a Médico cirujano; b médico cirujano, magíster en Epidemiología Clínica; c médico cirujano, magís... more a Médico cirujano; b médico cirujano, magíster en Epidemiología Clínica; c médico cirujano, magíster en Medicina. Objetivo: La diabetes es una enfermedad no transmisible con prevalencia creciente que provoca alta carga de enfermedad por su tardío diagnóstico, complicaciones discapacitantes y elevada mortalidad. Para homogeneizar la atención el Ministerio de Salud peruano publicó la "Guía de práctica clínica para el diagnóstico, tratamiento y control de la diabetes mellitus tipo
Objectives: The primary objective is to determine the effect of a daily dose of ivermectin admini... more Objectives: The primary objective is to determine the effect of a daily dose of ivermectin administered in three consecutive days to non-severe COVID-19 patients with no more than 96 hours of symptoms, on the detection of SARS-CoV-2 RNA by PCR from nasopharyngeal swabs at day seven post-treatment initiation. The secondary objectives are: 1. To assess the efficacy of ivermectin to reduce the SARS-CoV-2 viral load in the nasopharyngeal swab on days 4, 7, 14 and 21 post-treatment initiation 2. To assess the efficacy of ivermectin on the improvement of symptoms 3. To assess the proportion of seroconversions at day 21 4. To assess the safety of ivermectin at the proposed dose 5. To determine the magnitude of the immune response against SARS-CoV-2 6. To assess correlation of the presence of intestinal helminths on participants on baseline and day 14 with COVID-19 progression and treatment. Trial design: SAINT PERU is a triple-blinded, randomized, placebo-controlled trial with two parallel arms to evaluate the efficacy of ivermectin in negativizing nasopharyngeal PCR in patients with SARS-CoV-2 infection.
Hace más de 20 años se publicó la primera definición de sepsis basado en el concepto de Respuesta... more Hace más de 20 años se publicó la primera definición de sepsis basado en el concepto de Respuesta Inflamatoria Sistémica (SIRS), definición que utilizamos hasta la actualidad. Recientemente, el Grupo de Trabajo de las Definiciones de Sepsis (Sepsis Definitions Task Force) ha publicado un consenso con las definiciones actualizadas de sepsis y shock séptico (SEPSIS-3) que utiliza un nuevo concepto de sepsis como disfunción orgánica potencialmente mortal causada por una respuesta disregulada del huésped a la infección, utilizando el sistema de puntuación SOFA (Sequential Organ Failure Assessment), y propugna se abandonen los antiguos criterios. Realizamos una revisión de los antecedentes de esta nueva propuesta de definición, las definiciones planteadas por este nuevo consenso, comparando estas nuevas definiciones con las antiguas, limitaciones y evaluamos su aplicabilidad en la práctica clínica.
Málaga G, Herrera Añazco P. Hipocalemia sintomática asociada al uso de Llantén ("Plantago major")... more Málaga G, Herrera Añazco P. Hipocalemia sintomática asociada al uso de Llantén ("Plantago major"). Rev haban cienc méd [Internet]. 2020 [citado ]; 19(6):e3355.
Revista Peruana de Medicina Experimental y Salud Pública, Sep 24, 2020
a Médica cirujana; b médico internista, magister en medicina. La infección neurológica por el vir... more a Médica cirujana; b médico internista, magister en medicina. La infección neurológica por el virus del herpes simple tipo 2 (VHS-2) es responsable de una morbimortalidad significativa que debe ser diagnosticada y tratada lo antes posible. Clásicamente se caracteriza por la tríada de fiebre, cefalea y cambios de comportamiento. La asociación de los síntomas, los resultados de las pruebas de laboratorio y las imágenes son fundamentales para el diagnóstico precoz y el tratamiento inmediato de esta patología, a fin de prevenir que su progresión sea fatal. Presentamos el caso de un paciente varón de 45 años con diagnóstico de encefalitis por VHS-2 después del uso crónico de corticoides. La infección neurológica por VHS-2 en pacientes adultos previamente sanos después del uso crónico de corticoides es extremadamente infrecuente y la asociación no había sido descrita previamente.
