Hormona adrenocorticotropa en pacientes con síndrome de West y progresión al síndrome de Lennox-Gastaut

Background: This paper will evaluate the use of adrenocorticotropic hormone as a therapy modality for West syndrome and the time required for development of the severely progressive form of West syndrome (LGS, Lennox-Gastaut syndrome). There is little data on this condition for our population. Material and Methods: This is a cohort review in which 139 patient records were evaluated in two pediatric units in Lima, Peru; and they were analyzed between 2000 and 2010. All patients who met the following criteria were included in the study: massive spasms, delayed psychomotor development, and hypsarrhythmia in electroencephalogram (EEG) tracing. Adrenocorticotropic hormone was administered to a group of patients as post-diagnosis therapy. The follow-up period for these patients was 10 years. Results: The hazard ratio (HR) for progression to Lennox-Gastaut Syndrome in patients using adrenocorticotropic hormone was 0.45 (95% CI: 0.24-0.83, p= 0.011) compared to those without adrenocorticotropic hormone. Adjusted RR for progression to Lennox-Gastaut Syndrome for all variables studied (age of onset, sex, frequency of seizures, etiology, and time from diagnosis to therapy initiation) in patients who used adrenocorticotropic hormone was 0.56 (95% CI 0.29 to 0.08, P= 0.085) compared with those without adrenocorticotropic hormone. Conclusions: The use of adrenocorticotropic hormone in patients with West syndrome could protect against progression to Lennox-Gastaut syndrome. We consider this supports the evidence found in populations similar to ours, and we believe this finding could be confirmed with clinical trials.Introducción: Se evaluará el uso de la hormona adrenocorticotropa como tratamiento del síndrome de West (síndrome de Lennox-Gastaut) y el tiempo requerido para la progresión hacia la evolución grave. Existen escasos datos sobre esta patología para nuestra población. Material y Métodos: Se trata de una cohorte donde se analizaron 139 historias clínicas de pacientes evaluados en dos unidades de pediatría de la ciudad de Lima entre los años 2000 y 2010. Se incluyeron todos los pacientes que cumplían con los criterios: 1) Espasmos masivos, 2) Retraso en el desarrollo psicomotor y 3) Electroencefalograma que mostró hipsarritmia. Se administró hormona adrenocorticotropa como tratamiento posterior al diagnóstico. El período de seguimiento duró 10 años. Resultados: El cociente de riesgo (CR) de la progresión al Síndrome de Lennox-Gastaut en pacientes que utilizaron la hormona adrenocorticotropa en comparación con aquellos sin hormona adrenocorticotropa fue de 0,45 (IC del 95%: 0,24-0,83, p=0,011). El CR de la progresión al Síndrome de Lennox-Gastaut ajustado para todas las variables estudiadas (edad de inicio, sexo, frecuencia de las crisis, etiología y tiempo desde el diagnóstico hasta el inicio del tratamiento) en pacientes que utilizaban la hormona adrenocorticotropa en comparación con aquellos sin hormona adrenocorticotropa fue de 0,56 (IC del 95%: 0,29 a 0,08; p=0,085). Conclusiones: El uso de la hormona corticotropina en pacientes con síndrome de West podría proteger contra la progresión al síndrome Lennox-Gastaut. Consideramos que esto apoya la evidencia encontrada en poblaciones similares a la nuestra, y creemos que este hallazgo podría ser confirmado con ensayos clínicos

Intervenciones para la prevención de factores de riesgo e incidencia de diabetes tipo 2 en ambiente laboral: una revisión sistemática

