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Introduction and aim: Gastric cancer is one of the most frequent neoplasias in Peru and worldwide, with surgery as the only potentially curative or palliative treatment. Laparoscopic gastrectomy is the most frequent alternative surgical technique utilized, but one of its main drawbacks is the technical difficulty involved in perigastric lymphadenectomy. The aim of the present study was to evaluate the clinical and surgical characteristics, postoperative complications, and survival rate in patients with advanced gastric cancer that underwent open gastrectomy or laparoscopic gastrectomy at the Hospital Nacional P.N.P “Luis N. Sáenz” in Lima, Peru, within the time frame of 2005 to 2014. Materials and methods: An analytic, longitudinal, retrospective cohort study was conducted on 482 patients that underwent surgery for gastric cancer, within the time frame of January 2005 to December 2014. The clinical, epidemiologic, and postoperative characteristics were evaluated, and a survival analysis was carried out. Results: Of the 475 patients included in the study, 236 underwent open gastrectomy and 239 had laparoscopic gastrectomy. Median follow-up time was 61.9 months in the open surgery group and 46.7 months in the laparoscopy group. There were fewer postoperative complications in the laparoscopy group and no statistically significant difference between the two groups in relation to the survival analysis. Conclusions: In our study, laparoscopic gastrectomy resulted in fewer postoperative complications, compared with the open procedure, but did not modify overall survival during the follow-up period. Resumen: Introducción y objetivo: El cáncer gástrico es una de las neoplasias más frecuentes en el Perú y el mundo, con la cirugía como único tratamiento con potencial curativo y paliativo en otros casos, para la cual se utiliza con mayor frecuencia la gastrectomía laparoscópica como técnica quirúrgica alternativa, siendo las dificultades técnicas en la linfadenectomía perigástrica uno de sus principales inconvenientes. El presente estudio buscó evaluar las características clínicas y quirúrgicas, las complicaciones postoperatorias y la sobrevida en pacientes con cáncer gástrico avanzado utilizando gastrectomía abierta frente a la gastrectomía laparoscópica en el Hospital Nacional P.N.P «Luis N. Sáenz», en Lima-Perú, entre los años 2005 y 2014. Métodos: Se realizó un estudio analítico, longitudinal, de tipo cohorte retrospectiva, que incluyeron 482 pacientes operados por cáncer gástrico recolectados entre enero de 2005 a diciembre de 2014, evaluándose las características clínicas, epidemiológicas, postoperatorias y de análisis de supervivencia. Resultados: De los 475 pacientes incluidos, se realizaron 236 gastrectomías abiertas y 239 gastrectomías laparoscópicas, con una mediana de tiempo de seguimiento de 61.9 meses en el grupo de cirugía abierta y 46.7 meses en el grupo de laparoscopias, encontrando menores complicaciones postoperatorias en el grupo de cirugías laparoscópicas y sin diferencias estadísticamente significativas en los análisis de sobrevida entre ambos grupos. Conclusiones: Nuestro estudio encuentra que la cirugía laparoscópica tiene menores complicaciones postoperatorias en comparación a la gastrectomía abierta, pero sin modificar la sobrevida global durante el periodo de seguimiento. Keywords: Gastric cancer, Gastrectomy, Laparoscopy, Survival analysis, Palabras clave: Cáncer gástrico, Gastrectomía, Laparoscopia, Análisis de supervivencia

Objective: This study aims to determine surgical complications and graft outcome in children undergoing renal transplantation at Cayetano Heredia National Hospital (CHNH). Materials and Methods: A case study series focused on the incidence of surgical complications and graft outcome in pediatric patients with end stage renal disease (ESRD) who underwent renal transplant (RT) between December 2007 and March 2011. Results: The study described 29 pediatric transplant patients whose average age was 13.69 ± 3.38 (6.2-17.9) years. The etiology of end stage renal disease (ESRD) was renal hypoplasia in 12 patients (41.38%), primary glomerulopathy in 10 patients (34.48%), obstructive uropathy in 4 patients (13.79%), vasculitis in 2 patients (6.9%) and hemolytic uremic syndrome (HUS) in 1 (3.45%) patient. There were 11 surgical complications (34.48%): 2 cases of arterial thrombosis, 3 cases of urinary fistula, 3 of lymphocele, 1 of venous thrombosis, urinoma and perineal collection. The follow-up time was 15.84 ± 12.19 months. Graft survival at 12, 24, and 40 months was 89.29%, 77.16% and 77.16%, respectively. Conclusion: Surgical complications and graft survival in pediatric renal transplantation in our series did not differ from other published series.