Objectives: The primary objective is to determine the effect of a daily dose of ivermectin admini... more Objectives: The primary objective is to determine the effect of a daily dose of ivermectin administered in three consecutive days to non-severe COVID-19 patients with no more than 96 hours of symptoms, on the detection of SARS-CoV-2 RNA by PCR from nasopharyngeal swabs at day seven post-treatment initiation.
Background Retinopathy of prematurity is the leading worldwide cause of visual impairment. There ... more Background Retinopathy of prematurity is the leading worldwide cause of visual impairment. There is little available data on its epidemiology and related factors and consequences in developing countries such as Peru. Due to this lack of information, we decided to do this study. Objectives To evaluate factors related to the development of retinopathy of prematurity in very low birth weight newborn patients. Methods We did a case-control (paired 1:1) study of patients admitted to the Neonatal Intensive Care Unit of the Hospital Cayetano Heredia between 2008 and 2018 who had a complete record in the Neocosur network database (N = 293). The case was defined as a preterm newborn patient with a birth weight lower than 1500 grams who developed any type or stage of retinopathy of prematurity; control was defined as a patient with similar characteristics without retinopathy. Univariate and bivariate analysis (using logistic regression model) was performed to obtain the odds ratio with a 95% ...
Background: Cardiac arrest in patients with pulmonary embolism (PE) is associated with high morbi... more Background: Cardiac arrest in patients with pulmonary embolism (PE) is associated with high morbidity and mortality. Thrombolysis is expected to improve the outcome in these patients. However studies evaluating rescue-thrombolysis in patients with PE are missing, mainly due to the difficulties of clinical diagnosis of PE. We aimed to determine the success influencing factors of thrombolysis during resuscitation in patients with PE. Methodology/Principal Findings: We analyzed retrospectively the outcome of 104 consecutive patients with confirmed (n = 63) or highly suspected (n = 41) PE and monitored cardiac arrest. In all patients rtPA was administrated for thrombolysis during cardiopulmonary resuscitation. In 40 of the 104 patients (38.5%) a return of spontaneous circulation (ROSC) could be achieved successfully. Patients with ROSC received thrombolysis significantly earlier after CPR onset compared to patients without ROSC (13.661.2 min versus 24.660.8 min; p,0.001). 19 patients (47.5%) out of the 40 patients with initially successful resuscitation survived to hospital discharge. In patients with hospital discharge thrombolysis therapy was begun with a significantly shorter delay after cardiac arrest compared to all other patients (11.061.3 vs. 22.560.9 min; p,0.001). Rescue-thrombolysis should be considered and started in patients with PE and cardiac arrest, as soon as possible after cardiac arrest onset.
American Journal of Respiratory and Critical Care Medicine, 2011
Rationale: Because of high mortality, end-of-life care is an important component of intensive car... more Rationale: Because of high mortality, end-of-life care is an important component of intensive care. Objectives: We evaluated the effectiveness of a quality-improvement intervention to improve intensive care unit (ICU) end-of-life care. Methods: We conducted a cluster-randomized trial randomizing 12 hospitals. The intervention targeted clinicians with five components: clinician education, local champions, academic detailing, clinician feedback of quality data, and system supports. Outcomes were assessed for patients dying in the ICU or within 30 hours of ICU discharge using surveys and medical record review. Families completed Quality of Dying and Death (QODD) and satisfaction surveys. Nurses completed the QODD. Data were collected during baseline and follow-up at each hospital (May 2004 to February 2008). We used robust regression models to test for intervention effects, controlling for site, patient, family, and nurse characteristics. Measurements and Main Results: All hospitals completed the trial with 2,318 eligible patients and target sample sizes obtained for family and nurse surveys. The primary outcome, family-QODD, showed no change with the intervention (P 5 0.33). There was no change in family satisfaction (P 5 0.66) or nurse-QODD (P 5 0.81). There was a nonsignificant increase in ICU days before death after the intervention (hazard ratio 5 0.9; P 5 0.07). Among patients undergoing withdrawal of mechanical ventilation, there was no change in time from admission to withdrawal (hazard ratio 5 1.0; P 5 0.81). Conclusions: We found this intervention was associated with no improvement in quality of dying and no change in ICU length of stay before death or time from ICU admission to withdrawal of lifesustaining measures. Improving ICU end-of-life care will require interventions with more direct contact with patients and families. Clinical trial registered with www.clinicaltrials.gov (NCT00685893).
