Abstract Introduction: Hypertension (HTN) is a public health problem. The prevalence and mortality rates are significantly higher in middle and low-income countries, such as Peru. This study aimed to ...determine the trend of mortality attributable to HTN for the 2005-2016 period in Peru. Methods: We conducted a secondary analysis based on death certificates provided by the Ministry of Health. We applied linear regression models to test the HTN mortality rate trend. Results: The age-standardized HTN mortality per 100,000 inhabitants decreased from 14.43 for the 2005 to 2010 period to 11.12 for the 2011 to 2016 period. The coast was the natural region with the highest decrease in mortality rate. Moreover, Tumbes, Callao, and Lambayeque were regions with the highest decline in mortality rate. Conclusion: The age-standardized mortality attributable to HTN decreased in Peru, with variations in both natural and political regions of the country.
Resumo Introdução: A hipertensão arterial (HA) é um problema de saúde pública. As taxas de prevalência e mortalidade são significativamente mais altas em países de média e baixa renda, como o Peru. O objetivo do estudo foi determinar a tendência de mortalidade atribuível à HA para o período de 2005-2016 no Peru. Métodos: Realizamos uma análise secundária com base em atestados de óbito fornecidos pelo Ministério da Saúde. Aplicamos modelos de regressão linear para testar a tendência da taxa de mortalidade por HA. Resultados: A mortalidade por HA padronizada para idade por 100.000 habitantes diminuiu de 14,43 no período de 2005 a 2010 para 11,12 no período de 2011 a 2016. O litoral foi a região natural com maior queda na taxa de mortalidade. Além disso, Tumbes, Callao e Lambayeque foram as regiões com maior declínio na taxa de mortalidade. Conclusão: A mortalidade padronizada para idade atribuível à HA diminuiu no Peru, com variações tanto em regiões naturais como políticas do país.
ABSTRACT Introduction: Acute kidney injury (AKI) is a common disorder that causes high healthcare costs. There are limited epidemiological studies of this disorder in low- and middle-income ...countries. The aim of this study was to describe trends in the age-standardized incidence and mortality rates of AKI in Peru. Methods: We conducted an ecological study based on a secondary data sources of the basic cause of death from healthcare and death records obtained from establishments of the Ministry of Health of Peru for the period 2005-2016. The age-standardized incidence and mortality rates of AKI were described by region and trend effects were estimated by linear regression models. Results: During the period 2005-2016, 26,633 cases of AKI were reported nationwide. The age-standardized incidence rate of AKI per 100,000 people increased by 15.2%, from 10.5 (period 2005-2010) to 12.1 (period 2011-2016). During the period 2005-2016, 6,812 deaths due to AKI were reported, which represented 0.49% of all deaths reported for that period in Peru. The age-standardized mortality rate of AKI per 100,000 people decreased by 11.1%, from 2.7 (period 2005-2010) to 2.4 (period 2011-2016). The greatest incidence and mortality rates were observed in the age group older than 60 years. Conclusions: During the study period, incidence of AKI increased and mortality decreased, with heterogeneous variations among regions.
RESUMO Introdução: A lesão renal aguda (LRA) é um distúrbio comum que causa altos custos para a saúde. Existem estudos epidemiológicos limitados sobre esse distúrbio em países de baixa e média renda. O objetivo deste estudo foi descrever as tendências nas taxas de incidência e mortalidade padronizadas por idade da LRA no Peru. Métodos: Realizamos um estudo ecológico com base em fontes de dados secundárias da causa básica de morte de registros de saúde e óbito obtidos de estabelecimentos do Ministério da Saúde do Peru no período de 2005 a 2016. A incidência padronizada por idade e as taxas de mortalidade por LRA foram descritas por região, e os efeitos de tendência foram estimados por modelos de regressão linear. Resultados: No período de 2005 a 2016, 26.633 casos de LRA foram relatados em todo o país. A taxa de incidência padronizada de LRA por idade por 100.000 pessoas aumentou 15,2%, de 10,5 (período de 2005 a 2010) para 12,1 (período de 2011 a 2016). Durante o período de 2005 a 2016, foram relatadas 6.812 mortes por LRA, o que representou 0,49% de todas as mortes relatadas para esse período no Peru. A taxa de mortalidade por LRA padronizada por idade por 100.000 pessoas diminuiu 11,1%, de 2,7 (período de 2005 a 2010) para 2,4 (período de 2011 a 2016). As maiores taxas de incidência e mortalidade foram observadas na faixa etária acima de 60 anos. Conclusões: Durante o período do estudo, a incidência de LRA aumentou e a mortalidade diminuiu, com variações heterogêneas na epidemiologia entre as regiões.