Objetivo: Determinar la relación entre el grado de "trabeculación" vesical, el residuo pos miccional y el grado de obstrucción al flujo de salida urinario en pacientes con hiperplasia benigna de próstata (HBP) sintomática. Material y métodos: Serie de casos analítico y retrospectivo que incluyó 37 pacientes con HBP sintomática atendidos ambulatoriamente en el servicio de Urología del Hospital Nacional Cayetano Heredia en el 2009. El grado de "trabeculación" vesical se determinó por cistoscopia, el residuo vesical post-miccional por ecografía y el grado de obstrucción mediante uroflujometría. Resultados: La edad de los pacientes fue: 68,2 ± 7,9 (50-83) años. Los valores del volumen prostático, porcentaje de residuo post-miccional y el flujo máximo fueron: 46,4 ± 20,6 cc (20-113); 33,4% ± 20,7 (5- 80) y 6,7 ± 2,12 7 ml/seg (3-10), respectivamente. No se encontró correlación entre: el porcentaje de residuo post-miccional y el flujo urinario máximo (rs = -0,07; p=0,67) y entre el volumen prostático y el flujo máximo con (rs= 0,05; p= 0,7). Tampoco se encontró concordancia entre el grado de "trabeculación" vesical y el flujo máximo (Kappa= 0,0034; p=0,5) y entre el porcentaje de residuo post-miccional y el grado de "trabeculación" (Kappa= 0,18; p=0,06). Conclusión: No se encontró relación entre el flujo máximo urinario, el porcentaje de residuo post-miccional y el grado de "trabeculación", en pacientes con HBP sintomática. Objective: To determine the relationship between the degree of bladder trabeculation, post mictional residue and degree of urinary outflow obstruction in patients with benign prostatic hyperplasia (BPH). Methods: Retrospective case series of 37 ambulatory patients with symptomatic BPH attended at the Urology Service of Hospital Nacional Cayetano Heredia in 2009. The degree of bladder trabeculation was determined by cystoscopy, post-mictional residue was measured by ultrasound, and the degree of outflow obstruction was measured by uroflowmetry. Results: Mean (SD) age of patients was 68.2 ± 7.9 years. Mean (SD) values for prostatic volume, percentage of post-mictional residue and maximum flow were 46.4 ± 20.6 ml; 33.4 ± 20.7% y 6.7 ± 2.1 ml/seg, respectively. No correlation between the percentage of post-mictional residue and maximum urinary flow (rs = -0.07; p = 0.67), and between prostatic volume and maximum urinary flow was found (rs = 0.05; p = 0.7). There were also no correlations between the degree of bladder trabeculation and maximum urinary flow (Kappa = 0.0034; p = 0.5), and between the percentage of post-mictional residue and the degree of bladder trabeculation Kappa = 0.18; p = 0.06). Conclusions: No relationship was found between the maximum urinary flow, percentage of post-mictional residue and degree of trabeculation in patients with symptomatic BPH.