African Journal for Physical, Health Education, Recreation and Dance, 2006
The purpose of this study was to measure the relationship between socio-economic status (SES) and... more The purpose of this study was to measure the relationship between socio-economic status (SES) and educational achievements (EA) of rural South African children. The data come from a sample of 238 children (118 boys and 120 girls) from the ongoing Ellisras Longitudinal Study. A questionnaire was used to gather information on six SES measures: Availability of TV and radio at home; type of dwelling; educational level of the father; number of people sharing a bedroom; cooking mode used; and household income. EA was measured using the Educational Achievement Tests. In this sample, with a very low average SES, no strong relationships were found between SES and EA. The general absence of significant relationships between SES and EA may be due to difficulties in accurately and adequately measuring SES and EA, and the little variations in SES. The ‘type of dwelling' and ‘cooking mode' however, was positively associated with EA. Based on this result, improvement of housing and cooking facilities may lead to improvement in the educational achievement of children in low SES rural communities. Keywords : socio-economic status, educational achievements, rural South African children African Journal for Physical, Health Education, Recreation and Dance Vol. 12 (3) 2006: 298-309
Revista Peruana de Medicina Experimental y Salud Pública, Jun 19, 2015
El presente estudio tuvo como objetivo determinar el uso y percepciones hacia las tecnologías de ... more El presente estudio tuvo como objetivo determinar el uso y percepciones hacia las tecnologías de información y comunicación (TIC), en 206 pacientes portadores de hipertensión arterial, dislipidemia y diabetes, reclutados de la consulta externa en un hospital nacional de Lima, Perú. El 54,4% fueron adultos mayores y 70,4% mujeres. El uso diario de llamadas por celular fue 44,7%; la mayoría nunca había usado una computadora (78,2%), correo electrónico (84%) o Internet (84%). Muchos nunca han enviado (80,6%) o recibido (69,9%) un mensaje de texto. El 70% ha olvidado alguna vez tomar su medicina. Al 72,8% le gustaría que le recuerden tomar sus medicinas y 67,9% tiene algún familiar que podría ayudarlos a acceder a las TIC. Pese al bajo uso de las TIC en esta población, existe predisposición y expectativa por los pacientes a participar en programas que las implementen.
Revista Peruana de Medicina Experimental y Salud Pública, Jun 19, 2015
Con el objetivo de determinar el nivel de actividad física que realizan los pacientes ambulatorio... more Con el objetivo de determinar el nivel de actividad física que realizan los pacientes ambulatorios con diabetes mellitus tipo 2 (DM 2) que acuden a un Hospital Nacional de Lima, Perú se incluyó a 120 pacientes en quienes se aplicó el cuestionario internacional de actividad física IPAQ. El 66% fueron mujeres, la edad media fue 61,6 años, el 70% presentó mal control glicémico. El 20% de pacientes calificaba como inactivo, 68% con mínima actividad y 12% con actividad física adecuada. No se halló relación entre actividad física, tiempo de enfermedad, control glicémico, ni el índice de masa corporal. La edad se asoció negativamente con la actividad física. Se concluye que existen bajos niveles de actividad física en pacientes con DM 2 y esta no se enfoca en actividades de ocio que proveen beneficios a la salud.