OBJETIVO: Evaluar la efectividad de las intervenciones para la prevención de factores de riesgo e incidencia de diabetes tipo 2 en población empleada. MÉTODOS: Revisión sistemática sobre intervenciones dirigidas a población empleada adulta en riesgo de diabetes tipo 2 publicadas en Medline, Embase, Web of Science, Registro Central Cochrane de Ensayos Controlados y Lilacs. Se seleccionaron ensayos aleatorizados, estudios cuasi-experimentales y de cohortes; en idioma inglés, español y portugués; publicados entre los años 2000 al 2017. La efectividad de la intervención fue evaluada en términos de incidencia de diabetes tipo 2 y de reducción significativa del peso corporal u otro parámetro antropométrico o metabólico. RESULTADOS: Se generaron 3.024 artículos, de los cuales fueron eliminados 2.825 que no respondieron la pregunta de investigación, 130 que no evaluaron intervenciones originales, 57 fuera del ámbito laboral y dos revisiones; quedando 10 artículos seleccionados. Las intervenciones basadas en programas estructurados previamente evaluados e integrados al ámbito laboral tuvieron impacto favorable en la reducción del peso corporal y otros factores de riesgo. CONCLUSIONES: La efectividad de las intervenciones en estilo de vida para la prevención de diabetes tipo 2 debe estar basada en programas estructurados con efectividad probada y adaptados al ámbito laboral, con participación del empleador en la disposición de horarios y ambientes en el trabajo.OBJECTIVE: To evaluate the effectiveness of interventions aimed at the prevention of risk factors and incidence of type 2 diabetes in the workers population. METHODS: Systematic review of interventions aimed at adult workers at risk of type 2 diabetes published in Medline, Embase, Web of Science, Central Cochrane Registry of Controlled Trials, and Lilacs. Randomized trials, quasi-experimental research and cohort studies were selected; in English, Spanish and Portuguese; published from 2000 to 2017. Intervention effectiveness was evaluated concerning the incidence of type 2 diabetes and a significant reduction in body weight, or another anthropometric or metabolic parameter. RESULTS: 3,024 articles were generated, of which 2,825 that did not answer the research question were eliminated, as well as 130 that did not evaluate original interventions, 57 carried out outside the workplace and two reviews; so that 10 selected items remained. Interventions based on structured programs previously evaluated and integrated into the workplace had a favorable impact on the reduction of body weight and other risk factors. CONCLUSIONS: The effectiveness of lifestyle interventions for the prevention of type 2 diabetes should be based on structured programs with proven effectiveness and adapted to the workplace, with employer participation in the provision of schedules and work environments

Las pruebas de laboratorio para la identificación de sars-cov-2 en tiempos de pandemia en el Perú: Algunas precisiones acerca del «rendimiento diagnóstico»

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Oxidized LDL Is Associated With Metabolic Syndrome Traits Independently of Central Obesity and Insulin Resistance

This study assesses whether oxidative stress, using oxidized LDL (ox-LDL) as a proxy, is associated with metabolic syndrome (MS), whether ox-LDL mediates the association between central obesity and MS, and whether insulin resistance mediates the association between ox-LDL and MS. We examined baseline data from 3,987 subjects without diabetes in the Progression of Early Subclinical Atherosclerosis (PESA) Study. For the second, third, and fourth ox-LDL quartiles versus the first, the odds ratios (95% CI) for MS were 0.84 (0.52, 1.36), 1.47 (0.95, 2.32), and 2.57 (1.66, 4.04) (P < 0.001 for trend) once adjusted for age, sex, smoking, LDL-cholesterol, BMI, waist circumference, and HOMA-insulin resistance (HOMA-IR). Results showing the same trend were found for all MS components except glucose concentration. Ox-LDL mediated 13.9% of the association of waist circumference with triglycerides and only 1-3% of the association with HDL-cholesterol, blood pressure, and insulin concentration. HOMA-IR did not mediate the association between ox-LDL and MS components. This study found higher ox-LDL concentrations were associated with MS and its components independently of central obesity and insulin resistance. Ox-LDL may reflect core mechanisms through which MS components develop and progress in parallel with insulin resistance and could be a clinically relevant predictor of MS development.Y.H.-R. received support from Republic of Peru and the Inter-American Development Bank through FINCyT Science and Technology Program Scholarships No. 088-FINCyT-BDE-2014 under agreement 1663/OC-PE. M.L. received partial support from the Institute de Salud Carlos III, cofunded by the European Regional Development Fund/European Social Fund, "Investing in Your Future" grants PI10/00021 and PI14/00009. The PESA study is supported by a noncompetitive unrestricted grant shared between the CNIC and Santander Bank. The CNIC is supported by the Spanish Ministry of Economy and Competitiveness (MINECO) and the Pro-CNIC Foundation and is a Severo Ochoa Center of Excellence (MINECO award SEV-2015-0505).S

