ORCID Profile
0000-0002-7828-300X
Current Organisations
Autonomous University of Queretaro
,
Hospital Nacional Cayetano Heredia
,
Universidad Peruana Cayetano Heredia
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Oxford University Press (OUP)
Date: 09-2015
DOI: 10.5665/SLEEP.4988
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2015
Publisher: Instituto Nacional de Salud (Peru)
Date: 24-09-2020
DOI: 10.17843/RPMESP.2020.373.5980
Abstract: Las personas con diabetes mellitus tipo 2 infectadas por SARS-CoV-2 tienen mayores riesgos de desarrollar COVID-19 con complicaciones y de morir como consecuencia de ella. La diabetes es una condición crónica en la que se requiere continuidad de cuidados que implican un contacto con los establecimientos de salud, pues deben tener acceso regular a medicamentos, exámenes y citas con personal de salud. Esta continuidad de cuidados se ha visto afectada en el Perú a raíz de la declaratoria del estado de emergencia nacional, producto de la pandemia por la COVID-19 pues muchos establecimientos de salud han suspendido las consultas externas. Este artículo describe algunas estrategias que han desarrollado los diferentes proveedores de salud peruanos en el marco de la pandemia para proveer continuidad del cuidado a las personas con diabetes y finalmente brinda recomendaciones para que reciban los cuidados que necesitan a través del fortalecimiento del primer nivel de atención, como el punto de contacto más cercano con las personas con diabetes.
Publisher: Colegio Medico del Peru
Date: 07-2020
DOI: 10.35663/AMP.2020.372.1030
Abstract: -
Publisher: American Medical Association (AMA)
Date: 24-03-2010
Abstract: Theory and simulation suggest that randomized controlled trials (RCTs) stopped early for benefit (truncated RCTs) systematically overestimate treatment effects for the outcome that precipitated early stopping. To compare the treatment effect from truncated RCTs with that from meta-analyses of RCTs addressing the same question but not stopped early (nontruncated RCTs) and to explore factors associated with overestimates of effect. Search of MEDLINE, EMBASE, Current Contents, and full-text journal content databases to identify truncated RCTs up to January 2007 search of MEDLINE, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects to identify systematic reviews from which in idual RCTs were extracted up to January 2008. Selected studies were RCTs reported as having stopped early for benefit and matching nontruncated RCTs from systematic reviews. Independent reviewers with medical content expertise, working blinded to trial results, judged the eligibility of the nontruncated RCTs based on their similarity to the truncated RCTs. Reviewers with methodological expertise conducted data extraction independently. The analysis included 91 truncated RCTs asking 63 different questions and 424 matching nontruncated RCTs. The pooled ratio of relative risks in truncated RCTs vs matching nontruncated RCTs was 0.71 (95% confidence interval, 0.65-0.77). This difference was independent of the presence of a statistical stopping rule and the methodological quality of the studies as assessed by allocation concealment and blinding. Large differences in treatment effect size between truncated and nontruncated RCTs (ratio of relative risks <0.75) occurred with truncated RCTs having fewer than 500 events. In 39 of the 63 questions (62%), the pooled effects of the nontruncated RCTs failed to demonstrate significant benefit. Truncated RCTs were associated with greater effect sizes than RCTs not stopped early. This difference was independent of the presence of statistical stopping rules and was greatest in smaller studies.
Publisher: BMJ
Date: 02-2014
Publisher: Ubiquity Press, Ltd.