Objective. The objective of this study was to assess patients' achievement of ADA (American Diabe... more Objective. The objective of this study was to assess patients' achievement of ADA (American Diabetes Association) guideline recommendations for glycosylated hemoglobin, lipid profile, and blood pressure in a type 2 diabetes mellitus (T2DM) outpatient clinic in a low-middle income country (LMIC) setting. Methods. This is a descriptive cross-sectional study with 123 ambulatory T2DM patients who are being treated at a public hospital in Lima, Peru. Data was gathered via standardized interviews, clinical surveys, and anthropomorphic measurements for each patient. Blood samples were drawn in fasting state for measures of glucose, glycosylated hemoglobin (HbA1c), and lipid profile. Laboratory parameters and blood pressure were evaluated according to ADA recommendations. Results. Of the 123 patients, 81 were women and the mean age was 61.8 years. Glycemic control was abnormal in 82 (68.33%) participants, and 45 (37.50%) were unable to control their blood pressure. Lipid profile was abnormal in 73 (60.83%) participants. Only nine (7.50%) participants fulfilled ADA recommendations for glycemic, blood pressure, and lipid control. Conclusions. Amongst individuals with type 2 diabetes, there was poor attainment of the ADA recommendations (HbA1c, blood pressure and LDL-cholesterol) for ambulatory T2DM patients. Interventions are urgently needed in order to prevent longterm diabetic complications.
Objective: To characterize the prevalence and clustering of multimorbidity in four diverse geogra... more Objective: To characterize the prevalence and clustering of multimorbidity in four diverse geographical settings in Peru. Methods: Multimorbidity, defined as having 2 chronic conditions, was studied in adults aged 35 years in four diverse settings in Peru: Lima, Tumbes, and urban and rural Puno. Six of these conditions (alcohol disorder, asthma, chronic obstructive pulmonary disease, depression, diabetes, and hypertension) were cataloged as objectively ascertained chronic conditions and paired in dyads to explore clusters of multimorbidity. Results: We analyzed data from 2890 adults, mean age 55.2 years, 49% males. Overall, 19.1% of participants had multimorbidity, ranging from 14.7% in semi-urban Tumbes to 22.8% in Lima. The dyads with the highest coexistence (approximately 20%) were observed in hypertension and diabetes in Tumbes, whereas the dyads with lowest coexistence (approximately 1%) were those involving asthma in all study sites. In terms of clusters, Tumbes showed a predominance of hypertension and diabetes, urban and rural Puno a predominance of depression and alcohol disorders, and Lima a higher degree of coexistence of all of the six conditions than in the other clusters. Conclusion: Multimorbidity is common and the pattern of clusters is highly heterogeneous. The conditions to prioritize will vary in each setting.
a Médico cirujano; b médico cirujano, magíster en Epidemiología Clínica; c médico cirujano, magís... more a Médico cirujano; b médico cirujano, magíster en Epidemiología Clínica; c médico cirujano, magíster en Medicina. Objetivo: La diabetes es una enfermedad no transmisible con prevalencia creciente que provoca alta carga de enfermedad por su tardío diagnóstico, complicaciones discapacitantes y elevada mortalidad. Para homogeneizar la atención el Ministerio de Salud peruano publicó la "Guía de práctica clínica para el diagnóstico, tratamiento y control de la diabetes mellitus tipo
Objectives: The primary objective is to determine the effect of a daily dose of ivermectin admini... more Objectives: The primary objective is to determine the effect of a daily dose of ivermectin administered in three consecutive days to non-severe COVID-19 patients with no more than 96 hours of symptoms, on the detection of SARS-CoV-2 RNA by PCR from nasopharyngeal swabs at day seven post-treatment initiation. The secondary objectives are: 1. To assess the efficacy of ivermectin to reduce the SARS-CoV-2 viral load in the nasopharyngeal swab on days 4, 7, 14 and 21 post-treatment initiation 2. To assess the efficacy of ivermectin on the improvement of symptoms 3. To assess the proportion of seroconversions at day 21 4. To assess the safety of ivermectin at the proposed dose 5. To determine the magnitude of the immune response against SARS-CoV-2 6. To assess correlation of the presence of intestinal helminths on participants on baseline and day 14 with COVID-19 progression and treatment. Trial design: SAINT PERU is a triple-blinded, randomized, placebo-controlled trial with two parallel arms to evaluate the efficacy of ivermectin in negativizing nasopharyngeal PCR in patients with SARS-CoV-2 infection.