Highlights • This is the first study in youth Hispanic with T2D born and raised in Latin America. • Insulin resistance is the main pathophysiologic characteristic in this target group. • Therapeutic target should focus on insulin resistance., Objective To characterize and compare the beta-cell function and insulin resistance among Peruvian adolescents with type 2 diabetes (T2D) and their non-diabetic, overweight and lean peers. Methods Cross-sectional study of 54 adolescents aged 10–19 years, distributed in three sex- and age-matched groups (n = 18): (i) adolescents with T2D; (ii) overweight adolescents without T2D; and (iii) lean adolescents without T2D, at the Diabetes, Obesity and Nutrition Research Center in Lima, Peru. Fasting glucose, insulin, C-peptide, and glycated hemoglobin were measured for all participants. In addition, a two-hour oral glucose tolerance test (OGTT, 1.75 mg of glucose/kg body weight) was performed, during which glucose and C-peptide were quantified. The homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-B) were derived for all participants, and beta-cell function was further examined by the area under the curve (AUC) of C-peptide. Results The median HOMA-IR score was higher in adolescents with T2D compared to lean adolescents (6.1 vs. 2.1; p = 0.002), but was not different from that of overweight adolescents (6.1 vs. 4.0; p = 0.322). The median HOMA-B was higher in overweight adolescents than in lean adolescents (256.9 vs. 134.2; p = 0.015), and adolescents with T2D (256.9 vs. 119.8; p = 0.011). The mean AUC of glucose in adolescents with T2D was 1.8-fold higher than that of overweight adolescents, and 1.9-fold higher than that of lean adolescents (p

Objectives. To perform the psychometric validation of the International Index of Erectile Function (IIEF) in patients with erectile dysfunction. Materials and methods. Prospective case series to evaluate the validity and the reliability of the scale. Results. More than 90 % of experts considered that the IIEF questions evaluated the domains and the construct (content validity). There was a perfect concordance between the expert evaluation and the IIEF results (criteria validity, Kappa = 1). Significant differences were found in the score media by domains between patients with and without ED but when severity was evaluated, only differences in the erectile function domain were found (discriminatory validity). The Chronic Prostatitis Symptom Index (ISPC) and the IIEF showed divergent results (Kappa < 0.01, p = 0.44) in relation with the severity and the total scores showed no correlation (divergent validity) (rs = -0.22, p = 0.16). The correlation coefficients by domains were mild to moderate and the correlation between the total scores was high (rs = 0.8, p < 0.001) (test retest repeatability). A high degree of internal consistency with Cronbach's alpha values > 0.8 in the five domains was found. Conclusions. The cross-culturally validated IIEF in Peru is a valid and reliable instrument for its local use in the fields of clinics and research. Objetivos. Realizar la validación psicométrica del instrumento Índice Internacional de Función Eréctil (IIFE) en pacientes con Disfunción Eréctil (DE). Materiales y métodos. Serie de casos prospectivo donde se evaluó la validez y confiabilidad del cuestionario. Resultados. Más del 90 % de los expertos consideraron que las preguntas del IIEF evaluaban los dominios y el constructo (validez de contenido). Hubo una concordancia perfecta entre la evaluación del experto y los resultados del IIFE (Kappa = 1). Se encontró diferencias significativas en las medias del puntaje por dominios entre los pacientes con DE y sin DE pero al evaluar la severidad solo hubo diferencias en el dominio de función eréctil (validez discriminante). Con relación a la severidad, el Índice de Síntomas de Prostatitis Crónica (ISPC) y el IIFE mostraron resultados divergentes (Kappa < 0,01, p=0,44), y los puntajes totales no correlacionaron (validez divergente) (rs = - 0,22, p = 0,16). Los coeficientes de correlación por dominios fueron leves a moderados y la correlación entre los puntajes totales fue alta (rs = 0,8, p < 0,001) (fiabilidad test retest). Se encontró un alto grado de consistencia interna con un α-Cronbach > 0,8 en los cinco dominios. Conclusiones. El IIFE validado culturalmente en el Perú es un instrumento válido y confiable para su uso a nivel local en el campo clínico y de investigación.