Date: 03-2015
Publisher: Elsevier BV
Date: 09-2017
Publisher: BMJ
Date: 23-01-2017
Publisher: American Medical Association (AMA)
Date: 03-12-2014
Abstract: Acute kidney injury, a common complication of surgery, is associated with poor outcomes and high health care costs. Some studies suggest aspirin or clonidine administered during the perioperative period reduces the risk of acute kidney injury however, these effects are uncertain and each intervention has the potential for harm. To determine whether aspirin compared with placebo, and clonidine compared with placebo, alters the risk of perioperative acute kidney injury. A 2 × 2 factorial randomized, blinded, clinical trial of 6905 patients undergoing noncardiac surgery from 88 centers in 22 countries with consecutive patients enrolled between January 2011 and December 2013. Patients were assigned to take aspirin (200 mg) or placebo 2 to 4 hours before surgery and then aspirin (100 mg) or placebo daily up to 30 days after surgery, and were assigned to take oral clonidine (0.2 mg) or placebo 2 to 4 hours before surgery, and then a transdermal clonidine patch (which provided clonidine at 0.2 mg/d) or placebo patch that remained until 72 hours after surgery. Acute kidney injury was primarily defined as an increase in serum creatinine concentration from the preoperative concentration by either an increase of 0.3 mg/dL or greater (≥26.5 μmol/L) within 48 hours of surgery or an increase of 50% or greater within 7 days of surgery. Aspirin (n = 3443) vs placebo (n = 3462) did not alter the risk of acute kidney injury (13.4% vs 12.3%, respectively adjusted relative risk, 1.10 95% CI, 0.96-1.25). Clonidine (n = 3453) vs placebo (n = 3452) did not alter the risk of acute kidney injury (13.0% vs 12.7%, respectively adjusted relative risk, 1.03 95% CI, 0.90-1.18). Aspirin increased the risk of major bleeding. In a post hoc analysis, major bleeding was associated with a greater risk of subsequent acute kidney injury (23.3% when bleeding was present vs 12.3% when bleeding was absent adjusted hazard ratio, 2.20 95% CI, 1.72-2.83). Similarly, clonidine increased the risk of clinically important hypotension. In a post hoc analysis, clinically important hypotension was associated with a greater risk of subsequent acute kidney injury (14.3% when hypotension was present vs 11.8% when hypotension was absent adjusted hazard ratio, 1.34 95% CI, 1.14-1.58). Among patients undergoing major noncardiac surgery, neither aspirin nor clonidine administered perioperatively reduced the risk of acute kidney injury. clinicaltrials.gov Identifier: NCT01082874.
Publisher: CMA Impact Inc.
Date: 06-2018
DOI: 10.1503/CJS.010217
Abstract: Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is strongly associated with 30-day mortality however, it remains mostly undetected without systematic troponin T monitoring. We evaluated the cost and consequences of postoperative troponin T monitoring to detect MINS. We conducted a model-based cost-consequence analysis to compare the impact of routine troponin T monitoring versus standard care (troponin T measurement triggered by ischemic symptoms) on the incidence of MINS detection. Model inputs were based on Canadian patients enrolled in the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study, which enrolled patients aged 45 years or older undergoing inpatient noncardiac surgery. We conducted probability analyses with 10 000 iterations and extensive sensitivity analyses. The data were based on 6021 patients (48% men, mean age 65 [standard deviation 12] yr). The 30-day mortality rate for MINS was 9.6%. We determined the incremental cost to avoid missing a MINS event as $1632 (2015 Canadian dollars). The cost-effectiveness of troponin monitoring was higher in patient subgroups at higher risk for MINS, e.g., those aged 65 years or more, or with a history of atherosclerosis or diabetes ($1309). The costs associated with a troponin T monitoring program to detect MINS were moderate. Based on the estimated incremental cost per health gain, implementation of postoperative troponin T monitoring seems appealing, particularly in patients at high risk for MINS.
Publisher: Elsevier BV
Date: 10-2010
Publisher: Public Library of Science (PLoS)
Date: 03-12-2014
Publisher: Public Library of Science (PLoS)
Date: 23-11-2015
Publisher: Wiley
Date: 15-05-2017
DOI: 10.1111/DME.13335
Publisher: Elsevier BV
Date: 05-2008
Publisher: Elsevier BV
Date: 04-2019
Publisher: BMJ
Date: 11-01-2018
DOI: 10.1136/HEARTJNL-2017-312255
Abstract: The prevalence of and factors associated with ideal cardiovascular health (ICH) by sociodemographic characteristics in Peru is not well known. The American Heart Association’s ICH score comprised 3 ideal health factors (blood pressure, untreated total cholesterol and glucose) and 4 ideal health behaviours (smoking, body mass index, high physical activity and fruit and vegetable consumption). ICH was having 5 to 7 of the ideal health metrics. Baseline data from the Center of Excellence in Chronic Diseases, a prospective cohort study in adults aged ≥35 years in 4 Peruvian settings, was used (n=3058). No one met all 7 of ICH metrics while 322 (10.5%) had ≤1 metric. Fasting plasma glucose was the most prevalent health factor (72%). Overall, compared with ages 35–44 years, the 55–64 years age group was associated with a lower prevalence of ICH (prevalence ratio 0.54, 95% CI 0.40 to 0.74, P .001). Compared with those in the lowest tertile of socioeconomic status, those in the middle and highest tertiles were less likely to have ICH after adjusting for sex, age and education (P .001). There is a low prevalence of ICH. This is a benchmark for the prevalence of ICH factors and behaviours in a resource-poor setting.
