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Introducción: La alta prevalencia de hipertensión arterial (HTA) es un problema de salud pública a nivel global. Diversas condiciones comprometen un adecuado control de esta enfermedad, siendo una de reciente interés las alteraciones del sueño. Describimos mediante una revisión narrativa los hallazgos recientes en la literatura acerca de los efectos de la calidad y cantidad de horas de sueño en pacientes hipertensos. Se seleccionaron 18 artículos que cumplieron los criterios de inclusión para esta revisión. En la presente revisión se detallarán los hallazgos encontrados en relación con las complicaciones que guardan relación con la duración y calidad del sueño en pacientes con HTA, así como factores predictores de una mala calidad del sueño en estos pacientes.

Objective: To evaluate the psychometric properties of the Spanish version of Jenkins Sleep Scale with 4 items (JSS-4) of the Peruvian health system's (PHS) nurses and physicians. Methods: We carried out a psychometric study based on secondary analysis in a sample from a nationally representative survey that used acomplex sampling design. The participants were physicians and nurses aged 18–65 years, working in PHS private and public facilities, who have fulfilled all JSS-4 items. We performed a confirmatory factor analysis. Reliability was evaluated via two estimates - classic alpha (α) and categorical omega (ω) coefficients. Also, we tested the invariance across groups of variables. The convergent validity was evaluated based on the relation between JSS-4 and PHQ-2 using Pearson's correlation coefficient and effect size (Cohen's d). Also, we designed normative values based on percentiles. Results: We included 2100 physicians and 2826 nurses in the analysis. We observed that the unidimensional model has adequate goodness-of-fit indices and values of α and ω coefficients. No measurement invariance was found between the groups of professionals and age groups; however, invariance was achieved between sex, monthly income, work-related illness, and chronic illness groups. Regarding the relation with other variables, the JSS-4 has a small correlation with PHQ-2. Also, profession and age-specific normative values were proposed. Conclusion: JSS-4 Spanish version has adequate psychometric properties in PHS nurses and physicians. Revisión por pares

Background The association between international migration and mental health is conditioned to several factors, and discrimination may play a significant role. Currently, Peru is one of the principal Venezuelan migrant-receiving countries in Latin America. There are around one million Venezuelan refugees and migrants in the country. This study evaluates the association between self-perceived discrimination and mental health problems in Venezuelan population living in Peru. Method We analyzed data from the Venezuelan Population Residing in Peru Survey 2018, a nationally representative urban sample aimed at collecting information on several dimensions of Venezuelan population wellbeing. We applied logistic regression models to assess the association between self-perceived discrimination and mental health problems. Moreover, we applied the propensity score matching method as a robustness check of our results. Results Of 9487 Venezuelans surveyed, 6806 included complete information. From this sample, 6.3% reported mental health problems related to fear, anger, anxiety, or stress. Logistic regression models showed that Venezuelans who perceived being discriminated against had 2.4 higher odds of presenting mental health problems than their non-discriminated counterparts. Moreover, propensity score matching models showed that Venezuelans who perceived being discriminated against increased by 3.5 percentage points their probability of presenting mental health problems compared to their non-discriminated counterparts. Conclusions There is evidence that self-perceived discrimination is associated with mental health deterioration in Venezuelan migrants living in Peru. Our findings are relevant in the current geopolitical context and could be useful in the decision making processes in international health.