Objetivo: Determinar el nivel de actividad física global de los pacientes con factores de riesgo cardiovascular, mediante el cuestionario IPAQ. Material y métodos: Estudio tipo serie de casos. La población estuvo compuesta por pacientes con hipertensión arterial, obesidad y diabetes mellitus entre 35 y 69 años de edad. Se utilizó el IPAQ para medir el nivel de actividad física. Resultados: De 180 entrevistados, 122 (67,8%) fueron del sexo femenino. La edad media fue 56,9 ± 8,8 años, el IMC promedio fue 29,0 ± 5,2 (18,6 - 48,5). Ciento nueve (60,5%) pacientes tenían un solo factor de riesgo cardiovascular modificable por medio de actividad física, 59 (32,8%) dos factores y 12 (6,7%) tres factores. El tiempo promedio de diagnóstico en meses fue 34,6 (hipertensos) y 51,1 (diabéticos). El nivel de actividad física fue trabajo en 30 (16,7%) pacientes, en 80 (44,4%) moderado y en 70 (38,9%) alto. No hubo diferencias en el nivel de actividad física según la edad y sexo. Se encontró diferencia significativa en los pacientes con hipertensión quienes tenían actividad moderada (p=0,02) en los hipertensos obesos quienes tenían actividad físca alta (p=0,07). Conclusión: El nivel de actividad física global de los pacientes con factores de riesgo cardiovascular seleccionados fue predominantemente moderado y alto.(Rev Med Hered 2011;22:115-120). Objective: To evaluate the global physical activity level of patients with cardiovascular risk factors, using IPAQ. Material and methods: Serial cases type. We included patients with arterial hypertension, obesity, diabetes between 35 to 69 years old. We used IPAQ, to measure physical activity level. Results: From 180 interviewed patients, 122 (67.8%) were female. The media age was 56.9 ± 8.8 years, the average BMI was 29.0 ± 5.2 (18.6 - 48.5). 109 (60.5%) presented one cardiovascular risk factor, 59 (32.8%) two risk factors and 12 (6.7%) three risk factors. The media diagnostic time in months was 34.6 (hypertensive patients) and 51.1 (diabetic patients). 30 (16.7%) patients had low level, 80 (44.4%) moderate and 70 (38.9%) high. There was no statistical difference between level of physical activity and sex or age. Hypertensive patients presented predominantly moderate level of physical activity (p = 0.02) and patients with hypertension + obesity showed predominantly high level of activity (p = 0.07). Conclusion: The level of global physical activity of patients with selected cardiovascular risk factors of our study was predominantly moderate and high.(Rev Med Hered 2011;22:115-120).

Objective: To assess the factors that affect the mortality in acute renal failure (ARF) in children. Patients and methods: We studied 149 patients with ARF and described the findings by age, gender, pathophysiological mechanism of renal damage, and type of renal damage, which can be oligoanuric and/or septic. We used multiple logistic analysis, Cox analysis for survival, and Kaplan–Meier curves. Results: The male/female ratio was 91/58. The most affected age groups were newborns (44.3%) and infants (37.6%). The ARF mechanism was ischemic in 87 cases (58%) and the most frequent clinical type was nonoliguric in 118 cases (79.2%). In the multiple logistic regression analysis, only oliguria (P=0.07) and age group (P=0.049) were associated with mortality. In the survival analysis using the Cox method, oliguria (P=0.003) and sepsis (P=0.03) were associated with mortality. The survival curves showed that the cumulative probability of dying in the first 10, 20, or 40 days after the event was 75, 70, and 45% respectively. When oliguria was present, the survival at day 10 was 47% and when sepsis was present it was 68%. Conclusion: Oliguria, age, and sepsis are factors associated with mortality in children with ARF.

