Therapies for patients with coexisting heart failure with reduced ejection fraction and non-alcoholic fatty liver disease

Heart failure with reduced ejection fraction (HFrEF) and nonalcoholic fatty liver disease (NAFLD) are two common comorbidities that share similar pathophysiological mechanisms. There is a growing interest in the potential of targeted therapies to improve outcomes in patients with coexisting HFrEF and NAFLD. This manuscript reviews current and potential therapies for patients with coexisting HFrEF and NAFLD. Pharmacological therapies, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, mineralocorticoids receptor antagonist, and sodium-glucose cotransporter-2 inhibitors, have been shown to reduce fibrosis and fat deposits in the liver. However, there are currently no data showing the beneficial effects of sacubitril/valsartan, ivabradine, hydralazine, isosorbide nitrates, digoxin, or beta blockers on NAFLD in patients with HFrEF. This study highlights the importance of considering HFrEF and NAFLD when developing treatment plans for patients with these comorbidities. Further research is needed in patients with coexisting HFrEF and NAFLD, with an emphasis on novel therapies and the importance of a multidisciplinary approach for managing these complex comorbidities.Revisión por pare

Therapies for patients with coexisting heart failure with reduced ejection fraction and non-alcoholic fatty liver disease

Heart failure with reduced ejection fraction (HFrEF) and nonalcoholic fatty liver disease (NAFLD) are two common comorbidities that share similar pathophysiological mechanisms. There is a growing interest in the potential of targeted therapies to improve outcomes in patients with coexisting HFrEF and NAFLD. This manuscript reviews current and potential therapies for patients with coexisting HFrEF and NAFLD. Pharmacological therapies, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, mineralocorticoids receptor antagonist, and sodium-glucose cotransporter-2 inhibitors, have been shown to reduce fibrosis and fat deposits in the liver. However, there are currently no data showing the beneficial effects of sacubitril/valsartan, ivabradine, hydralazine, isosorbide nitrates, digoxin, or beta blockers on NAFLD in patients with HFrEF. This study highlights the importance of considering HFrEF and NAFLD when developing treatment plans for patients with these comorbidities. Further research is needed in patients with coexisting HFrEF and NAFLD, with an emphasis on novel therapies and the importance of a multidisciplinary approach for managing these complex comorbidities

Reactivación de Herpes zóster en población vacunada por COVID 19: Una revisión narrativa

La presente revisión describe la evidencia actual sobre la relación reportada entre la aplicación de la vacuna COVID-19 y la reactivación del virus Herpes zóster. Se revisaron reportes de casos publicados en la base de datos bibliográficos de Pubmed, Scopus, Web of Science y Google Scholar desde el año 2020 al 2021. Los hallazgos se dividieron en los siguientes apartados: Datos epidemiológicos, vacunas COVID-19 asociadas, manifestaciones clínicas, de laboratorio, comorbilidades o antecedentes de inmunosupresión, grado de enfermedad, complicaciones, infección y vacunación previa contra varicela; y finalmente manejo y tratamiento. La revisión bibliográfica incluye 15 artículos tipo reporte de caso, encontrándose un total de 52 pacientes afectados posteriormente a recibir la vacuna contra el COVID - 19, siendo las vacunas Pfizer, Moderna las más reportadas, siendo el sexo masculino él predominante y los dermatomas torácicos y lumbares las zonas más afectadas. Alrededor del mundo se han notificado casos de herpes zóster asociados a las vacunas contra el COVID-19. Si bien se postulan mecanismos fisiopatológicos que podría explicar esta asociación, aun es necesario realizar más estudios para confirmarlo.This review describes the current evidence on the reported relationship between the application of the COVID-19 vaccine and the reactivation of the Herpes zoster virus. Reports of cases published in the bibliographic databases of Pubmed, Scopus, Web of Science and Google Scholar from 2020 to 2021 were reviewed. The findings were divided into the following sections: Epidemiological data, associated COVID-19 vaccines, clinical manifestations, laboratory, comorbidities or history of immunosuppression, degree of disease, complications, infection and previous vaccination against varicella; and finally management and treatment. The bibliographic review includes 15 case report-type articles, finding a total of 52 patients affected after receiving the COVID-19 vaccine, being the Pfizer, Modern vaccines the most reported, being the male sex the predominant one and thoracic dermatomes and lumbar the most affected areas. Cases of shingles associated with COVID-19 vaccines have been reported around the world. Although pathophysiological mechanisms are postulated that could explain this association, more studies still need to be carried out to confirm it.Tesi