Objetive: To identify factors associated with perceived quality of care in the adult population affiliated with Social Security Health (EsSalud) Material and methods: We analyzed the National Socioeconomic Survey of Access to Health of the EsSalud Insured. Perceived quality of health care was evaluated in ambulatory care, hospitalization and emergency medical services. We reported adjusted ratios of means (RMa) estimated by multiple Poisson regression. Results: Being employed (RMa=0.98; IC95% 0.96-0.99), not knowing the services provided by EsSalud (RMa=0.97; IC95% 0.95-1.00), not receiving information about right to health (RMa=0.95; IC95% 0.93-0.98), perceiving as low the level of accessibility to the health facility (RMa=0.97; IC95% 0.95-0.99) and not feeling comfortable in the health facility of EsSalud (RM=0.92; IC95% 0.91-0.94) were factors associated with lower scores of perceived quality in ambulatory care. In hospitalization, being between 40-59 years old (RMa=0.93; IC95% 0.88-0.97), having a low wealth index (RMa=0.92; IC95% 0.87-0.97), not having received information about right to health (RMa=0.90; IC95% 0.84-0.95) and not feeling comfortable in the health facility of EsSalud (RMa=0.92; IC95% 0.89-0.96) were associated with lower quality score. In emergency, not feeling comfortable in the health facility of EsSalud (RMa=0.89; IC95% 0.93-1.00) was the only factor associated with a lower perceived quality score. Conclusions: We identified factors related to users and service offerings independently associated with perceived quality of care, which can be considered by decision makers for better management of EsSalud.

Background: Depressive symptoms may affect female mid-life sexuality, whereas sexual problems tend to aggravate depression. Despite this, data assessing this association drawn from mid-aged Paraguayan women are scarce. Objective: This study aimed to assess the association between depressed mood and the risk of sexual dysfunction during female mid-life. Methods: Sexually active urban-living women from Asuncion, Paraguay (n = 193, aged 40-60 years) were surveyed with the 6-item Female Sexual Function Index (FSFI-6), the 10-item Center for Epidemiological Studies Depression Scale (CESD-10), and a general questionnaire containing personal and partner information. Depressed mood was defined as a total CESD-10 score of 10 or more, and an increased risk for sexual dysfunction as an FSFI-6 total score of 19 or less. The association of depressed mood and an increased risk of sexual dysfunction was evaluated with multivariable Poisson regression. Results: The mean age (+/- standard deviation) of surveyed woman was 48.3 +/- 6.0 years and 61.1% (n = 118) were perimenopausal and postmenopausal. A total of 21.8% (n = 42) had depressed mood and 28.5% (n = 55) had an increased risk of sexual dysfunction. The final adjusted regression model determined that women with depressed mood were twice as likely to have an increased risk of sexual dysfunction, compared to women with normal mood (adjusted prevalence ratio = 2.14, 95% confidence interval 1.26-3.60). On the other hand, depressed mood was associated with a mean total FSFI-6 score that was 20% lower than that observed among women with normal mood (adjusted incidence rate ratio = 0.80, 95% confidence interval 0.68-0.93). Conclusion: In this mid-aged Paraguayan female sample there was a significant association between depressed mood and an increased risk of sexual dysfunction.

Objective To design and validate a questionnaire on the knowledge of primary open-angle glaucoma (POAG) in Spanish-speaking patients. Methods An observational study was conducted on adults with diagnosis of POAG and who received outpatient medical care in a national reference health care institute of Peru. The questionnaire was based on a literature review and expert judgment. A pilot study was carried out on 60 patients. The items were classified and weighted according to the expert judgment. The final questionnaire was completed by 314 patients and its overall score was scaled by tertiles. Results A total of 72 items were found by primary searching. The initial questionnaire was made up of 20 items, which was tested in a pilot study. A total of 14 items were selected that were then classified into three weighted domains: risk factors (10 %), clinical aspects (36 %), and treatment (54 %). The questionnaire has a score range from 0 to 100 points (lowest to highest level). In patients, the mean score was 62.6 ± 14.1. The overall score was classified into three categories of knowledge level: low (0–55 points), medium (56–69 points), and high (70–100 points). Conclusions The questionnaire provides evidence of validity to assess knowledge of POAG in Peruvian Spanish-speaking patients.