Hace más de 20 años se publicó la primera definición de sepsis basado en el concepto de Respuesta... more Hace más de 20 años se publicó la primera definición de sepsis basado en el concepto de Respuesta Inflamatoria Sistémica (SIRS), definición que utilizamos hasta la actualidad. Recientemente, el Grupo de Trabajo de las Definiciones de Sepsis (Sepsis Definitions Task Force) ha publicado un consenso con las definiciones actualizadas de sepsis y shock séptico (SEPSIS-3) que utiliza un nuevo concepto de sepsis como disfunción orgánica potencialmente mortal causada por una respuesta disregulada del huésped a la infección, utilizando el sistema de puntuación SOFA (Sequential Organ Failure Assessment), y propugna se abandonen los antiguos criterios. Realizamos una revisión de los antecedentes de esta nueva propuesta de definición, las definiciones planteadas por este nuevo consenso, comparando estas nuevas definiciones con las antiguas, limitaciones y evaluamos su aplicabilidad en la práctica clínica.
Málaga G, Herrera Añazco P. Hipocalemia sintomática asociada al uso de Llantén ("Plantago major")... more Málaga G, Herrera Añazco P. Hipocalemia sintomática asociada al uso de Llantén ("Plantago major"). Rev haban cienc méd [Internet]. 2020 [citado ]; 19(6):e3355.
Revista Peruana de Medicina Experimental y Salud Pública, Sep 24, 2020
a Médica cirujana; b médico internista, magister en medicina. La infección neurológica por el vir... more a Médica cirujana; b médico internista, magister en medicina. La infección neurológica por el virus del herpes simple tipo 2 (VHS-2) es responsable de una morbimortalidad significativa que debe ser diagnosticada y tratada lo antes posible. Clásicamente se caracteriza por la tríada de fiebre, cefalea y cambios de comportamiento. La asociación de los síntomas, los resultados de las pruebas de laboratorio y las imágenes son fundamentales para el diagnóstico precoz y el tratamiento inmediato de esta patología, a fin de prevenir que su progresión sea fatal. Presentamos el caso de un paciente varón de 45 años con diagnóstico de encefalitis por VHS-2 después del uso crónico de corticoides. La infección neurológica por VHS-2 en pacientes adultos previamente sanos después del uso crónico de corticoides es extremadamente infrecuente y la asociación no había sido descrita previamente.
Objectives: The primary objective is to determine the effect of a daily dose of ivermectin admini... more Objectives: The primary objective is to determine the effect of a daily dose of ivermectin administered in three consecutive days to non-severe COVID-19 patients with no more than 96 hours of symptoms, on the detection of SARS-CoV-2 RNA by PCR from nasopharyngeal swabs at day seven post-treatment initiation.
Background Retinopathy of prematurity is the leading worldwide cause of visual impairment. There ... more Background Retinopathy of prematurity is the leading worldwide cause of visual impairment. There is little available data on its epidemiology and related factors and consequences in developing countries such as Peru. Due to this lack of information, we decided to do this study. Objectives To evaluate factors related to the development of retinopathy of prematurity in very low birth weight newborn patients. Methods We did a case-control (paired 1:1) study of patients admitted to the Neonatal Intensive Care Unit of the Hospital Cayetano Heredia between 2008 and 2018 who had a complete record in the Neocosur network database (N = 293). The case was defined as a preterm newborn patient with a birth weight lower than 1500 grams who developed any type or stage of retinopathy of prematurity; control was defined as a patient with similar characteristics without retinopathy. Univariate and bivariate analysis (using logistic regression model) was performed to obtain the odds ratio with a 95% ...
Background: Cardiac arrest in patients with pulmonary embolism (PE) is associated with high morbi... more Background: Cardiac arrest in patients with pulmonary embolism (PE) is associated with high morbidity and mortality. Thrombolysis is expected to improve the outcome in these patients. However studies evaluating rescue-thrombolysis in patients with PE are missing, mainly due to the difficulties of clinical diagnosis of PE. We aimed to determine the success influencing factors of thrombolysis during resuscitation in patients with PE. Methodology/Principal Findings: We analyzed retrospectively the outcome of 104 consecutive patients with confirmed (n = 63) or highly suspected (n = 41) PE and monitored cardiac arrest. In all patients rtPA was administrated for thrombolysis during cardiopulmonary resuscitation. In 40 of the 104 patients (38.5%) a return of spontaneous circulation (ROSC) could be achieved successfully. Patients with ROSC received thrombolysis significantly earlier after CPR onset compared to patients without ROSC (13.661.2 min versus 24.660.8 min; p,0.001). 19 patients (47.5%) out of the 40 patients with initially successful resuscitation survived to hospital discharge. In patients with hospital discharge thrombolysis therapy was begun with a significantly shorter delay after cardiac arrest compared to all other patients (11.061.3 vs. 22.560.9 min; p,0.001). Rescue-thrombolysis should be considered and started in patients with PE and cardiac arrest, as soon as possible after cardiac arrest onset.