The objectives of the study were to determine differences in the parameters of red blood cells (RBC), white blood cells (WBC), and platelets at low altitude (LA) and at high altitude (HA) and with ...the gestation being advanced, and to determine correlations between parameters of RBC and platelets. We also studied the association of RBC and platelets with markers of iron status. In addition, markers of iron status and inflammation were measured and compared at each trimester of gestation in pregnant women at LA and HA. A cross-sectional comparative study was conducted at Lima (150 m above sea level) and Cusco at 3400 m above sea level from May to December 2019. Hematological parameters in pregnant women (233 at LA and 211 at HA) were analyzed using an automated hematology analyzer. Serum ferritin levels, soluble transferrin receptor (sTfR), hepcidin, erythropoietin, testosterone, estradiol, and interleukin-6 (IL6) levels were measured by ELISA. One-way ANOVA supplemented with post hoc test, chi-square test, and Pearson correlation test statistical analyses were performed. p < 0.05 was considered significant. Pregnant woman at HA compared to LA had significantly lower WBC (p < 0.01), associated with higher parameters of the RBC, except for the mean corpuscular volume (MCV) that was no different (p > 0.05). Platelets and mean platelet volume (MPV) were higher (p < 0.01), and platelet distribution width (PDW) was lower at HA than at LA (p < 0.01). A higher value of serum ferritin (p < 0.01), testosterone (p < 0.05), and hepcidin (p < 0.01) was observed at HA, while the concentration of sTfR was lower at HA than at LA (p < 0.01). At LA, neutrophils increased in the third trimester (p < 0.05). RBC parameters decreased with the progress of the gestation, except RDW-CV, which increased. The platelet count decreased and the MPV and PDW were significantly higher in the third trimester. Serum ferritin, hepcidin, and serum testosterone decreased, while sTfR and serum estradiol increased during gestation. At HA, the WBC and red blood cell distribution width- coefficient of variation (RDW-CV), PCT, and serum IL-6 did not change with gestational trimesters. RBC, hemoglobin (Hb), hematocrit (Hct), mean corpuscular hemoglobin concentration (MCHC), and platelet count were lower as gestation advanced. MCV, MPV, and PDW increased in the third trimester. Serum ferritin, testosterone, and hepcidin were lower in the third trimester. Serum estradiol, erythropoietin, and sTfR increased as gestation progressed. Direct or inverse correlations were observed between RBC and platelet parameters and LA and HA. A better number of significant correlations were observed at HA. Hb, Hct, and RDW-CV showed a significant correlation with serum ferritin at LA and HA. Of these parameters, RDW-CV and PDW showed an inversely significant association with ferritin (p < 0.05). In conclusion, a different pattern was observed in hematological markers as well as in iron status markers between pregnant women at LA and HA. In pregnant women a significant correlation between several RBC parameters with platelet marker parameters was also observed. Data suggest that pregnant women at HA have adequate iron status during pregnancy as reflected by higher serum ferritin levels, lower sTfR levels, and higher hepcidin values than pregnant women at LA.
