Repositorio Institucional EsSalud
Not a member yet
5274 research outputs found
Sort by
Reparación de aneurismas abdominopélvicos múltiples: ¿sigue siendo válido el enfoque abierto? Reporte de un caso
Get PDFMultiple Aneurysmal Arterial Disease (MAD) is an extremely rare arterial vascular condition and is produced by an abnormal alteration of smooth muscle cells and neutrophils, producing a multiple-aneurysmal degeneration. We present the case of a 36-year-old patient with a MAD in the cerebral territory and extremities with no surgical indication; however, with an aneurysm of the right inferior renal segmental artery, inferior mesenteric artery, left common iliac artery, and right internal iliac artery with surgical indication. An open approach with single-stage surgical repair, including graft interposition, bypass, exclusion, and vascular reimplantation, was performed. The surgical and postoperative course was uneventful, and the patient was discharged with an indication for outpatient follow-up. The open approach may be the best option for young patients with MAD, especially in the abdominopelvic region, without the need for high resources, with satisfactory results and improved patient survival.La enfermedad arterial multianeurismática (EAM) es una afección vascular arterial extremadamente rara y se produce por una alteración de las células musculares lisas y los neutrófilos, produciendo una degeneración multianeurismática. Presentamos el caso de un paciente de 36 años con una EAM en territorio cerebral y extremidades, sin indicación quirúrgica; sin embargo, con un aneurisma de la arteria segmentaria renal inferior derecha, arteria mesentérica inferior, arteria ilíaca común izquierda y arteria ilíaca interna derecha con indicación quirúrgica. Se realizó un abordaje abierto con reparación quirúrgica en un solo tiempo que incluyó interposición de injerto, bypass, exclusión y reimplante vascular. La evolución quirúrgica y posoperatoria transcurrió sin complicaciones y el paciente fue dado de alta con indicación de seguimiento ambulatorio. El abordaje abierto puede ser la mejor opción para pacientes jóvenes con EAM, especialmente en la región abdominopélvica, sin necesidad de altos recursos, con resultados satisfactorios y mejoría en la supervivencia del paciente
Clinical comparison in the remote management of bronchial asthma during the COVID-19 pandemic between two controller therapies: Fluticasone and beclomethasone
Get PDFObjetivo: Comparar el nivel de control del asma mediante el uso del Asthma Control Test (ACT) y manifestaciones clínicas en dos grupos de pacientes tratados con diferentes corticosteroides inhalados (GCI).
Materiales y métodos. Estudio descriptivo, observacional y prospectivo donde se registró en 521 niños del programa de asma del Hospital III Yanahuara (Arequipa, Perú) el Nivel de Control del Asma, durante el periodo de junio del 2020 a diciembre 2021, por medio de la consulta remota empleando el ACT y la recopilación de los hallazgos clínicos (síntomas diurnos, nocturnos, visita a emergencias y uso de broncodilatadores beta 2 agonistas), en dos momentos durante la pandemia COVID-19.
Resultados. Ambos grupos tuvieron un control óptimo al inicio y final del estudio, con una mejoría significativa en el último control (P 0.05) en ambos controles. El nivel promedio del ACT de la Fluticasona al egreso, tuvo una superioridad significativa frente a la Beclometasona (P = 0.03).