Association of ferritin elevation and metabolic syndrome in males. Results from the Aragon Workers' Health Study (AWHS)

Context: Ferritin concentration is associated with metabolic syndrome, but the possibility of a nonlinear association has never been explored. Objective: This study aimed to examine the relationship between serum ferritin levels and the metabolic syndrome in Spanish adult males. Design: This was a cross-sectional analysis of baseline data from the Aragon Workers' Health Study. Setting: Healthy workers from a factory were studied during their annual checkup. Participants: Spanish male adults (n = 3386) between the ages of 19 and 65 years participated. We excluded participants with ferritin > 500 µg/L, ferritin 10 mg/L. Main Outcome Measure: Metabolic syndrome was defined according to the 2009 consensus definition from the Joint Interim Statement of several international societies. Results: Metabolic syndrome prevalence was 27.1%. We found a positive association between elevated iron stores, measured as serum ferritin concentration, and metabolic syndrome and its criteria. Participants within the highest serum ferritin quintile had a higher risk than those in the lowest quintile for central obesity (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.46–2.42), hypertriglyceridemia (OR, 2.15; 95% CI, 1.69–2.74), and metabolic syndrome (OR, 1.92; 95% CI, 1.48–2.49). The association was nonlinear and occurred at serum ferritin concentrations > 100 µg/L (~ 33th percentile). Ferritin was also associated with insulin resistance, measured by homeostatic model assessment–insulin resistance (HOMA-IR) (P trend < .001). Conclusions: Our findings suggest that serum ferritin is significantly associated with metabolic syndrome and its criteria (especially central obesity and hypertriglyceridemia), suggesting that ferritin could be an early marker of metabolic damage in the development of metabolic syndrome

Glycated Hemoglobin, Fasting Insulin and the Metabolic Syndrome in Males. Cross-Sectional Analyses of the Aragon Workers' Health Study Baseline

Background and Aims Glycated hemoglobin (HbA1c) is currently used to diagnose diabetes mellitus, while insulin has been relegated to research. Both, however, may help understanding the metabolic syndrome and profiling patients. We examined the association of HbA1c and fasting insulin with clustering of metabolic syndrome criteria and insulin resistance as two essential characteristics of the metabolic syndrome. Methods We used baseline data from 3200 non-diabetic male participants in the Aragon Workers' Health Study. We conducted analysis to estimate age-adjusted odds ratios (ORs) across tertiles of HbA1c and insulin. Fasting glucose and Homeostatic model assessment - Insulin Resistance were used as reference. Here we report the uppermost-to-lowest tertile ORs (95\% CI). Results Mean age (SD) was 48.5 (8.8) years and 23\% of participants had metabolic syndrome. The ORs for metabolic syndrome criteria tended to be higher across HbA1c than across glucose, except for high blood pressure. Insulin was associated with the criteria more strongly than HbA1c and similarly to Homeostatic model assessment - Insulin Resistance (HOMA-IR). For metabolic syndrome, the OR of HbA1c was 2.68, of insulin, 11.36, of glucose, 7.03, and of HOMA-IR, 14.40. For the clustering of 2 or more non-glycemic criteria, the OR of HbA1c was 2.10, of insulin, 8.94, of glucose, 1.73, and of HOMA-IR, 7.83. All ORs were statistically significant. The areas under the receiver operating characteristics curves for metabolic syndrome were 0.670 (across HbA1c values) and 0.770 (across insulin values), and, for insulin resistance, 0.647 (HbA1c) and 0.995 (insulin). Among non-metabolic syndrome patients, a small insulin elevation identified risk factor clustering. Conclusions HbA1c and specially insulin levels were associated with metabolic syndrome criteria, their clustering, and insulin resistance. Insulin could provide early information in subjects prone to develop metabolic syndrome.M. Laclaustra was supported in part by grant FIS CP08/00112 from Instituto de Salud Carlos III. Y. Hurtado-Roca was supported by Scholarship No 088-FINCyT-BDE-2014 from Peruvian government. This study was supported in part by grants PI14/00009, PI12/01087, PI12/01703, PI10/00021 (Fondo de Investigacion Sanitaria del Instituto de Salud Carlos III), co-funding by Fondo Europeo de Desarrollo Regional (FEDER 2007-2013), and RETIC RIC RD12/0042/0055 from Instituto de Salud Carlos III. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.S