International migrants are a particularly vulnerable group in the context of the coronavirus disease 2019 (COVID-19) pandemic. Immigrants in Chile tend to experience multidimensional poverty and layers of social vulnerability. Our analysis aims to describe the perceived social and health-related needs of international migrants during the COVID-19 pandemic in Chile in terms of migration as a social determinant of health and layered social vulnerability. We carried out a qualitative analysis of responses to an open-ended question focused on the social and health-related needs linked to the pandemic included in an online questionnaire disseminated during April 2020 aimed at international migrants residing in Chile. The information gathered was thematically analysed. We included 1690 participants. They expressed needs related to health and others linked to the overall socio-economic and political response, employment, material conditions and psychosocial aspects. They also reported needs related to ‘being a migrant’. Additionally, some participants described situations of vulnerability. We analysed their needs and situations of vulnerability identified around the following emerging frames: (a) work and living conditions, (b) regularisation traps and perceived lack of support and (c) and physical and mental health needs. International migrants in Chile report experiencing interrelated layers of social vulnerability during the COVID-19 pandemic, where ‘being a migrant’ exacerbates physical and mental health risks. The issues revealed are immediate and direct public health challenges, as well as different aspects of social vulnerability linked to migratory status, employment and barriers to accessing healthcare that should be addressed through comprehensive policies and measures.

To evaluate the association between premature ovarian insufficiency (POI) and mortality.This was a secondary analysis of a long-term cohort of Chilean women who received preventive health care between 1990 and 1993. The exposure variable was POI and the outcome was death, and follow-up time was 30 years. Patient data were extracted from medical records. Data related to deaths were obtained from the records of the official government registry as of January 2021. Cox regression proportional hazard models were used to estimate crude and adjusted hazard ratios (HR) and 95 % confidence intervals (CI).Data for a total of 1119 women were included in the analysis. Median age was 47 years (interquartile range: 44-52). The baseline prevalence of POI was 6.7 %. At the end of the follow-up, 34.7 % of women with POI had died, compared with 19.3 % of women without the condition (p 0.001). A larger proportion of women with POI died from cardiovascular disease (12.0 % vs. 5.1 %; OR: 2.55, 95 % CI: 1.21-5.39) whereas there was no significant difference in cancer mortality (6.7 % vs. 7.7 %; OR: 0.86, 95 % CI: 0.34-2.19). In the adjusted Cox model, POI was among the main factors associated with mortality (hazard ratio [HR] 1.60, 95 % CI: 1.03-2.47), after diabetes (HR 2.51, 95 % CI: 1.40-4.51) and arterial hypertension (HR 1.75, 95 % CI: 1.29-2.37).Although POI affects a small group of women, its association with mortality seems to be relevant; hence it is necessary to implement measures that reduce this risk.

Background To assess the validity and reliability of the set of scales (general professional activity, health services management, and working conditions) on the different areas of job satisfaction in Peruvian physicians based on the data from the National Survey of Satisfaction of Users in Health (ENSUSALUD). Method We carried out a psychometric study based on the secondary data analysis of Questionnaire 2 of ENSUSALUD-2016. Participants were selected from a two-stage stratified national probability representative sampling by political region. Validity was assessed by exploratory and confirmatory factor analyses, and measurement invariance analysis. We assessed the reliability using internal consistency coefficients (alpha and omega). The set of scales were composed of items related to three different areas of job satisfaction: 1) satisfaction with general professional activity, 2) satisfaction with the health services management, and 3) satisfaction with the working conditions of the health center. Results We included 2137 participants in the analysis. The general professional activity scale with six items (Comparative Fit Index, CFI = 0.946; Root Mean Square Error of Approximation, RMSEA = 0.071; Standardized Root Mean Square Residual, SRMR = 0.035), the health services management scale with eight items (CFI) = 0.972; RMSEA = 0.081; SRMR = 0.028), showed good measurement properties for the one-dimensional model. The working conditions scale with eight items for individual conditions and three items for infrastructural conditions (CFI = 0.914; RMSEA = 0.080; SRMR = 0.055) presented adequate measurement properties with a two-dimensional model. The invariance analysis showed that comparisons between sex, age, civil status, medical speciality, working in other institutions, work-related illness, chronic disease, and time working in the healthcare center. All scales had adequate internal consistency (ω and α between 0.70 and 0.90). Conclusions The set of scales has a solid factorial structure and measurement invariance, making it possible for group comparison. The study achieved stability in the scores as they showed adequate internal consistency coefficients. Based on our findings, these instruments are suitable for measuring job satisfaction among outpatient physicians throughout Peru, as our data is representative of the country level.