Association between supplementation with Vitamin A, Iron and Micronutrients with Adequate Psychomotor Development in children from 9 to 36 months in Peru: Secondary Analysis of the Demographic and Family Health Survey - ENDES 2018 to 2020

Introducción: El desarrollo psicomotor es el proceso por el cual el ser humano va aprendiendo a realizar actividades cada vez más complejas durante la infancia. En el Perú se evalua mediante el Control de Crecimiento y Desarrollo (CRED), a traves de las destrezas físicas y cognitivas que adquiere el infante a medida que avanzan los años. Nuestro objetivo principal es evaluar si existe asociación entre la suplementación con Vitamina A, Hierro y Micronutrientes con un Desarrollo Psicomotor Adecuado en niños de 9 a 36 meses a nivel nacional de Perú usando la Encuesta Demográfica y de Salud Familiar - ENDES entre los años 2018 al 2020. Metodología: Estudio observacional, analítico de tipo transversal basado en el análisis secundario de las Bases de Datos de la Encuesta Demográfica y de Salud Familiar - ENDES entre los años 2018 al 2020. Las variables independientes son la suplementación de Vitamina A, Hierro y/o Micronutrientes. Las variables de dependientes son el Desarrollo Motor para niños de 9 a 18 meses, Desarrollo Psicológico para niños de 9 a 18 meses, y Desarrollo Psicológico para niños de 19 a 36 meses. Las variables fueron descritas con frecuencias absolutas, frecuencias relativas (porcentajes), y su porcentaje ponderado según los pesos muestrales. El análisis bivariado se realizó en forma estratificada, para niños de 9 a 18 meses, y para niños de 19 a 36 meses. Se calculó prevalencias del desenlace para cada una de las variables de exposición y las variables de control. La comparación se realizó usando la prueba de chi2 corregida para conglomerados, usando la corrección de Rao-Scott. Se obtuvieron razones de prevalencia (RPs) usando regresión de Poisson. Las regresiones se hicieron en forma cruda y ajustada corregidas por muestreo complejo usando Linealización de Taylor para estimar los RPs. Las varianzas se obtuvieron en forma robusta por conglomerados. Resultados: Hubo un total de 24 838 participantes; de los cuales 17.22% consumía vitamina A, 47.34% consumía hierro y 54.19% consumía micronutrientes. Entre los niños de 9 a 12 meses de edad un 94.60% cumplía con el desarrollo motor adecuado y un 76.71% con el desarrollo cognitivo adecuado. Entre los niños de 13 a 18 meses de edad, un 94.13% cumplia con el desarrollo motor adecuado y un 72.15% cumplía con el desarrollo cognitivo adecuado. Para los grupos de 19 a 23 meses y 24 a 36 meses solo fueron evaluados para desarrollo cognitivo y se encontró que un 64.58% y 49.85% cumplían con un desarrollo cognitivo adecuado, respectivamente. Los factores asociados en el modelo de regresion ajustada para el desarrollo motor adecuado entre 9 a 18 meses de edad fueron: región de residencia (p < 0.001), hacinamiento (p=0.006) y lactancia materna exclusiva (p<0.013). Los factores asociados en en el modelo de regresion ajustada para el desarrollo cognitivo adecuado entre 9 a 18 meses de edad fueron: suplementación de vitamina A (p=0.034), educación de la madre (p=0.025), sexo del niño (p<0.001), complicaciones del parto (p=0.047) y vacunas completas (p=0.006). Los factores asociados en el modelo de regresion ajustada para el desarrollo psicológico adecuado para los niños entre 19 a 36 meses de edad fueron: educación de la madre (p<0.001), trabajo materno (p=0.014), sexo del niño (p<0.001) y peso al nacer (p=0.007). Conclusiones: No se encontró asociación de desarrollo adecuado con la suplementación nutricional, salvo entre Vitamina A y desarrollo psicológico adecuado en niños de 9-18 meses (RP: 1.06; IC95% 1.01–1.13). El desarrollo motor adecuado en niños de 9-18 meses se asoció negativamente a vivir en la región Sierra, hacinamiento y recibir lactancia materna exclusiva. El desarrollo psicológico adecuado en niños de 9-18 meses se asoció a nivel educativo secundario de la madre, niño de sexo femenino y tener vacunas completas. El desarrollo psicológico adecuado en niños de 19-36 meses se asoció a nivel educativo secundario o superior, madre trabajadora y tener sexo femenino; en cambio se asoció negativamente a bajo peso al nacer.Introduction: Psychomotor development is the process by which the human being learns to perform complex activities during childhood. In Peru, it is evaluated through the Control de Crecimiento y Desarrollo (CRED), through the physical and cognitive skills that the infant acquires as the years progress. Our main objective is to evaluate if there is an association between supplementation with Vitamin A, Iron and Micronutrients with Adequate Psychomotor Development in children from 9 to 36 months at the national level of Peru using the Demographic and Family Health Survey - ENDES between the years 2018 to 2020. Methodology: Observational, analytical cross-sectional study based on the secondary analysis of the Databases of the la Encuesta Demográfica y de Salud Familiar - ENDES between the years 2018 to 2020. The independent variables are the consumption of Vitamin A, Iron and Micronutrients. The dependent variables are Motor Development for children from 9 to 18 months, Psychological Development for children from 9 to 18 months, and Psychological Development for children from 19 to 36 months. The variables were described with absolute frequencies, relative frequencies (percentages), and their percentage weighted according to the sample weights. The bivariate analysis was performed in a stratified manner, for children from 9 to 18 months, and for children from 19 to 36 months. Outcome prevalences were calculated for each of the exposure variables and the control variables. The comparison was made using the chi2 test corrected for clusters, using the Rao-Scott correction. Prevalence ratios (PRs) were obtained using Poisson regression. Regressions were made in crude and adjusted form corrected by complex sampling using Taylor linearization to estimate the RPs. The variances were obtained in a robust way by clusters. Results: There were a total of 24,838 participants; of which 17.22% consumed vitamin A, 47.34% consumed iron and 54.19% consumed micronutrients. Among children from 9 to 12 months of age, 94.60% had adequate motor development and 76.71% with adequate cognitive development. Among children 13 to 18 months of age, 94.13% had adequate motor development and 72.15% had adequate cognitive development. For the groups of 19 to 23 months and 24 to 36 months, they were only evaluated for cognitive development and it was found that 64.58% and 49.85% complied with adequate cognitive development, respectively. The associated factors in the adjusted regression model for adequate motor development between 9 and 18 months of age were: region of residence (p <0.001), overcrowding (p = 0.006) and exclusive breastfeeding (p <0.013). The associated factors in the adjusted regression model for adequate cognitive development between 9 to 18 months of age were: vitamin A consumption (p = 0.034), mother's education (p = 0.025), child sex (p < 0.001), delivery complications (p = 0.047) and complete vaccinations (p = 0.006). The associated factors in the adjusted regression model for adequate psychological development for children between 19 and 36 months of age were: mother's education (p <0.001), maternal work (p = 0.014), child sex (p < 0.001) and birth weight (p = 0.007). Conclusions: No association of adequate development was found with nutritional supplementation, except between Vitamin A and adequate psychological development in children aged 9-18 months (PR: 1.06; 95% CI 1.01–1.13). Adequate motor development in children aged 9-18 months was negatively associated with living in the Sierra region, overcrowding, and receiving exclusive breastfeeding. Adequate psychological development in children aged 9-18 months was associated with the mother's secondary educational level, a female child, and having complete vaccinations. Adequate psychological development in children aged 19-36 months was associated with a secondary or higher educational level, a working mother, and having a female sex; instead, it was negatively associated with low birth weight.Tesi

