Prevalence of metabolic syndrome in workers of the mother-child center Miguel Grau, Chaclacayo, Peru

Introducción: Las enfermedades crónicas en el Perú están incrementando de manera preocupante, y el síndrome metabólico (SM) sigue la misma tendencia. Ante esta problemática le corresponde al equipo de salud cumplir un rol en educación y prevención. Objetivos: Determinar la prevalencia de síndrome metabólico en trabajadores de un centro materno infantil y examinar su relación con variables sociodemográficas e índice de masa corporal (IMC). Diseño: Estudio descriptivo, corte transversal. Lugar: Centro Materno Infantil (CMI) Miguel Grau, de la DISA IV Lima Este, Chaclacayo, Lima, Perú. Participantes: Trabajadores del centro de salud. Intervenciones: A 108 trabajadores que dieron su consentimiento informado se les encuestó para recoger los datos sociodemográficos. Además se les midió peso, talla, perímetro de cintura, presión arterial y, en una muestra, de 5 mL de sangre venosa en ayunas, se determinó glicemia y perfil lipídico. Se realizó análisis estadístico descriptivo y pruebas U de Mann Whitney, Kruskal Wallis y chi2; se consideró para todas las pruebas un nivel de significancia de 0,05 Principales medidas de resultados: Síndrome metabólico, perfil lipídico, categorías del IMC, glicemia, número de factores de riesgo. Resultados: El 35,2% de los trabajadores presentó síndrome metabólico. Se observó asociación del SM con la edad y categorías del IMC. No se encontró asociación con el sexo, tampoco con el grupo ocupacional. Conclusiones: La tercera parte de los trabajadores del CMI Miguel Grau presentó SM, valor superior al de la población peruana.Introduction: Chronic diseases in Peru are increasing at alarming rate and the metabolic syndrome (MS) follows the same trend. Faced with this problem the health team must play a role in education and prevention. Objectives: To determine the prevalence of metabolic syndrome in workers of a primary health care center and to examine its relationship with sociodemographic variables and body mass index (BMI). Design: Cross-sectional study. Location: Maternal Child Center (WCC) Miguel Grau, DISA IV Lima Este, Peru. Participants: Health workers. Interventions: All 108 workers who gave informed consent were surveyed for demographic data, and weight, height, waist circumference and blood pressure were obtained. In a 5 mL serum sample fasting blood glucose and lipid profile were determined. Descriptive statistics and U-Mann Whitney, Kruskal Wallis and chi2 tests were done; P value of 0.05 was used to determine significance. Main outcome measures: Metabolic syndrome, lipid profile, BMI categories, glycemia, number of risk factors. Results: 35.2% of workers had metabolic syndrome. SM was associated with age and BMI. No association was found with gender or occupational group. Conclusions: One-third of workers at the WCC Miguel Grau had MS, higher rate than in the Peruvian population

Efectos en la salud asociados a la ingesta de frutas cítricas en infantes de 6 a 24 meses de edad: Protocolo de una revisión sistemática

Introduction: In Latin America, the recommendations about the introduction of citrus in the complementary feeding are heterogeneous. Food restriction during the first years of life can increase the risk of nutritional deficiencies. The objective of the review is to identify the health effects associated with the citrus intake in infants from 6 to 24 months of age.Material and Methods: We will include studies with preterm infants, without diseases or surgical interventions that require dietary modification. Citrus are considered as Orange, Camu Camu, Tangelo, Lemon, Mandarin, Lime, Cider, Grapefruit, and Clementine, consumed in the natural form or in juices or extracts, or in combination with other foods. All health effects associated with the intake of citrus will be reported. The databases of MEDLINE (through PubMed), Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Epistemonikos, LILACS, and SciELO will be searched.Also, grey literature will be searched in international thesis repositories. Observational studies, randomized and non-randomized clinical trials will be included. Study selection, data extraction and risk of bias assessment will be done independently, in duplicate and with blinding. At the end of each stage, blinding will be lifted to resolve conflicts between reviewers through consensus. A narrative synthesis of the results of the primary studies and the risk of bias will be conducted.Ethics and Dissemination: The protocol is registered in PROSPERO: CRD42021230561.Introducción: En América Latina, las recomendaciones sobre la introducción de frutas cítricas en la alimentación complementaria son heterogéneas. La restricción de alimentos durante los primeros años de vida puede incrementar el riesgo de tener deficiencias nutricionales. El objetivo de la revisión es identificar los efectos en la salud asociados a la ingesta de frutas cítricas en infantes de 6 a 24 meses de edad. Metodología: Se incluirán a estudios que tengan como población a infantes nacidos pretérmino, sin enfermedades o intervenciones quirúrgicas que demanden de la modificación de la dieta. Se considera como frutas cítricas a la Naranja, Camu Camu, Tangelo, Limón, Mandarina, Lima, Sidra, Pomelo y Clementina, consumidas en su forma natural o en jugos o extractos, o en combinación con otros alimentos. Se reportarán todos los efectos en la salud asociados a la ingesta de frutas cítricas. Se realizarán búsquedas en MEDLINE (a través de PubMed), SCOPUS, LILACS, SciELo, Epistemonikos, y CENTRAL. También, se realizarán búsquedas de literatura gris en repositorios de tesis internacionales. Se incluirán a estudios observacionales, ensayos clínicos aleatorizados y no aleatorizados. La selección de estudios, extracción de datos y evaluación de riesgo de sesgo se realizará de forma independiente, por duplicado y con cegamiento. Al culminar cada etapa, se levantará el cegamiento para resolver los conflictos entre los revisores mediante el consenso. Se realizará una síntesis narrativa de los resultados de los estudios primarios y el riesgo de sesgo. Ética y diseminación: El protocolo está registrado en PROSPERO: CRD42021230561