Introduction: Hypertension is a public health problem; sleep disturbances are conditions that predispose to hypertension and aggravate the quality of life of hypertensive patients.Objectives: To ...describe the characteristics of sleep quality in patients with hypertension in a national hospital in the city of Cusco-Peru, at 3400 meters above sea level (msnm).Material and Methods: A descriptive cross-sectional study was carried out with data of patients with arterial hypertension who attended an outpatient consultation of the cardiology service of a national hospital in Cusco-Peru between August and December, 2017. The patients were older than 40 years without comorbidities. To characterize sleep quality, Pittsburg sleep quality index was used with prior informed consent of the patients.Results: A total of 272 patients were studied. The average age was 65 years and the average time of the disease was 8 years. The results show that 75% of the patients had poor sleep quality and most of the patients had a sleep duration between 6 and 7 hours. All the patients presented some sleep disturbance and 94.1% did not take any medication to sleep.Conclusions: Sleep quality was poor in most of the patients studied. The follow-up of this clinical condition is necessary to evaluate the possible complications that it can cause in the long term.
Introducción: la hipertensión arterial es un problema de salud pública. Los disturbios del sueño son condiciones que predisponen a la hipertensión y agravan la calidad de vida de los pacientes hipertensos.Objetivo: describir las características de la calidad de sueño y las características de los pacientes con hipertensión arterial en un hospital nacional de Cusco-Perú a 3400 metros sobre el nivel del mar (msnm).Material y Métodos: se realizó un estudio descriptivo transversal con datos de pacientes con hipertensión arterial que acudieron entre los meses de agosto a diciembre de 2017 a consulta ambulatoria del servicio de cardiología de un hospital nacional de Cusco-Perú. Los pacientes fueron mayores de 40 años y sin comorbilidades. Para caracterizar la calidad de sueño se aplicó el cuestionario del índice de Pittsburg, previo consentimiento informado de los pacientes.Resultados: Se estudiaron 272 pacientes con hipertensión arterial, con edad promedio de 65 años y tiempo de enfermedad media de 8 años. El 75 % de los pacientes tenían mala calidad de sueño y la mayoría tenía una duración del sueño entre 6 y 7 horas. Todos los pacientes presentaron disturbios del sueño y el 94,1 % no usaba medicación para dormir. Conclusiones: La calidad de sueño en pacientes de la población estudiada fue mala en la mayoría. Es necesario hacer seguimiento de este parámetro clínico para evaluar las posibles complicaciones que puede ocasionar a largo plazo.
One of the leading causes of pneumonia in children between 5 to 15 years is Mycoplasma pneumoniae, a bacterium that causes atypical clinical manifestations such as myositis and encephalitis. We ...report a 5-year-old girl who presented functional limitations of the lower extremities preceded by an upper respiratory infection. Later on, she developed pneumonia and encephalitis. Antibiotics and antivirals were administered due to the clinical deterioration of the patient. IgM serology for Mycoplasma pneumoniae was positive, while the other viral studies were negative. The clinical course was favorable with a progressive decrease in respiratory distress, sensorial disorder, and improvement in the functional limitations of the lower limbs after 15 days of treatment.
Peru is a developing country with increasing scientific production. However, it is necessary to understand the trends, impact, and collaborative networks of research to plan for policy improvements.
...We analyzed the production, impact, and collaboration networks in the Peruvian scientific production between 2000 and 2019.
We did an observational analytical study. We searched Scopus for all the publications with at least one author with a Peruvian affiliation declared in the author byline. A descriptive analysis of the different characteristics, trends, and scientific collaboration was carried out. Collaboration networks were plotted using VOSviewer.
Between 2000 and 2019, Peru had a total of 24 482 publications in scientific journals, with an average annual growth of 13.6%. Of the total, 70% of all the articles were cataloged as Clinical Medicine and Biomedical Sciences. Only half of the articles had a Peruvian affiliation. The countries with the largest share of collaboration were the United States and Brazil, and the articles with international collaboration had the highest number of citations per publication.