Association between supplementation with vitamin A, iron and micronutrients with adequate psychomotor development in children from 9 to 36 months in Peru

Background: Worldwide, it is estimated that 52.9 million children <5 years of age experience delayed psychomotor development, which is associated with multiple factors. Our primary objective is to evaluate whether there is an association between supplementation with Vitamin A, Iron, and Micronutrients and Adequate Psychomotor Development in children aged 9–36 months at the national level in Peru. Methods: The study was an observational, analytical, cross-sectional study based on the secondary analysis of the Demographic and Family Health Survey databases from 2018 to 2020. The independent variables include the consumption of Vitamin A, Iron, and Micronutrients. The dependent variables encompass Motor Development in children aged 9–18 months, Psychological Development in children aged 9–18 months, and Psychological Development in children aged 19–36 months. Results: The study included a total of 24 838 participants. In the adjusted regression model, the factors associated with adequate motor development between 9 and 18 months of age were: region of residence, overcrowding, and exclusive breastfeeding. For adequate cognitive development between 9 and 18 months of age, the associated factors were: vitamin A consumption, mother's education, child sex, delivery complications, and complete vaccinations. Regarding adequate psychological development in children aged 19–36 months, the associated factors were: mother's education, maternal employment, child sex, and birth weight. Conclusions: There was no association found between nutritional supplementation and adequate development, except for the relationship between Vitamin A consumption and adequate psychological development in children aged 9–18 months. Therefore, further research, such as cohort studies and clinical trials, is suggested to corroborate this association.Revisión por pare