Objetivos. Estimar la carga de enfermedad asociada al tabaquismo y evaluar el potencial impacto económico y en salud del aumento de los impuestos a los cigarrillos en el Perú. Materiales y métodos. Mediante un modelo de microsimulación se estimó el impacto en mortalidad, calidad de vida y costos atribuibles al tabaquismo por enfermedad cardiaca y cerebrovascular, enfermedad pulmonar obstructiva crónica, neumonía, cáncer de pulmón y otras nueve neoplasias. Se evaluaron tres escenarios de aumento de impuestos. Resultados. Un total anual de 16 719 muertes, 6926 diagnósticos de cáncer, 7936 accidentes cerebrovasculares y 7548 hospitalizaciones por enfermedad cardiovascular se pueden atribuir al tabaquismo en Perú. Asimismo, se pierden 396 069 años de vida por muerte prematura y discapacidad cada año, y el costo de tratar los problemas de salud ocasionados por el tabaco asciende a 2500 millones de soles (PEN 2015). Actualmente, los impuestos al tabaco llegan a cubrir solamente el 9,1% de dicho gasto. Un incremento del 50% en el precio de los cigarrillos podría evitar 13 391 muertes, 6210 eventos cardiovasculares y 5361 nuevos cánceres en los próximos diez años, y representaría un beneficio económico de 3145 millones (PEN) por ahorro de costos sanitarios y aumento de la recaudación impositiva. Conclusiones. La carga de enfermedad y el costo para el sistema de salud asociados al tabaquismo son elevados en Perú. Incrementar los impuestos al cigarrillo podría derivar en importantes beneficios para el país, tanto sanitarios como económicos. Objectives. To calculate the burden of smoking-related disease and evaluate the potential economic and health impact of tax-induced cigarette price increase in Peru. Materials and methods. A microsimulation model was used to estimate smoking-attributable impact on mortality, quality of life, and costs associated with heart and cerebrovascular disease, chronic obstructive pulmonary disease, pneumonia, lung cancer, and another nine cancers. Three scenarios, involving increased taxes, were evaluated. Results. A yearly total of 16,719 deaths, 6,926 cancer diagnoses, 7,936 strokes, and 7,548 hospital admissions due to cardiovascular disease can be attributed to smoking in Peru. Similarly, 396,069 years of life are lost each year from premature death and disability, and the cost of treating smoking-attributable health issues rises to 2,500 million soles (PEN 2015). Currently, taxes on tobacco cover only 9.1% of this expense. If cigarette prices were to increase by 50% over the next 10 years, 13,391 deaths, 6,210 cardiovascular events, and 5,361 new cancers could be prevented, representing an economic benefit of 3,145 million (PEN) in savings in health costs and increases in tax revenues. Conclusions. Smoking-attributable burden of disease and costs to the health system are very high in Peru. Higher cigarette taxes could have substantial health and economic benefits for the country.

OBJECTIVE: To determine the efficacy of Bixa Orellana (BO) in patients with benign prostatic hyperplasia (BPH) presenting moderate lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: It is a prospective double-blind randomized placebo-controlled study. One thousand four hundred and seventy eight patients presenting moderate LUTS associated to BPH were interviewed, from whom we selected 136 to fulfill the criteria of inclusion and exclusion. Assignation was performed at random in blocks of four to receive B0 at a dose of 250 mg 3 times a day or placebo (Pbo) for 12 months, 68 patients were assigned to each group. From the patients in the study we obtained data of demographic, epidemiologic, symptom score, uroflowmetry and post void residual urine variables. RESULTS: Basically both groups were compared clinically, demographically and biochemically. Throughout the study variations of symptom score, mean delta symptom score during each visit and the final average delta were similar for both groups (BO - 0.79 ± 1.87 and Pbo - 1.07 ± 1.49) (p = 0.33). Similarly variations of Qmax mean, Qmax average delta and final average delta were similar (BO 0.44 ± 1.07 and Pbo 0.47 ± 1.32) (p = 0.88). Variations of post void residual urine mean, post void residual urine average delta in each visit and the final average delta were similar for both groups (BO 4.24 ± 11.69 and Pbo 9.01 ± 18.66) (p = 0.07). No differences were found in the answers of clinically significant improvement assessed with relative risk and risk differences, even though the proportion of adverse effects was similar for both groups. CONCLUSION: Patients with BPH that present moderate LUTS did not show any benefit receiving BO when compared to placebo.