverse events (P-C vs P-S: RR 0.32, 95%CI 0.07-1.47) were worse with P-S regimen. Conclusion: The available evidence fails to identify any one superior regimen for the treatment of CT. However, P-S regimen has worse safety profile than P-C or TMP-SMX. Although current evidence does not allow a definitive recommendation, use of TMP-SMX for treatment of HIV-associated CT is consistent with the available data. More large studies comparing alternative therapies are needed.IDWeek, Evento que se llevó a cabo del 7 -11 de Octubre de 2015, en la ciudad de San Diego, CA, EE.UU. Evento Sesión HIV: Other Opportunistic Infections in HIV. Saturday, October 10, 2015. Room: Poster Hal

Low adherence to hemodialysis regime in patients with chronic renal disease in a Peruvian Ministry of Health reference hospital

[email protected]ón: La ausencia a una sesión mensual en un esquema de diálisis convencional puede incrementar la mortalidad en 30%. Objetivos: Describir la frecuencia y la percepción de las causas de falta de adherencia a diálisis en una población prevalente de un hospital público de referencia nacional en Perú. Diseño: Estudio descriptivo. Institución: Servicio de Nefrología, Hospital Nacional 2 de Mayo, Lima, Perú. Participantes: Pacientes con más de un año en diálisis Intervenciones: Se determinó el número de faltas y se aplicó un cuestionario para describir su percepción respecto a las causas de las faltas, validado por juicio de expertos. Principales medidas de resultados: Baja adherencia a diálisis definida como: pacientes con más de una falta al mes o más de 12 faltas, entre julio de 2012 y julio de 2013. Resultados: Se incluyó 54 pacientes, 27 eran varones, con una edad y tiempo de diálisis promedio de 57 ± 16,4 años y 40,6 ±11,5 meses, respectivamente; 7/54 pacientes tenían educación superior. Hubo 504 faltas (5,45%). El segundo día de la programación semanal fue el día con mayor frecuencia de faltas (292), seguido del tercer día (145); 13/54 tuvieron baja adherencia. Las principales causas reportadas fueron: una residencia alejada (6/13), la sensación de bienestar (6/13), el contar con escasos recursos económicos para solventar el traslado (5/13). Conclusiones: Uno de cada cuatro pacientes tuvo baja adherencia. El residir lejos o que se sintiera bien fueron las principales causas de la baja adherencia.Background: Failing to attend a monthly session within a scheme of conventional dialysis may increase mortality by 30%. Objectives: To describe the frequency and perceived causes of non-adherence to dialysis in a Peruvian national reference public hospital. Design: Descriptive study. Setting: Nephrology department, Hospital Nacional 2 de Mayo, Lima, Peru. Participants: Patients with more than one year on dialysis. Interventions: The number of absences to appointed sessions was determined and a validated questionnaire was used to describe perceptions regarding the causes of absences. Main outcomes measures: Low adherence to dialysis defined as patients with more than one absence per month or more than 12 absences between July 2012 and July 2013. Results: The study included 54 patients, of which 27 were male. Average age was 57 ± 16.4 years and average time on dialysis was 40.6 ± 11.5 months. Only 7 patients had higher education. There were 504 absences (5.45%). The second day of the weekly schedule was the day with more absences (292), followed by the third day (145). Overall 13 patients showed low adherence. Main causes of absence reported included a remote residence (6/13), feeling good (6/13), and insufficient financial resources to cover transportation costs (5/13). Conclusions: A quarter of patients had low adherence, and main factors were distance to health facility and wellbeing self-perception.Revisión por pare

