Performance del Índice Neutrófilo-Linfocito (INL) preoperatorio como predictor de complicaciones tempranas post - gastrectomía en manga

Introducción: La obesidad es un problema de salud pública y la cirugía bariátrica es considerada como un tratamiento efectivo a largo plazo. Estos procedimientos tienen una mortalidad de hasta el 0.08% dentro de los 30 días postoperatorios y una tasa de complicaciones de hasta el 17%. El índice neutrófilo linfocito (INL) es un marcador de inflamación que ha sido utilizado como marcador pronóstico en diversas patologías inflamatorias y cirugías. Objetivo: El presente estudio tuvo el objetivo de evaluar el rendimiento del índice neutrófilo-linfocito (INL) preoperatorio como predictor de complicaciones tempranas posterior a la gastrectomía en manga. Métodos: Se realizó un estudio de cohorte retrospectivo a partir del análisis de la base de datos institucional de la Clínica Avendaño durante los años 2017 a 2020. El índice neutrófilo linfocito se calculó a partir del hemograma preoperatorio. Se cálculo el área bajo la curva para determinar el rendimiento del INL preoperatorio como predictor de complicaciones tempranas post gastrectomía en manga y se presentaron diferentes escenarios de acuerdo a los puntos de corte de INL con sus respectivos parámetros estadísticos. Resultados: Se estudiaron 387 pacientes operados por gastrectomía en manga en la Clínica Avendaño. De dichos pacientes, 45 pacientes presentaron complicaciones en los 30 primeros días postoperatorios (11.6%). El área bajo la curva para INL como predictor de complicaciones generales tempranas post gastrectomía en manga fue de 0.423 y para complicaciones severas fue de 0.392. Conclusión: El INL preoperatorio no es un buen predictor de complicaciones tempranas por gastrectomía en manga.Background: Obesity is a public health problem. Bariatric surgery is an effective long term treatment for obesity. This procedure has a mortality up to 0.08% during the 30 days postoperative and up to 17% of complications. The neutrophil to lymphocyte ratio (NLR) is an inflammatory marker used for prognostic of inflammatory diseases and surgery. Objectives: The objective of our study is to evaluate the utility of preoperative neutrophil to lymphocyte ratio (NLR) as a predictor of early postoperative complications of sleeve gastrectomy. Methods: We performed a retrospective cohort study by the analysis of the institutional data base of Clinica Avendaño between 2017 and 2020. NLR values were obtained from the preoperative complete blood count. We calculated the ROC curve and different cut points with their statistic parameters for NLR as predictor of early postoperative complications after sleeve gastrectomy. Results: A total of 387 patients went under sleeve gastrectomy. Of the patients, 45 patients (11.6%) had early postoperative complications. The Receiver Operating Characteristic Curve (ROC curve) for NLR as predictor of early complications post sleeve gastrectomy was 0.423 and 0.392 for severe complications. Conclusion: Preoperative NLR it’s not a good predictor for early postoperative complications for sleeve gastrectomy.Tesi

Desabastecimiento de antidiabéticos y antihipertensivos en el contexto de la etapa inicial de la pandemia por la COVID-19 en Perú

Background: An adequate supply of medicines in health establishments will increase the possibility of adequate control of hypertension and diabetes. Objective: To determine the shortage of antidiabetic and antihypertensive drugs at the national level in the context of the initial stage of the COVID-19 pandemic in Peru. Material y methods: Analysis of the "Sistema Integrado de Suministro de Medicamentos e Insumos Médicos Quirúrgicos" (SISMED) Database, between June 13th and July 15th, 2020, according to the "National list for medicines of essential medicines" (PNUME) of Ministry of health. Results: And between 4 and 96% of the departments have a total shortage of at least one antidiabetic, and 4% and 96% of at least one antihypertensive. The most depleted antidiabetic was Metformin 500 mg, and the most depleted antihypertensive drugs were Labetalol 5 mg / ml iny, Atenolol 50 mg tab and Carvedilol 6.25 mg tab. The percentage of distribution was higher in hospitals and specialized institutes in comparison with primary health facilities. Conclusions: There is a shortage of antihypertensive and antidiabetic drugs in health centers in Peru. © 2021 Medical Body of the Almanzor Aguinaga Asenjo National Hospital.Revisión por pare

Balón intragástrico ingerible Elipse®: Primera experiencia en Perú

Letter to the Editor (without abstract)Carta al Editor (sin resumen

The Elipse® swallowable intragastric balloon: First experience in Peru

Carta al editorRevisión por pare

"Percentage of excess body mass index loss and cardiometabolic risk reduction in Peruvian adults undergoing sleeve gastrectomy"

"Objective: To assess the association between the percentage of excess body mass index loss (%EBMIL) and cardiometabolic risk reduction in Peruvian adults undergoing laparoscopic sleeve gastrectomy (LSG). Methods: Retrospective cohort study conducted with adult patients who underwent LSG in a bariatric clinic during 2016–2020. The outcome variable was cardiometabolic risk change (expressed in Δ) 1 year after LSG. To that effect, the variables total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, very LDL (VLDL) cholesterol, triglycerides, glucose, insulin, and HOMA-IR at baseline and after 12 months were considered. The exposure variable was %EBMIL. Crude and adjusted β coefficients were estimated with linear regression models. Results: Of the 110 patients analyzed, 68.2% were women, and the median patient age was 34.5 years. In the model adjusted for sex, age, and baseline BMI, we noted that each 25% increase in %EBMIL resulted in a decrease in the values for total cholesterol, LDL, triglycerides, and insulin by 10.36 mg/dL (p < 0.001), 7.98 mg/dL (p = 0.001), 13.35 mg/dL (p = 0.033), and 3.63 uU/mL (p = 0.040), respectively. Conclusion: %EBMIL was associated with a decrease in total cholesterol, LDL, triglycerides, and insulin levels, which could suggest a favorable cardiometabolic evolution during the first 12 months following LSG.