Publisher: BMJ
Date: 06-08-2015
Publisher: Elsevier BV
Date: 09-2015
Publisher: Springer Science and Business Media LLC
Date: 15-04-2014
Publisher: Elsevier BV
Date: 07-2012
Publisher: Elsevier BV
Date: 04-2017
Publisher: BMJ
Date: 23-12-2015
Publisher: American Medical Association (AMA)
Date: 27-06-2012
Publisher: Springer Science and Business Media LLC
Date: 19-04-2016
Publisher: Elsevier BV
Date: 05-2018
Publisher: Public Library of Science (PLoS)
Date: 25-03-2011
Publisher: Public Library of Science (PLoS)
Date: 05-2014
Publisher: Elsevier BV
Date: 03-2016
Publisher: Elsevier BV
Date: 08-2016
Publisher: Massachusetts Medical Society
Date: 17-04-2014
Publisher: Human Kinetics
Date: 06-2016
Abstract: Physical inactivity and sedentary behaviors have been linked with impaired health outcomes. Establishing the physical inactivity profiles of a given population is needed to establish program targets and to contribute to international monitoring efforts. We report the prevalence of, and explore sociodemographical and built environment factors associated with physical inactivity in 4 resource-limited settings in Peru: rural Puno, urban Puno, P as de San Juan de Miraflores (urban), and Tumbes (semiurban). Cross-sectional analysis of the CRONICAS Cohort Study’s baseline assessment. Outcomes of interest were physical inactivity of leisure time ( MET-min/week) and transport-related physical activity (not reporting walking or cycling trips) domains of the IPAQ, as well as watching TV, as a proxy of sedentarism (≥2 hours per day). Exposures included demographic factors and perceptions about neighborhood’s safety. Associations were explored using Poisson regression models with robust standard errors. Prevalence ratios (PR) and 95% confidence intervals (95% CI) are presented. Data from 3593 in iduals were included: 48.5% males, mean age 55.1 (SD: 12.7) years. Physical inactivity was present at rates of 93.7% (95% CI 93.0%–94.5%) and 9.3% (95% CI 8.3%–10.2%) within the leisure time and transport domains, respectively. In addition, 41.7% (95% CI 40.1%–43.3%) of participants reported watching TV for more than 2 hours per day. Rates varied according to study settings ( P .001). In multivariable analysis, being from rural settings was associated with 3% higher prevalence of leisure time physical inactivity relative to highly urban Lima. The pattern was different for transport-related physical inactivity: both Puno sites had around 75% to 50% lower prevalence of physical inactivity. Too much traffic was associated with higher levels of transport-related physical inactivity (PR = 1.24 95% CI 1.01–1.54). Our study showed high levels of inactivity and marked contrasting patterns by rural/urban sites. These findings highlight the need to generate synergies to expand nationwide physical activity surveillance systems.