American Journal of Respiratory and Critical Care Medicine, 2011
Rationale: Because of high mortality, end-of-life care is an important component of intensive car... more Rationale: Because of high mortality, end-of-life care is an important component of intensive care. Objectives: We evaluated the effectiveness of a quality-improvement intervention to improve intensive care unit (ICU) end-of-life care. Methods: We conducted a cluster-randomized trial randomizing 12 hospitals. The intervention targeted clinicians with five components: clinician education, local champions, academic detailing, clinician feedback of quality data, and system supports. Outcomes were assessed for patients dying in the ICU or within 30 hours of ICU discharge using surveys and medical record review. Families completed Quality of Dying and Death (QODD) and satisfaction surveys. Nurses completed the QODD. Data were collected during baseline and follow-up at each hospital (May 2004 to February 2008). We used robust regression models to test for intervention effects, controlling for site, patient, family, and nurse characteristics. Measurements and Main Results: All hospitals completed the trial with 2,318 eligible patients and target sample sizes obtained for family and nurse surveys. The primary outcome, family-QODD, showed no change with the intervention (P 5 0.33). There was no change in family satisfaction (P 5 0.66) or nurse-QODD (P 5 0.81). There was a nonsignificant increase in ICU days before death after the intervention (hazard ratio 5 0.9; P 5 0.07). Among patients undergoing withdrawal of mechanical ventilation, there was no change in time from admission to withdrawal (hazard ratio 5 1.0; P 5 0.81). Conclusions: We found this intervention was associated with no improvement in quality of dying and no change in ICU length of stay before death or time from ICU admission to withdrawal of lifesustaining measures. Improving ICU end-of-life care will require interventions with more direct contact with patients and families. Clinical trial registered with www.clinicaltrials.gov (NCT00685893).
African Journal for Physical, Health Education, Recreation and Dance, 2006
The purpose of this study was to measure the relationship between socio-economic status (SES) and... more The purpose of this study was to measure the relationship between socio-economic status (SES) and educational achievements (EA) of rural South African children. The data come from a sample of 238 children (118 boys and 120 girls) from the ongoing Ellisras Longitudinal Study. A questionnaire was used to gather information on six SES measures: Availability of TV and radio at home; type of dwelling; educational level of the father; number of people sharing a bedroom; cooking mode used; and household income. EA was measured using the Educational Achievement Tests. In this sample, with a very low average SES, no strong relationships were found between SES and EA. The general absence of significant relationships between SES and EA may be due to difficulties in accurately and adequately measuring SES and EA, and the little variations in SES. The ‘type of dwelling' and ‘cooking mode' however, was positively associated with EA. Based on this result, improvement of housing and cooking facilities may lead to improvement in the educational achievement of children in low SES rural communities. Keywords : socio-economic status, educational achievements, rural South African children African Journal for Physical, Health Education, Recreation and Dance Vol. 12 (3) 2006: 298-309
Revista Peruana de Medicina Experimental y Salud Pública, Jun 19, 2015
El presente estudio tuvo como objetivo determinar el uso y percepciones hacia las tecnologías de ... more El presente estudio tuvo como objetivo determinar el uso y percepciones hacia las tecnologías de información y comunicación (TIC), en 206 pacientes portadores de hipertensión arterial, dislipidemia y diabetes, reclutados de la consulta externa en un hospital nacional de Lima, Perú. El 54,4% fueron adultos mayores y 70,4% mujeres. El uso diario de llamadas por celular fue 44,7%; la mayoría nunca había usado una computadora (78,2%), correo electrónico (84%) o Internet (84%). Muchos nunca han enviado (80,6%) o recibido (69,9%) un mensaje de texto. El 70% ha olvidado alguna vez tomar su medicina. Al 72,8% le gustaría que le recuerden tomar sus medicinas y 67,9% tiene algún familiar que podría ayudarlos a acceder a las TIC. Pese al bajo uso de las TIC en esta población, existe predisposición y expectativa por los pacientes a participar en programas que las implementen.