Cannabinoids for Medical Use A Systematic Review and Meta-analysis

Importance Cannabis and cannabinoid drugs are widely used to treat disease or alleviate symptoms, but their efficacy for specific indications is not clear. Objective To conduct a systematic review of the benefits and adverse events (AEs) of cannabinoids. Data Sources Twenty-eight databases from inception to April 2015. Study Selection Randomized clinical trials of cannabinoids for the following indications: nausea and vomiting due to chemotherapy, appetite stimulation in HIV/AIDS, chronic pain, spasticity due to multiple sclerosis or paraplegia, depression, anxiety disorder, sleep disorder, psychosis, glaucoma, or Tourette syndrome. Data Extraction and Synthesis Study quality was assessed using the Cochrane risk of bias tool. All review stages were conducted independently by 2 reviewers. Where possible, data were pooled using random-effects meta-analysis. Main Outcomes and Measures Patient-relevant/disease-specific outcomes, activities of daily living, quality of life, global impression of change, and AEs. Results A total of 79 trials (6462 participants) were included; 4 were judged at low risk of bias. Most trials showed improvement in symptoms associated with cannabinoids but these associations did not reach statistical significance in all trials. Compared with placebo, cannabinoids were associated with a greater average number of patients showing a complete nausea and vomiting response (47% vs 20%; odds ratio [OR], 3.82 [95% CI, 1.55-9.42]; 3 trials), reduction in pain (37% vs 31%; OR, 1.41 [95% CI, 0.99-2.00]; 8 trials), a greater average reduction in numerical rating scale pain assessment (on a 0-10-point scale; weighted mean difference [WMD], −0.46 [95% CI, −0.80 to −0.11]; 6 trials), and average reduction in the Ashworth spasticity scale (WMD, −0.36 [95% CI, −0.69 to −0.05]; 7 trials). There was an increased risk of short-term AEs with cannabinoids, including serious AEs. Common AEs included dizziness, dry mouth, nausea, fatigue, somnolence, euphoria, vomiting, disorientation, drowsiness, confusion, loss of balance, and hallucination. Conclusions and Relevance There was moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity. There was low-quality evidence suggesting that cannabinoids were associated with improvements in nausea and vomiting due to chemotherapy, weight gain in HIV infection, sleep disorders, and Tourette syndrome. Cannabinoids were associated with an increased risk of short-term AEs.This funded by the Swiss Federal Office of Public Health (FOPH) under grant agreement 14.001443/204.0001/-1257Revisión por pare

Proteomic and transcriptomic profiling reveals a link between the PI3K pathway and lower estrogen-receptor (ER) levels and activity in ER+ breast cancer

IntroductionAccumulating evidence suggests that both levels and activity of the estrogen receptor (ER) and the progesterone receptor (PR) are dramatically influenced by growth-factor receptor (GFR) signaling pathways, and that this crosstalk is a major determinant of both breast cancer progression and response to therapy. The phosphatidylinositol 3-kinase (PI3K) pathway, a key mediator of GFR signaling, is one of the most altered pathways in breast cancer. We thus examined whether deregulated PI3K signaling in luminal ER+ breast tumors is associated with ER level and activity and intrinsic molecular subtype.MethodsWe defined two independent molecular signatures of the PI3K pathway: a proteomic (reverse-phase proteomic array) PI3K signature, based on protein measurement for PI3K signaling intermediates, and a PI3K transcriptional (mRNA) signature based on the set of genes either induced or repressed by PI3K inhibitors. By using these signatures, we scored each ER+ breast tumor represented in multiple independent expression-profiling datasets (four mRNA, n = 915; one protein, n = 429) for activation of the PI3K pathway. Effects of PI3K inhibitor BEZ-235 on ER expression and activity levels and cell growth were tested by quantitative real-time PCR and cell proliferation assays.ResultsWithin ER+ tumors, ER levels were negatively correlated with the PI3K activation scores, both at the proteomic and transcriptional levels, in all datasets examined. PI3K signature scores were also higher in ER+ tumors and cell lines of the more aggressive luminal B molecular subtype versus those of the less aggressive luminal A subtype. Notably, BEZ-235 treatment in four different ER+ cell lines increased expression of ER and ER target genes including PR, and treatment with IGF-I (which signals via PI3K) decreased expression of ER and target genes, thus further establishing an inverse functional relation between ER and PI3K. BEZ-235 had an additional effect on tamoxifen in inhibiting the growth of a number of ER+ cell lines.ConclusionsOur data suggest that luminal B tumors have hyperactive GFR/PI3K signaling associated with lower ER levels, which has been correlated with resistance to endocrine therapy. Targeting PI3K in these tumors might reverse loss of ER expression and signaling and restore hormonal sensitivity

The Antares Collaboration : Contributions to the 34th International Cosmic Ray Conference (ICRC 2015, The Hague)