We evaluated the relationship between job satisfaction, burnout syndrome, and depressive symptoms among Peruvian physicians using the job demand–control framework. We carried out a secondary data analysis of the National Survey of Satisfaction of Users in Health 2016 in Peru. The first part was based on the association among the variables based on the job demand–control framework. The second part focused on estimating the acceptability of the proposed model based on the study variables through the structural equation modeling technique. A total of 2,100 physicians were included, and the prevalence of depressive symptoms was 3.3%. Physicians who had a work-related illness were more than twice as likely to have depressive symptoms (PR=2.23) compared with those who did not. The first predictive model based on the variables, depressive symptoms, burnout syndrome, and job satisfaction had a low goodness-of-fit index. Therefore, for a second evaluation, models with correlated errors were considered, and optimal goodness-of-fit indices were found (CFI=0.974; RMSEA=0.060). Our study identified a stable model to explain the relationship between job satisfaction, burnout, and depressive symptoms among physicians. The results are consistent with the job demand–control framework and can be applied to decision making in occupational contexts in Peru.

Objective: This study aimed to evaluate the association between the intensity of menopausal symptoms and highly active antiretroviral therapy (HAART) adherence in middle-aged women with human immunodeficiency virus (HIV) infection. Methods: In this cross-sectional study, 313 Peruvian women with HIV infection (age 40-59 years) were surveyed and classified as adherent or non-adherent to HAART based on the Antiretroviral Treatment Adherence Evaluation Questionnaire. The intensity of menopausal symptoms was assessed with the Menopause Rating Scale, and categorized as none, mild, moderate, and/or severe. Age, sexual orientation, used HAART scheme, time since HIV diagnosis, menopausal status, risk of depression, and presence of comorbidities were also assessed. Poisson generalized linear models with robust variance were performed in order to estimate crude prevalence ratios (PRs) and adjusted PRs using statistical (a1PR) and epidemiological criteria (a2PR). Results: A total of 19.9%, 32.6%, and 15.0% of all women presented mild, moderate, and severe menopausal symptoms, respectively. Overall, 70.6% women were non-adherent to HAART. The probability of non-adherence was higher in women with mild, moderate, and severe symptoms as compared to asymptomatic women in the non-adjusted model (PR: 1.79, 95% confidence interval [CI]: 1.39–2.29; PR: 1.76, 95% CI: 1.38–2.23; and PR: 2.07, 95% CI: 1.64–2.61, respectively) and the adjusted model. Conclusion: The severity of menopausal symptoms was associated with HAART non-adherence in HIV-infected middle-aged women. Revisión por pares

Menopause and aging are associated with changes in circulating gonadal steroid hormones, insulin sensitivity, body composition, and also lifestyle and social coordinates. Vitamin D status influences different metabolic adjustments, aside from calcium-phosphorus and bone metabolism. The main blood marker used to measure endogenous vitamin D status is 25-hydroxyvitamin D. Aging is associated with increases in serum parathyroid hormone and alkaline phosphatase, and a decrease of serum calcium, phosphorus, and vitamin D metabolites. 25-Hydroxyvitamin D status is also influenced by the circannual rhythm of sun irradiation. Results of clinical association studies have not correlated with intervention trials, experimental studies, and/or meta-analyses regarding the role of vitamin D on different outcomes in women during their second half of life and the vitamin D supplementation dose needed to improve clinical endpoints. Discordant results have been related to the method used to measure vitamin D, the studied population (i.e., sociodemographics and ethnicity), study designs, and biases of analyses. Vitamin D supplementation with cholecalciferol or calcifediol may improve some metabolic variables and clinical outcomes in young postmenopausal and older women. Studies seem to suggest that calcifediol may have some advantages over other forms of vitamin D supplementation. Further studies are needed to define interventions with supplements and effective food fortification.