Factores asociados a la calidad de la atención en población adulta afiliada a la Seguridad Social: El caso peruano

Objetive: To identify factors associated with perceived quality of care in the adult population affiliated with Social Security Health (EsSalud) Material and methods: We analyzed the National Socioeconomic Survey of Access to Health of the EsSalud Insured. Perceived quality of health care was evaluated in ambulatory care, hospitalization and emergency medical services. We reported adjusted ratios of means (RMa) estimated by multiple Poisson regression. Results: Being employed (RMa=0.98; IC95% 0.96-0.99), not knowing the services provided by EsSalud (RMa=0.97; IC95% 0.95-1.00), not receiving information about right to health (RMa=0.95; IC95% 0.93-0.98), perceiving as low the level of accessibility to the health facility (RMa=0.97; IC95% 0.95-0.99) and not feeling comfortable in the health facility of EsSalud (RM=0.92; IC95% 0.91-0.94) were factors associated with lower scores of perceived quality in ambulatory care. In hospitalization, being between 40-59 years old (RMa=0.93; IC95% 0.88-0.97), having a low wealth index (RMa=0.92; IC95% 0.87-0.97), not having received information about right to health (RMa=0.90; IC95% 0.84-0.95) and not feeling comfortable in the health facility of EsSalud (RMa=0.92; IC95% 0.89-0.96) were associated with lower quality score. In emergency, not feeling comfortable in the health facility of EsSalud (RMa=0.89; IC95% 0.93-1.00) was the only factor associated with a lower perceived quality score. Conclusions: We identified factors related to users and service offerings independently associated with perceived quality of care, which can be considered by decision makers for better management of EsSalud.Objetivo: Identificar factores asociados a calidad percibida de atención en la población adulta afiliada al Seguro Social en Salud (EsSalud). Material y métodos: Analizamos la Encuesta Nacional Socioeconómica de Acceso a la Salud de los Asegurados de EsSalud. La calidad percibida fue evaluada en consultorio externo, hospitalización y emergencias. Reportamos razones de medias ajustadas (RMa) estimadas mediante regresión de Poisson múltiple. Resultados: Estar empleado (RMa=0,98; IC95% 0,96-0,99), no conocer los servicios que brinda EsSalud (RMa=0,97; IC95% 0,95-1,00), no recibir información sobre los derechos como usuarios (RMa=0,95; IC95% 0,93-0,98), valorar como bajo el nivel de accesibilidad al EESS (RMa=0,97; IC95% 0,95-0,99) y no sentirse cómodo en el EESS al que acude (RM=0,92; IC95% 0,91-0,94) fueron factores asociados a menor puntaje de calidad percibida en consultorio externo. En hospitalización, tener entre 40-59 años (RMa=0,93; IC95% 0,88-0,97), contar con un índice de riqueza bajo (RMa=0,92; IC95% 0,87-0,97), no haber recibido información sobre los derechos como usuarios (RMa=0,90; IC95% 0,84-0,95) y no sentirse cómodos en el EESS (RMa=0,92; IC95% 0,89-0,96) se asociaron a menor puntuación de calidad. En emergencia, no sentirse cómodo en el EESS (RMa=0,89; IC95% 0,93-1,00) fue el único factor asociado a una menor puntuación de calidad percibida. Conclusiones: Identificamos factores relativos a los usuarios y a la oferta de servicios independientemente asociados a calidad percibida de atención, los cuales pueden ser considerados por los tomadores de decisiones para la mejor gestión de EsSalud