Revista Peruana de Medicina Experimental y Salud Pública, Jun 19, 2015
Con el objetivo de determinar el nivel de actividad física que realizan los pacientes ambulatorio... more Con el objetivo de determinar el nivel de actividad física que realizan los pacientes ambulatorios con diabetes mellitus tipo 2 (DM 2) que acuden a un Hospital Nacional de Lima, Perú se incluyó a 120 pacientes en quienes se aplicó el cuestionario internacional de actividad física IPAQ. El 66% fueron mujeres, la edad media fue 61,6 años, el 70% presentó mal control glicémico. El 20% de pacientes calificaba como inactivo, 68% con mínima actividad y 12% con actividad física adecuada. No se halló relación entre actividad física, tiempo de enfermedad, control glicémico, ni el índice de masa corporal. La edad se asoció negativamente con la actividad física. Se concluye que existen bajos niveles de actividad física en pacientes con DM 2 y esta no se enfoca en actividades de ocio que proveen beneficios a la salud.
Objective. The objective of this study was to assess patients' achievement of ADA (American Diabe... more Objective. The objective of this study was to assess patients' achievement of ADA (American Diabetes Association) guideline recommendations for glycosylated hemoglobin, lipid profile, and blood pressure in a type 2 diabetes mellitus (T2DM) outpatient clinic in a low-middle income country (LMIC) setting. Methods. This is a descriptive cross-sectional study with 123 ambulatory T2DM patients who are being treated at a public hospital in Lima, Peru. Data was gathered via standardized interviews, clinical surveys, and anthropomorphic measurements for each patient. Blood samples were drawn in fasting state for measures of glucose, glycosylated hemoglobin (HbA1c), and lipid profile. Laboratory parameters and blood pressure were evaluated according to ADA recommendations. Results. Of the 123 patients, 81 were women and the mean age was 61.8 years. Glycemic control was abnormal in 82 (68.33%) participants, and 45 (37.50%) were unable to control their blood pressure. Lipid profile was abnormal in 73 (60.83%) participants. Only nine (7.50%) participants fulfilled ADA recommendations for glycemic, blood pressure, and lipid control. Conclusions. Amongst individuals with type 2 diabetes, there was poor attainment of the ADA recommendations (HbA1c, blood pressure and LDL-cholesterol) for ambulatory T2DM patients. Interventions are urgently needed in order to prevent longterm diabetic complications.
Objective: To characterize the prevalence and clustering of multimorbidity in four diverse geogra... more Objective: To characterize the prevalence and clustering of multimorbidity in four diverse geographical settings in Peru. Methods: Multimorbidity, defined as having 2 chronic conditions, was studied in adults aged 35 years in four diverse settings in Peru: Lima, Tumbes, and urban and rural Puno. Six of these conditions (alcohol disorder, asthma, chronic obstructive pulmonary disease, depression, diabetes, and hypertension) were cataloged as objectively ascertained chronic conditions and paired in dyads to explore clusters of multimorbidity. Results: We analyzed data from 2890 adults, mean age 55.2 years, 49% males. Overall, 19.1% of participants had multimorbidity, ranging from 14.7% in semi-urban Tumbes to 22.8% in Lima. The dyads with the highest coexistence (approximately 20%) were observed in hypertension and diabetes in Tumbes, whereas the dyads with lowest coexistence (approximately 1%) were those involving asthma in all study sites. In terms of clusters, Tumbes showed a predominance of hypertension and diabetes, urban and rural Puno a predominance of depression and alcohol disorders, and Lima a higher degree of coexistence of all of the six conditions than in the other clusters. Conclusion: Multimorbidity is common and the pattern of clusters is highly heterogeneous. The conditions to prioritize will vary in each setting.
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