Objetivo. Describir la evolución de la cobertura de aseguramiento en salud (CAS) en Perú para el periodo 2009-2017 y evaluar los principales factores demográficos, sociales y económicos asociados. Materiales y métodos. Realizamos un análisis secundario de la Encuesta Nacional de Hogares. Para cada año estimamos la CAS global, del Seguro Integral de Salud (SIS) y del Seguro Social en Salud (EsSalud), y realizamos pruebas de tendencias anuales. Para los años 2009 (Ley de Aseguramiento Universal en Salud), 2013 (reforma del sector salud) y 2017, construimos una variable politómica del tipo de aseguramiento (SIS/EsSalud/No asegurado) y estimamos razones relativas de prevalencia (RRP) con intervalos de confianza (IC) al 95% mediante modelos logísticos multinomiales para muestras complejas. Resultados. Observamos un incremento en la CAS global (2009: 60,5%; 2013: 65,5%; 2017: 76,4%), en el SIS (2009: 34%; 2013: 35,4%; 2017: 47%) y en EsSalud (2009: 22,8%; 2013: 26,4%; 2017: 26,3%). Observamos que ser mujer aumentó la posibilidad de afiliación al SIS (RRP=2009: 1,64 y 2017: 1,53), mientras que tener entre 18 y 39 años, residir Lima Metropolitana y ser no pobre redujeron esa posibilidad (RRP=2009: 0,16 y 2017: 0,31; 2009: 0,17 y 2017: 0,37; 2009: 0,51 y 2017: 0,53; respectivamente). Por su parte, ser mujer, tener más de 65 años, ser del ámbito urbano, residir en Lima Metropolitana y ser no pobre aumentó la probabilidad de estar afiliados a EsSalud (RRP=2013: 1,12 y 2017: 1,24; 2013: 1,32 y 2017: 1,34; 2009: 2,18 y 2017: 2,08; 2009: 2,14 y 2017: 2,54; 2009: 3,57 y 2017: 2,53; respectivamente). Conclusiones. La CAS ha incrementado durante el periodo 2009-2017. No obstante, las características de la población asegurada difieren de acuerdo con el tipo de seguro. Objective. To describe the trends in health insurance coverage (HIC) in Peru during the period 2009-2017 and evaluate associations with demographic, social and economic factors. Materials and Methods. We carried out a secondary data-analysis from the Peruvian National Household Survey. For each year, we estimated the global HIC, for the Integral Health Insurance (SIS) and the Social Security system (EsSalud). In addition, we performed a trend analysis. For 2009 (Universal Health Insurance Act), 2013 (health care reform act) and 2017, we used a polytomous variable for the insurance type (SIS/EsSalud/Non-affiliated). We performed logistic multinomial regressions to estimate relative prevalence ratios (RPR) and their 95% CI with correction for complex sampling. Results. We observed an increasing trend in the global HIC (2009:60.5%; 2013:65.5%; 2017:76.4%), SIS coverage (2009:34%; 2013:35.4%; 2017:47%) and EsSalud coverage (2009:22.8%; 2013:26.4%; 2017:26.3%). Multinomial logistic regressions showed that being a woman increased the likelihood to be affiliated to the SIS (RPR= 2009:1.64 and 2017:1.53), while people between 18 and 39 years old, living in Lima Metropolitan area under non-poverty conditions reduced the likelihood to be affiliated to the SIS (RPR= 2009:0.16 and 2017:0.31; 2009:0.17 and 2017:0.37; 2009:0.51 and 2017:0.53; respectively). Furthermore, being a woman, 65 years old or over, living in urban Lima, and under non-poverty conditions increased the likelihood of being affiliated with the EsSalud (RPR= 2013:1.12 and 2017:1.24; 2013:1.32 and 2017:1.34; 2009:2.18 and 2017:2.08; 2009:2.14 and 2017:2.54; 2009:3.57 and 2017:2.53; respectively). Conclusions. HIC has increased during the period 2009-2017. However, the characteristics of those affiliated are different between the various types of health insurance.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. Carta al editor. Revisión por pares

Peru, one of the most affected countries by the coronavirus disease 2019 (COVID‐19) pandemic, imposed one of the earliest and toughest lockdowns in the world.1 Despite regional variations, the overall picture situates Peru amongst the worst hit in the number of cases, deaths per million, and total excess deaths.2 Factors contributing to these results are diverse, including geopolitics, international supply chain, political instability, social and economic crisis, and corruption...

