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This article summarizes the clinical practice guideline (CPG) for the management of acute pancreatitis in the Social Security of Peru (EsSalud), to provide evidence-based clinical recommendations for the management of acute pancreatitis in EsSalud. A guideline development group (GEG) was formed that included medical specialists and methodologists. The GEG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when considered relevant- primary studies were carried out in PubMed during 2022. The evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice, and the corresponding flow charts. Finally, the CPG was approved with Resolution No. 105-IETSI-ESSALUD-2022. This CPG addressed 7 clinical questions on fluid therapy, start of enteral nutrition, analgesia, type of nutrition, antibiotic, and surgical treatment. Based on these questions, 8 recommendations (1 strong and 7 conditional), 13 BPCs, and 1 flowchart were formulated. This article summarizes the methodology and evidence-based conclusions of the CPG for the management of acute pancreatitis in EsSalud.

Background: Pregnancy in women addicted represents, in itself, a major risk of destruction of physical and mental health of the unborn child; urgent prevention is the same as essential to providing quality care to the mother and child knowledge., Objective: Describe the physical and sociodemographic characteristics of neonates in intensive care units, born of mothers with addictions., Materials and Method: Cross-sectional, descriptive study of neonates with addict mothers, analyzing age, gender, clinical symptoms and complications. Findings for frequency-percentages with regard to qualitative variables, and medians and ranges for quantitative variables. SPSS-20.0-Windows Statistics software package., Results: 618 patients admitted to the NICU, 180(29%) showing withdrawal symptoms; irritability in 117 (63%), intensive crying in 93 (51%), spontaneous Moro reflex 74 (42%), diarrhea 61 (30%), fever 61 (30%). Birth defects 124 (20%), from greater to lesser occurrence: disorders in central nervous system, digestive tract and abdominal wall, extremities, kidneys, and others. 309 (50%) weight lower than 2600g. The most frequent metabolic disorders were hypoglycemia, Metabolic Acidosis and jaundice, among others., Conclusions: Every day, we see more children born of substance-dependent mothers in the Mexico. Our study reveals high mortality rate and many complications for this group; thus, it becomes necessary to institute preventive measures among Mexican women of childbearing age in order to prevent illegal drug use and to increase treatment among pregnant addicts. Gynecologists, pediatricians and neonatologists must have extensive knowledge regarding the entire clinical-social spectrum of symptoms that may be observed in children of mothers suffering addictions.

Background: Chronic myeloid leukemia represents 15 % of all the leukemias in adults. With the introduction of tyrosine kinase inhibitors, overall survival at 10 years is 80-90 %. The objective was to describe the epidemiology, complete cytogenetic response and major molecular response with tyrosine kinase inhibitors in patients with chronic myeloid leukemia., Methods: It was performed a descriptive cross-sectional study of patients with chronic myeloid leukemia and Philadelphia chromosome-positive in treatment with tyrosine kinase inhibitors., Results: The sample included 54 patients with a mean age of 41 years; 78 % of patients were in chronic phase, and in 8 % of patients were identified complex karyotype at diagnosis. All patients received imatinib as first-line treatment. We identified mutations in 8 %. The patients with primary or secondary resistance (30%) received second-generation tyrosine kinase inhibitors as a second-line therapy. Of 35 patients treated with imatinib, 23 had complete cytogenetic response, 23 had major molecular response, and 16 had loss of response to treatment. Of nine patients treated with nilotinib, two presented complete cytogenetic response, two major molecular response, and five loss of response to treatment. Of seven patients treated with dasatinib, two had complete cytogenetic response, two major molecular response, and four loss of response to treatment., Conclusions: Of patients studied, 30 % was resistant to imatinib, 52 % achieved a complete cytogenetic response, and 42 % major molecular response. The use of second generation tyrosine kinase inhibitors led to obtain a complete cytogenetic and major molecular response in fewer time.

Objective: to show clinical and therapeutic findings in patients with diagnosis of acute megakaryoblastic leukemia (AML)., Methods: twenty four patients with diagnosis AML was carried out. Clinical, laboratory survey results and treatment response were studied. Nineteen patients had primary form and five secondary, attended during a period of eight years. The diagnosis was established by a highly clinical suspicious, with immunophenotype cytometry flow or/and bone biopsy with immunohistochemistry study which proves definitely AML., Results: Fourteen were women, the median age was 43 years, 18 were treated with antineoplasic agents, ten obtained response, six complete and four partial. The response may improve with schemes with high dose of cytosine arabinoside., Conclusions: our results with the treatment showed that 27 % patients are alive under maintenance treatment long 18 months. The allogeneic bone marrow transplant seems to be one more option in long term.

Background: The antiinflammatory and gastric cytoprotector effect of angiotensin II AT1 receptor antagonist, such as candesartan, losartan and valsartan was studied., Material and Methods: Wistar rats were ramdomly assigned to receive: (1) 96 degrees ethanol; (2) oral indometacin, (3) solid food (pellets) during two hours and subcutaneous indometacin (production of ulcers in the gastric antrum), (4) Carrageen footpad edema., Results: The three ATI receptor angiotensin antagonists yielded gastric cytoprotection against 96 degrees ethanol, almost total gastrointestinal protection against oral indometacin, prevented gastric ulcers formation in the antrum induced by subcutaneous indometacin, remarkable antiinflammatory response against neutrophil infiltration on the gastrointestinal mucosa, and anti-inflammatory effect in carrageen footpad edema., Conclusions: The AT1 receptor antagonists of angiotensin II are gastric cytiprotectors with a remarkable antiinflammatory effect.

The use of all-transretinoic acid (ATRA) in APL is a great advance in the treatment of acute leukemia, driving the maturation steps until adult form. The effect of this medication in pregnant women with APL is being a safe and effective treatment only after the first trimester of pregnancy. If used in the first three months, it can cause fetus malformations due to its potent teratogenicity. The two patients we reported here, gave birth to normal children, yet they received ATRA. After a week with ATRA treatment, fibrinogen level improved and "D" dimers decreased, so as observed slowly maturation of leukemic leucocytes. ATRA used at the same time with chemotherapy; such as Cytarabine and Idarrubicine seems highly useful for induction and long term control of disease. One short discussion about the findings and compare with those found in the literature are presented.