Proteína C reactiva elevada como factor asociado a pacientes con psoriasis severa del Hospital Regional Docente de Trujillo

Objetivo: Determinar si la Proteína C reactiva elevada es factor asociado a pacientes con psoriasis severa del Hospital Regional Docente de Trujillo. Material y métodos: Se llevó a cabo un estudio de tipo analítico, observacional, retrospectivo; en el que se incluyó a 132 pacientes con psoriasis, según criterios de selección; los cuales se dividieron en: 30 pacientes con psoriasis severa y 102 pacientes con psoriasis no severa; aplicándose el odds ratio y la prueba estadística chi cuadrado. Resultados: La frecuencia de obesidad, hipercolesterolemia y artritis fueron más frecuentes en pacientes con psoriasis severa que en el grupo con psoriasis no severa (p<0.05); la frecuencia de proteína C reactiva elevada en pacientes con psoriasis severa fue de 80%; la frecuencia de proteína C reactiva elevada en pacientes con psoriasis no severa fue de 41%; la proteína C reactiva elevada es factor asociado a severidad en psoriasis con un odds ratio de 5.71 el cual fue significativo (p<0.05); en el análisis multivariado se reconocen a las variables PCR elevada, obesidad, hipercolesterolemia y artritis como factores asociados a severidad en psoriasis (p<0.05). Conclusión: La Proteína C reactiva elevada es factor asociado a pacientes con Psoriasis severa del Hospital Regional Docente de Trujillo.Objective: To determine if increase C-reactive protein is a factor associated with patients with severe psoriasis at the “Hospital Regional Docente de Trujillo”. Material and methods: An analytical, observational, retrospective study was carried out in which 132 patients with psoriasis were included, according to selection criteria, which were: 30 patients with severe and 102 non-severe psoriasis; applying the odds ratio and the chi -square statistical test. Results: The frequency of obesity, hypercholesterolemia and arthritis were more frequent in patients with severe psoriasis than in the group with non-severe psoriasis (p <0.05); the frequency of increase C-reactive protein in patients with severe psoriasis was 80%; the frequency of increase C-reactive protein in patients with non-severe psoriasis was 41%; increase C-reactive protein is a factor associated with severity in psoriasis with an odds ratio of 5.71 which was significant (p <0.05); in the multivariate analysis, the variables increase CRP, obesity, hypercholesterolemia and arthritis are recognized as factors associated with severity In psoriasis (p <0.05). Conclusion: Increase C - reactive protein is a factor associated with patients with severe Psoriasis at “Hospital Regional Docente de Trujillo”.Tesi

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030