Revisión sobre obesidad como factor de riesgo para mortalidad por COVID-19

ABSTRACT This review presents evidence available up to June 2020 dealing with the effects from obesity as a possible factor increasing mortality in patients diagnosed with COVID-19 infection. Quality for most of the studies was good according to the Newcastle Ottawa scale (7/9 or higher). Studies reported follow-up periods between February 6th up to May 17th, 2020. In patients with COVID-19, obesity was a risk factor for mortality. Obese persons should be treated as a high- risk population, and preventive measures against transmission of the aforementioned infection must be intensified, and specialized assistance must be given to confirmed COVID-19 cases.RESUMEN Esta revisión presenta la evidencia disponible hasta el mes de junio del 2020 y trata sobre el efecto que tiene la obesidad como posible factor que aumenta la mortalidad en pacientes con diagnóstico por infección por COVID-19. La calidad de la mayoría de los estudios fue buena según la escala de Newcastle Ottawa (mayor o igual a 7/9). Los estudios reportaron seguimientos entre el 6 de febrero hasta el 17 de mayo del 2020. En pacientes con COVID-19, la obesidad fue un factor de riesgo para progresar a mortalidad. Las personas con obesidad deberían ser tratadas como una población de alto riesgo y se deben intensificar las medidas de prevención de contagio antes de la infección y proveer asistencia especializada en casos de confirmados de COVID-19

Recomendaciones clínicas para la evaluación y manejo de riesgo de COVID-19 en personal de salud del Seguro Social del Perú (EsSalud)

ABSTRACT We are currently experiencing a coronavirus disease (COVID-19) pandemic. A vulnerable group of being infected by this pathogenic agent is health personnel. For this reason, the Health Technology Assessment and Research Institute (IETSI in Spanish) of the Peruvian social insurance (EsSalud) has issued clinical recommendations on risk assessment and management of health care personnel in the context of the COVID-19 pandemic, which we will summarize in this paper. An evaluation and management flow chart are included, as well as a table to determine the risk of developing COVID-19 infection.RESUMEN Actualmente estamos viviendo una pandemia de enfermedad causada por coronavirus (COVID-19). Un grupo vulnerable de ser infectado por este agente patógeno es el personal de salud. Por ello, el Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) del Seguro Social del Perú (EsSalud) ha emitido recomendaciones clínicas sobre la Evaluación de riesgo y manejo de personal de salud en el contexto de la pandemia de COVID-19, que resumiremos en el presente artículo. Se incluye un flujograma de evaluación y manejo, así como una tabla para determinar el riesgo de presentar infección por COVID-19

Factores asociados a complicaciones crónicas de diabetes mellitus tipo 2 en pacientes de un hospital general del Seguro Social de Salud del Perú

Introduction. The chronic complications of type-2-diabetes mellitus (T2DM) increase mortality and burden of disease in Peru, then it is necessary to evaluate its prevalence and associated factors. Methods. Cross-sectional study in records of 212 adult outpatients with T2DM attended by a social security general hospital in Peru, during 2017. Results. 71,6% of patients were older than 60 years and with a time of illness less than 6 years (40,5%). 38,7% of the patients had any chronic complication, mainly nephropathy (48,8%) and neuropathy (45,1%). Hypertension (52,4%) and obesity (43,7%) were the most frequent comorbidities in outpatients with chronic complications. Complications from DMT2 were associated with the medical consultations and glycemic monitoring. Conclusions. There are risk factors associated to chronic complications of DMT2Introducción. Las complicaciones crónicas por diabetes mellitus tipo 2 (DMT2) elevan la mortalidad y carga de enfermedad en Perú, siendo necesario evaluar su prevalencia y factores asociados. Métodos. Estudio transversal, analítico, en registros de 212 pacientes adultos con DMT2 atendidos por consulta externa en un hospital general del Seguro Social del Perú, durante el año 2017. Resultados. El 71,6% de los pacientes fueron mayores de 60 años y con un tiempo de enfermedad menor de 6 años (40,5%). El 38,7% de los pacientes tuvieron alguna complicación crónica, principalmente nefropatía (48,8%) y neuropatía (45,1%). La hipertensión arterial (52,4%) y la obesidad (43,7%) fueron las comorbilidades más frecuentes en pacientes con complicaciones crónicas. Las complicaciones por DMT2 estuvieron asociadas al número de consultas médicas y monitoreo glicémico. Conclusiones. Existen factores de riesgos asociados a las complicaciones crónicas de DMT2