The ANTARES detector, completed in 2008, is the largest neutrino telescope in the Northern hemisphere. Located at a depth of 2.5 km in the Mediterranean Sea, 40 km off the Toulon shore, its main goal is the search for astrophysical high energy neutrinos. In this paper we collect the 21 contributions of the ANTARES collaboration to the 34th International Cosmic Ray Conference (ICRC 2015). The scientific output is very rich and the contributions included in these proceedings cover the main physics results, ranging from steady point sources, diffuse searches, multi-messenger analyses to exotic physics

Prevalence and factors associated with the intention to vaccinate against COVID-19 in Peru

Objetivos: Estimar la prevalencia y los factores asociados a la intención de vacunación (IDV) contra la COVID-19 en el Perú. Materiales y métodos: Estudio transversal analítico utilizando una encuesta realizada por la Universidad de Maryland, EUA, en Facebook. La variable dependiente fue la IDV. Se calcularon razones de prevalencia (RP) crudas y ajustadas, con sus intervalos de confianza al 95% (IC95%), mediante modelos lineales generalizados de la familia Poisson para evaluar la asociación de variables sociodemográficas, el cumplimiento de estrategias comunitarias de mitigación, los síntomas de la COVID-19, la salud mental y la aceptación de la vacunación ante la recomendación (AVR) por diversos actores y autoridades sanitarias. Resultados: Se analizaron los datos de 17 162 adultos. La prevalencia general de la IDV fue del 74,9%. Se asociaron a una menor prevalencia de la IDV ser de sexo femenino (RP = 0,95; IC95%: 0,94-0,97), vivir en un pueblo (RP = 0,95; IC95%: 0,91-0,99) o en una aldea u otra área rural (RP = 0,90; IC95%: 0,86-0,93) y la AVR de políticos (RP = 0,89; IC95%: 0,87-0,92). Contrariamente, tener síntomas de COVID-19 (RP = 1,06; IC95%: 1,03-1,09), inseguridad económica (RP = 1,04; IC95%: 1,01-1,06), miedo a enfermar o que un familiar enferme de COVID-19 (RP = 1,49; IC95%: 1,36-1,64) y la AVR de familiares y amigos (RP = 1,10; IC95%: 1,08-1,12), trabajadores de la salud (RP = 1,29; IC95%: 1,26- 1,32), la Organización Mundial de la Salud (RP = 1,34; IC95%: 1,29-1,40) y funcionarios del gobierno (RP = 1,18; IC95%: 1,15-1,22) se asociaron con mayor prevalencia de IDV. Conclusiones: Tres cuartas partes de los encuestados manifiestan IDV. Existen factores potencialmente modificables que podrían mejorar la aceptación de la vacuna.Objectives: To estimate the prevalence and factors associated with COVID-19 vaccination intention (VI) in Peru. Materials and methods: Analytical cross-sectional study using the survey conducted by the University of Maryland, USA, on Facebook. The dependent variable is VI. Crude and adjusted prevalence ratios (PR) were calculated, with their 95% confidence intervals (95%CI) using generalized linear models of the Poisson family, to evaluate the association of sociodemographic variables, com- pliance with community mitigation strategies, symptoms of COVID-19, mental health and acceptance of vaccination before the recommendation (AVR) by various actors and health authorities, with the ITV. Results: Data from 17,162 adults were analyzed. The overall prevalence of VI was 74.9%. A lower prevalence of VI was associated with the female sex (PR=0.95; 95%CI:0.94-0.97), living in a town (PR=0.95; 95%CI:0.91-0.99) or village or other rural area (PR=0.90; 95%CI:0.86-0.93) and the AVR of politicians (PR=0.89; 95%CI:0.87-0.92). Conversely, having COVID-19 symptoms (PR=1.06; 95%CI:1.03-1.09), economic insecurity (PR=1.04; 95%CI:1.01-1.06), fears of becoming seriously ill or that a family member becomes seriously ill from COVID-19 (PR=1.49; 95%CI:1.36-1.64) and the AVR of family and friends (PR=1.10; 95%CI: 1.08-1.12), healthca- re workers (PR=1.29; 95%CI: 1.26-1.32), World Health Organization (PR=1.34; 95%CI: 1.29-1.40) and government officials (PR=1.18; 95%CI: 1.15-1.22) was associated with a higher prevalence of VI. Conclusio of the respondents had VI. There are potentially modifiable factors that could improve vaccine acceptance