Publisher: Massachusetts Medical Society
Date: 17-04-2014
Publisher: Springer Science and Business Media LLC
Date: 06-07-2009
Abstract: Randomized clinical trials (RCTs) stopped early for benefit often receive great attention and affect clinical practice, but pose interpretational challenges for clinicians, researchers, and policy makers. Because the decision to stop the trial may arise from catching the treatment effect at a random high, truncated RCTs (tRCTs) may overestimate the true treatment effect. The St udy O f Trial P olicy Of I nterim T runcation (STOPIT-1), which systematically reviewed the epidemiology and reporting quality of tRCTs, found that such trials are becoming more common, but that reporting of stopping rules and decisions were often deficient. Most importantly, treatment effects were often implausibly large and inversely related to the number of the events accrued. The aim of STOPIT-2 is to determine the magnitude and determinants of possible bias introduced by stopping RCTs early for benefit. We will use sensitive strategies to search for systematic reviews addressing the same clinical question as each of the tRCTs identified in STOPIT-1 and in a subsequent literature search. We will check all RCTs included in each systematic review to determine their similarity to the index tRCT in terms of participants, interventions, and outcome definition, and conduct new meta-analyses addressing the outcome that led to early termination of the tRCT. For each pair of tRCT and systematic review of corresponding non-tRCTs we will estimate the ratio of relative risks, and hence estimate the degree of bias. We will use hierarchical multivariable regression to determine the factors associated with the magnitude of this ratio. Factors explored will include the presence and quality of a stopping rule, the methodological quality of the trials, and the number of total events that had occurred at the time of truncation. Finally, we will evaluate whether Bayesian methods using conservative informative priors to "regress to the mean" overoptimistic tRCTs can correct observed biases. A better understanding of the extent to which tRCTs exaggerate treatment effects and of the factors associated with the magnitude of this bias can optimize trial design and data monitoring charters, and may aid in the interpretation of the results from trials stopped early for benefit.
Publisher: Wiley
Date: 07-04-2015
DOI: 10.1111/DME.12752
Publisher: American Medical Association (AMA)
Date: 25-04-2017
Abstract: Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS). To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement. Starting in October 2008, participants were recruited at 23 centers in 13 countries follow-up finished in December 2013. Patients had hsTnT measurements 6 to 12 hours after surgery and daily for 3 days 40.4% had a preoperative hsTnT measurement. A modified Mazumdar approach (an iterative process) was used to determine if there were hsTnT thresholds associated with risk of death and had an adjusted hazard ratio (HR) of 3.0 or higher and a risk of 30-day mortality of 3% or higher. To determine potential diagnostic criteria for MINS, regression analyses ascertained if postoperative hsTnT elevations required an ischemic feature (eg, ischemic symptom or electrocardiography finding) to be associated with 30-day mortality. Among 21 842 participants, the mean age was 63.1 (SD, 10.7) years and 49.1% were female. Death within 30 days after surgery occurred in 266 patients (1.2% 95% CI, 1.1%-1.4%). Multivariable analysis demonstrated that compared with the reference group (peak hsTnT <5 ng/L), peak postoperative hsTnT levels of 20 to less than 65 ng/L, 65 to less than 1000 ng/L, and 1000 ng/L or higher had 30-day mortality rates of 3.0% (123/4049 95% CI, 2.6%-3.6%), 9.1% (102/1118 95% CI, 7.6%-11.0%), and 29.6% (16/54 95% CI, 19.1%-42.8%), with corresponding adjusted HRs of 23.63 (95% CI, 10.32-54.09), 70.34 (95% CI, 30.60-161.71), and 227.01 (95% CI, 87.35-589.92), respectively. An absolute hsTnT change of 5 ng/L or higher was associated with an increased risk of 30-day mortality (adjusted HR, 4.69 95% CI, 3.52-6.25). An elevated postoperative hsTnT (ie, 20 to <65 ng/L with an absolute change ≥5 ng/L or hsTnT ≥65 ng/L) without an ischemic feature was associated with 30-day mortality (adjusted HR, 3.20 95% CI, 2.37-4.32). Among the 3904 patients (17.9% 95% CI, 17.4%-18.4%) with MINS, 3633 (93.1% 95% CI, 92.2%-93.8%) did not experience an ischemic symptom. Among patients undergoing noncardiac surgery, peak postoperative hsTnT during the first 3 days after surgery was significantly associated with 30-day mortality. Elevated postoperative hsTnT without an ischemic feature was also associated with 30-day mortality.
Publisher: BMJ
Date: 2012
Publisher: BMJ
Date: 18-05-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2018
Publisher: Elsevier BV
Date: 02-2016
No related grants have been discovered for German Malaga.