Scientific production in Peru has increased in recent years, with a significant percentage of publications based on international collaboration and led by authors with non-Peruvian affiliations. It is necessary to strengthen collaboration ties between Peruvian and foreign institutions. Furthermore, it is essential to propitiate further research that will help solve the country's problems.
Actinomycosis is a rare infectious disease caused by Gram-positive bacteria. The most common species is Actinomyces israelii. Among its forms of presentation, the thoracic is the least frequent.
We ...report two patients with thoracic actinomycosis, 8 and 13 years old, from different geographical areas of Peru. The first case had empyema necessitans and the second, lung consolidation and recurrent hemoptysis. Both had a certain degree of difficulty in their diagnosis but responded favorably to antibiotics and surgical treatment. The diagnosis was based on the histopathological study. However, we were not able to ascertain the species of actinomyces.
Thoracic actinomycosis is rare in children and presents as a parenchymal lesion with possible fistulization to the chest wall. This article is one of the few in the Peruvian literature, constituting a contribution to the knowledge of the disease and its management in pediatrics.
Chronic kidney disease (CKD) is a growing public health problem and an important cause of morbidity and mortality. Disparities in CKD may be related to social determinants and health inequalities in ...low- and middle-income countries. This study determined how social determinants of health influence trends in the prevalence and mortality of CKD in Peru.
This was an ecological study based on a secondary analysis of health care and death records obtained from the Ministry of Health of Peru for the period 2010-2016. The standardized prevalence and mortality rates of CKD were descriptively reported using geospatial exploratory analysis. We also determined the association with social determinants of health according to the domains suggested by Healthy People 2020.
In the studied period, CKD prevalence increased by 300% and was associated with the health insurance coverage rate (β=5.9 95% CI 0.82 to 10.92), proportion of people with a secondary education level (β=11.4 95% CI 1.94 to 20.93), mean age (β=-10.7 95% CI -19.33 to -2.12), monetary poverty rate (β=-2.2 95% CI -3.88 to -0.60) and gross domestic product per capita (β=-63.2 95% CI -117.81 to -8.52). The standardized mortality decreased by 10% and was associated with mean age (β=-0.6 95% CI -1.22 to -0.06) and the proportion of people with a primary education level (β=-0.5 95% CI -0.9 to -0.05).
During the period 2010-2016, the prevalence of CKD increased and the mortality associated with CKD decreased. The observed changes were associated with some social determinants of health, such as increased health coverage and education. The health system of Peru must be prepared to take on the challenge.
Type 2 diabetes mellitus is a health problem in low and middle-income countries like Peru. There are few published reports on trends and surveillance of this disease in the young Peruvian population.
...To describe the prevalence of type 2 diabetes mellitus in the population under 30 registered between 2005 and 2018 by the Ministry of Health of Peru.
A descriptive study was conducted from a secondary analysis of the national registries of type 2 diabetes (ICD 10: E11) in the population under 30 treated in the health facilities of the Ministry of Health of Peru between 2015 and 2018. Described by department and geographic region, the prevalence of diabetes was adjusted for age and sex.
In the period between 2005 and 2018, the national prevalence of type 2 diabetes mellitus increased from 2.1 to 22.1 cases/100 000 population. Women had a higher prevalence. Geographic regions with the highest prevalence increase were the Coast from 3.8 to 35.3/100 000 population and the Rainforest from 1.1 to 22.1/100 000 population. In the same period, the departments with the highest prevalence increase were Cajamarca (1733.3%) and Puno (1704.2%). Furthermore, Tumbes, Ica, Lambayeque, Callao, Lima, Loreto, and Madre de Dios reported prevalence rates over the national average.
The prevalence of type 2 diabetes mellitus in the population under 30 and covered by the Peruvian Ministry of Health has increased more than ten times in the period between 2005 and 2018. The Coast and the cities with the highest population density had the highest prevalence. A greater focus to improve the strategies of risk factor control in the population under 30 is needed, including preventive actions on obesity and inadequate lifestyles, as well as a screening at a younger age for diabetes in the population at risk.
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