Conclusiones. La Teleconsulta es una herramienta eficaz para el monitoreo de enfermedades crónicas como lo es el asma. Tanto Fluticasona cómo Beclometasona lograron un control óptimo de la enfermedad, destacando que el verdadero factor determinante para lograr un buen control es el uso continuo de cualquier GCI. Sin embargo, se encontró una diferencia estadística significativa a favor de la Fluticasona; no obstante, por su menor precio, la relación costo-eficacia favorece a Beclometasona como opción económica y eficiente para un óptimo control del asma.Objective: To compare the level of asthma control using the Asthma Control Test (ACT) and clinical manifestations in two groups of patients treated with different inhaled corticosteroids (ICG): fluticasone and beclometasone. Materials and methods: An observational, comparative and prospective study was conducted in 521 children in the asthma program of Hospital III Yanahuara. During the period from June 2020 to December 2021, the level of asthma control was assessed by remote consultations using ACT and collection of clinical findings. Patients were grouped according to the type of ICG they were using. Data were recorded at two different time points for each patient, with a 4-month interval between each control, during the COVID-19 pandemic and the level of control was compared by ACT score and clinical manifestations between the two groups of patients at both time points of the study. Results: Both groups had optimal control at baseline and at the end of the study. In clinical manifestations there was no statistical difference (P > 0.05) in favor of either drug in either control. However, in the second control (discharge) a significant difference was found for fluticasone versus beclometasone (P = 0.030). Conclusions: Fluticasone was found to have superiority in the level of asthma control over beclomethasone. However, the determining factor in achieving good control is the continuous use of any IGC
Diagnostic accuracy of Xpert MTB/RIF and Xpert ultra tests in pulmonary and extrapulmonary tuberculosis compared to Löwenstein-Jensen culture
Get PDFBackground: Tuberculosis (TB) is one of the leading causes of death worldwide. However, an accurate diagnosis contributes to timely treatment, reducing its adverse consequences. The aim of this research was to determine the diagnostic accuracy of the molecular test Xpert MTB/RIF and Xpert MTB/RIF Ultra (Xpert Ultra) for the diagnosis of pulmonary and extrapulmonary TB compared to Löwenstein-Jensen culture.
Methods: We conducted a cross-sectional study of diagnostic accuracy. We included samples from patients who attended a Peruvian laboratory between 2011 and 2022. The index test was the Xpert MTB/RIF and Xpert Ultra and the reference standard was Löwenstein-Jensen solid culture for Mycobacterium tuberculosis. We calculated sensitivity, specificity, and positive and negative likelihood ratios.
Results: We evaluated 1023 samples, of which 737 were pulmonary samples, 197 tested positive for the Xpert MTB/RIF and Xpert Ultra tests; and 151 tested positive for culture. The Xpert (MTB/RIF and Ultra) showed a joint sensitivity and specificity of: 97 % (95%CI: 93–99) and 93 % (95%CI: 91–95) in pulmonary samples, 100 % (95%CI: 29.2–100) and 98.3 % (95%CI: 94.1–99.8) in cerebrospinal fluid, 66.7 % (95%CI: 22.3–95.7) and 96.8 % (95%CI: 91–99.3) in pleural fluid, 100 % (95%CI: 15.8–100) and 94.3 % (95%CI: 80.8–99.3) in urine. For the detection of pulmonary TB, the Xpert MTB/RIF had a sensitivity and specificity of 97.1 % (95%CI: 89.9–99.6) and 95.6 % (95%CI: 92.9–97.5) and the Xpert Ultra of 97 % (95%CI: 88.5–99.6) 89.5 % (95%CI: 84.9–93.1) respectively.
Conclusion: Our results suggest that the Xpert MTB/RIF and the Xpert Ultra are tests with high diagnostic performance for the detection of pulmonary TB and adequate specificity in pulmonary, cerebrospinal fluid, pleural, and urine samples. However, the results for other samples were imprecise
Resistencia a cefalosporinas y quinolonas en Escherichia coli aisladas de agua de riego del río Rímac en Lima Este, Perú.