The inhibition of complement system in formal and emerging indications: results from parallel one-stage pairwise and network meta-analyses of clinical trials and real-life data studies

Producción CientíficaThis manuscript presents quantitative findings on the actual effectiveness of terminal complement component 5 (C5) inhibitors and complement component 1 (C1) esterase inhibitors through their formal and common “off-label” (compassionate) indications. The results emanated from pairwise and network meta-analyses to present evidence until September 2019. Clinical trials (CT) and real-life non-randomized studies of the effects of interventions (NRSI) are consistent on the benefits of C5 inhibitors and of the absence of effects of C1 esterase inhibitors (n = 7484): Mathematically, eculizumab (surface under the cumulative ranking area (SUCRA) >0.6) and ravulizumab (SUCRA ≥ 0.7) were similar in terms of their protective effect on hemolysis in paroxysmal nocturnal hemoglobinuria (PNH), thrombotic microangiopathy (TMA) in atypical hemolytic uremic syndrome (aHUS), and acute kidney injury (AKI) in aHUS, in comparison to pre-/off-treatment state and/or placebo (SUCRA < 0.01), and eculizumab was efficacious on thrombotic events in PNH (odds ratio (OR)/95% confidence interval (95% CI) in CT and real-life NRSI, 0.07/0.03 to 0.19, 0.24/0.17 to 0.33) and chronic kidney disease (CKD) occurrence/progression in PNH (0.31/0.10 to 0.97, 0.66/0.44 to 0.98). In addition, meta-analysis on clinical trials shows that eculizumab mitigates a refractory generalized myasthenia gravis (rgMG) crisis (0.29/0.13 to 0.61) and prevents new acute antibody-mediated rejection (AMR) episodes in kidney transplant recipients (0.25/0.13 to 0.49). The update of findings from this meta-analysis will be useful to promote a better use of complement inhibitors, and to achieve personalization of treatments with this class of drugs

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Prevalencia de síndrome metabólico en trabajadores del centro materno infantil Miguel Grau- Chaclacayo-Perú

Introduction: Chronic diseases in Peru are increasing at alarming rate and the metabolic syndrome (MS) follows the same trend. Faced with this problem the health team must play a role in education and prevention. Objectives: To determine the prevalence of metabolic syndrome in workers of a primary health care center and to examine its relationship with sociodemographic variables and body mass index (BMI). Design: Cross-sectional study. Location: Maternal Child Center (WCC) Miguel Grau, DISA IV Lima Este, Peru. Participants: Health workers. Interventions: All 108 workers who gave informed consent were surveyed for demographic data, and weight, height, waist circumference and blood pressure were obtained. In a 5 mL serum sample fasting blood glucose and lipid profile were determined. Descriptive statistics and U-Mann Whitney, Kruskal Wallis and chi2 tests were done; P value of 0.05 was used to determine significance. Main outcome measures: Metabolic syndrome, lipid profile, BMI categories, glycemia, number of risk factors. Results: 35.2% of workers had metabolic syndrome. SM was associated with age and BMI. No association was found with gender or occupational group. Conclusions: One-third of workers at the WCC Miguel Grau had MS, higher rate than in the Peruvian population.Introducción: Las enfermedades crónicas en el Perú están incrementando de manera preocupante, y el síndrome metabólico (SM) sigue la misma tendencia. Ante esta problemática le corresponde al equipo de salud cumplir un rol en educación y prevención. Objetivos: Determinar la prevalencia de síndrome metabólico en trabajadores de un centro materno infantil y examinar su relación con variables sociodemográficas e índice de masa corporal (IMC). Diseño: Estudio descriptivo, corte transversal. Lugar: Centro Materno Infantil (CMI) Miguel Grau, de la DISA IV Lima Este, Chaclacayo, Lima, Perú. Participantes: Trabajadores del centro de salud. Intervenciones: A 108 trabajadores que dieron su consentimiento informado se les encuestó para recoger los datos sociodemográficos. Además se les midió peso, talla, perímetro de cintura, presión arterial y, en una muestra, de 5 mL de sangre venosa en ayunas, se determinó glicemia y perfil lipídico. Se realizó análisis estadístico descriptivo y pruebas U de Mann Whitney, Kruskal Wallis y chi2; se consideró para todas las pruebas un nivel de significancia de 0,05 Principales medidas de resultados: Síndrome metabólico, perfil lipídico, categorías del IMC, glicemia, número de factores de riesgo. Resultados: El 35,2% de los trabajadores presentó síndrome metabólico. Se observó asociación del SM con la edad y categorías del IMC. No se encontró asociación con el sexo, tampoco con el grupo ocupacional. Conclusiones: La tercera parte de los trabajadores del CMI Miguel Grau presentó SM, valor superior al de la población peruana