Get PDFObjetives. Bacterial resistance to antibiotics is a public health problem, however, few studies are performed in natural water ecosystems in middle-low-income countries. The objective of this study was to evaluate the presence and sensitivity to antimicrobials of Escherichia coli strains isolated from 24 irrigation water samples from the Rimac River in eastern Lima. Materials and methods. E.coli were identified by PCR. Antibiotic susceptibility was determined by disk diffusion method. The extended-spectrum beta-lactamase (ESBL), quinolones and virulence involved genes were determined by PCR. Results. All samples exceeded the permissible limits established in the Environmental Quality Standards for vegetable irrigation. Of the 94 strains, 72.3% showed resistance to at least one antibiotic, 24.5% were multidrug-resistant (MDR), and 2.1% were extremely drug resistant. The highest percentages of resistance were observed against nalidixic acid (50%), trimethoprim-sulfamethoxazole (35.5%) and ciprofloxacin (20.4%). Among the isolates, 3.2% presented ESBL phenotype related to blaCTX-M-15 gene. The transferable mechanisms of resistance to quinolones, qnrB were more frequent (20.4%), and 2.04% had the qnrS. It was determined that 5.3% were diarrheagenic E. coli and of these, 60% were enterotoxigenic E. coli, 20% were enteropathogenic E. coli and 20% were enteroaggregative E. coli. Conclusions. Our results show the existence diarrheagenic pathotypes in water used to irrigate fresh produce and highlights the presence of ESBL-producers and MDR E. coli, demonstrating the role that irrigation water plays in disseminating resistance genes in Peru.Objetivos. Evaluar la presencia y sensibilidad a los antimicrobianos de cepas de Escherichia coli aisladas de
24 muestras de agua de riego del rio Rímac de Lima Este, Perú. Materiales y métodos. Las cepas de E. coli
fueron identificadas por PCR. La susceptibilidad a los antibióticos se procesaron por el método de difusión
en disco. Los genes implicados en betalactamasas de espectro extendido (BLEE), quinolonas y virulencia se
determinaron por PCR. Resultados. Todas las muestras superaron los limites permisibles establecidos en las
Normas de Calidad Ambiental para el riego de hortalizas. De los 94 aislados, el 72,3% mostro resistencia al
menos a un antibiótico, el 24,5% eran multirresistentes (MDR) y el 2,1% extremadamente resistentes. Los mayores
porcentajes de resistencia se observaron para ampicilina-sulbactam (57,1%), el ácido nalidixico (50%),
trimetoprim-sulfametoxazol (35,5%) y ciprofloxacino (20,4%). Entre los aislados, el 3,2% presentaba fenotipo
BLEE relacionado con el gen bla CTX-M-15. Los mecanismos transferibles de resistencia a las quinolonas, qnrB
fueron más frecuentes (20,4%), y el 2,04% tenian el qnrS. Se calcularon que el 5,3% eran E. coli diarreagenicas y
de estas, el 60% eran E. coli enterotoxigenicas, el 20% E. coli enteropatogenas y el 20% E. coli enteroagregantes.
Conclusiones. Los resultados muestran la existencia de patotipos diarreogenicos en el agua utilizada para el
riego de productos frescos y destaca la presencia de E. coli productores de BLEE y MDR, demostrando el papel
que juega el agua de riego en la diseminación de genes de resistencia en el Perú
Cáncer de Cervix y Virus Papiloma Humano: Los retos de la vacunación
No full textEl cáncer de cuello uterino es una enfermedad bastante frecuente en nuestro país, más o menos son 500,000 casos de cáncer de cérvix nuevos por año en el mundo, la mayor tasa de incidencia de cáncer se da en países como el África, Sudamérica y algunos países asiáticos, por encima de los 26 casos por cada 100,000 habitantes; mientras que en países como Estados Unidos, Canadá y Australia pueden llegar a tener tasa de incidencia sumamente baja, por debajo
de siete casos por 100,000 habitantes
Importance of muscle magnetic resonance in the diagnostic approach of muscle pathologies, a case report
Get PDFLa resonancia magnética muscular consiste en un método no invasivo el cual está adquiriendo importancia en el ámbito de patologías neuromusculares. Con este método de estudio no solamente es posible la descripción de patrones de afectación muscular, la solicitud de estudios genéticos o la selección de lugar de la biopsia sino también se utiliza en la valoración de la progresión de la enfermedad y una utilidad especial en caso de variantes genéticas de significado incierto pues apoya en la interpretación de estas. En nuestro centro como en el de muchos a nivel nacional no se cuenta con la disponibilidad de estudios genéticos de primera mano, por lo que el uso de los métodos diagnósticos disponibles resulta de vital importancia para los fines diagnósticos. Presentamos el caso de un paciente con manifestaciones crónicas y sin diagnóstico en los que el estudio de resonancia magnética permitió orientar el estudio genético adecuado para confirmar su diagnóstico.Muscle magnetic resonance imaging is a non-invasive method which is gaining importance in the field of neuromuscular pathologies. With this study it is possible to describe patterns of muscle involvement, request genetic studies or select a biopsy site, but it is also used in the assessment of the progression of the disease and is especially useful in case of variants of uncertain significance as it supports their interpretation. In our center, as in many nationwide, there is no availability of first-hand genetic studies, so the use of available diagnostic methods is of vital importance for final diagnoses. We present the case of a patient with chronic manifestations and no clear diagnosis in whom the magnetic resonance study made it possible to guide the appropriate genetic study to confirm his diagnosis
Primary neuroendocrine tumor of the liver
Get PDFLos tumores neuroendocrinos generalmente se originan en el tracto digestivo o páncreas, desarrollando metástasis hepática a lo largo de su evolución. La presencia de un tumor neuroendocrino primario de hígado es motivo de controversia y de muy escasa casuística. Presentamos el caso de un tumor neuroendocrino primario de hígado confirmado por estudio anatomo-patológico e imágenes. La paciente fue sometida a dos resecciones hepáticas mayores, preservando sólo el segmento IV.Neuroendocrine tumors generally originate in the digestive tract or pancreas, developing liver metastases throughout their evolution. The presence of a primary neuroendocrine tumor of the liver is still controversial and there are very few cases. We present a case of a primary neuroendocrine tumor of the liver confirmed by anatomo-pathological study and images. The patient underwent two major liver resections, lastly preserving only segment IV
Comunicado de Seguridad de Farmacovigilancia Nº 07-2024. Hipo tras el consumo de tramadol
No full textInformación para profesionales de la saludTramadol, es un opioide sintético ampliamente prescrito en el manejo del dolor moderado a intenso, su
mecanismo de acción se basa en interactuar sobre los receptores opioides, con cierta afinidad por el
receptor μ, además de actuar sobre la inhibición de la recaptación de noradrenalina y serotonina, hecho
que contribuye a su actividad analgésica. Tramadol en EsSalud se encuentra disponible en tres
presentaciones distintas: frasco de 100mg/mL x 10 mL, tabletas de 50 mg y ampollas de 50mg/Ml x 2 Ml
WCN24-2649 Calcified masses in a peritoneal dialysis patient: uremic tumor calcinosis
Get PDFUremic tumor calcinosis is an uncommon condition characterized by calcium salt deposition in different regions of periarticular soft tissue in patients with chronic kidney disease. Its prevalence is estimated at 1.6% in patients receiving peritoneal dialysis. The risk factors described for the development of this pathology include persistent hyperphosphatemia, elevated levels of calcium x phosphorus (CaxP) product, and severe secondary hyperparathyroidism. Diagnosis is based on the clinical presentation of masses in periarticular areas, laboratory tests related to alterations in bone and mineral metabolism (calcium, phosphorus, parathormone), imaging of the lesion, and, if possible, a biopsy of the lesion. This case is particularly interesting because the diagnosis of uremic tumor calcinosis is based on histopathological findings and existing clinical correlation
Abstracts of the 2023 Annual Meeting of the ALEH
No full textIntroduction and Objectives: Autoimmune liver diseases (AILD), including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC), are chronic immune-mediated liver conditions. This study aimed to assess the reality of AILD in Latin America (LA)