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. Objective: To evaluate the safety and tolerability of an oral herbal supplement containing glucosinolates, phytosterols, and citrus flavonoids (Warmi®, Lima Perú;) in otherwise healthy adult women. Methods: This was a phase-I, randomized parallel three arms, double-blinded, and a placebo-controlled clinical trial. A total of 55 participants aged 18-40 were randomly assigned to one of three groups to receive for three months: (1) an oral herbal supplement of 1650 mg/day; (2) an oral herbal supplement of 3300 mg/day; or (3) an oral placebo 3300 mg/day. The primary endpoints were oral safety and tolerability of the supplement. The secondary endpoint was its effect on vital functions, anthropometrics, and laboratory tests. We used an exploratory approach by covariance analysis (ANCOVA) adjusted for the variables’ baseline value for the secondary outcomes. Results: All women completed three months of follow-up, reporting no side effects. Our exploratory analysis revealed that treatment with the herbal supplement of 1650 mg/day was associated with increased glucose and uric acid levels. In comparison, the herbal supplement 3300 mg/day was associated with reduced breathing rate, increased basal temperature, and systolic blood pressure, both compared to the placebo group. However, despite significant differences, none of these was clinically significant. Conclusion: The oral herbal supplement had a favorable safety and tolerability profile in studied women. There is a need to study its potential as an option to treat menopausal symptoms. Revisión por pares

Background: To assess the evidences of validity and reliability of a set of scales on different areas of job satisfaction (general professional activity, health services management, and working conditions) in Peruvian physicians based on data from the National Survey of Satisfaction of Users in Health (ENSUSALUD). Method: We carried out a psychometric study based on secondary data analysis. Participants were selected from a two-stage probabilistic national representative sampling stratified by political region. Validity was assessed by exploratory and confirmatory factor analysis and measurement invariance analysis. Reliability was assessed by internal consistency coefficients (alpha and omega). The set of scales was composed of items related to three different areas of job satisfaction: 1) satisfaction with general professional activity, 2) satisfaction with the health services management, and 3) satisfaction with the working conditions of the health center. Results: We included 2,137 participants in the analysis. General professional activity scale with 6 items (CFI=0.946; RMSEA=0.071; SRMR=0.035) and the health services management scale with 8 items (CFI=0.972; RMSEA=0.081; SRMR=0.028) showed good measurement properties for the one-dimensional model. The scale of working conditions presented adequate measurement properties with a two-dimensional model (CFI=0.914; RMSEA=0.080; SRMR=0.055): individual conditions (8 items) and infrastructural conditions (3 items). The invariance analysis presented that comparisons can be made between sex, age, civil status, medical specialty, working in other institutions, work-related illness, chronic disease, and time working in health care center. All scales had adequate internal consistency (ω and α between 0.70 and 0.90). Conclusions: The set of scales solid factorial structure and measurement invariance, which makes it possible for group comparison. They also achieved stability in their scores as they showed adequate internal consistency coefficients. Based on our findings, these instruments are suitable for measuring job satisfaction among outpatient physicians throughout Peru, as our data is representative at the country level.

Since the COVID-19 pandemic began in China in late 2019, infection from the SARS-CoV-2 virus has spread virtually worldwide. This infection has adversely affected several countries; governments have outlined a series of political measures aimed to preserve the health and safety of their populations. In Peru, most actions have prioritised COVID-19 attention, with a subsequent gap in the healthcare facilities needed for other diseases. Cancer, one principal cause of death in the country, is usually diagnosed late. Moreover, in the pandemic context, the prevention and control of cancer have been negatively affected. Therefore, we carried out a multidisciplinary analysis using the Ishikawa diagram to identify the probable factors that contribute to cancer progression and deaths in Peru.

Introduction: Biological products, including infliximab (INF), are a therapeutic option for various medical conditions. In the Peruvian Social Security (EsSalud), infliximab is approved for the treatment of rheumatoid arthritis, psoriasis, psoriatic arthropathy, ankylosing spondylitis, ulcerative colitis and Crohn’s disease (in cases refractory to conventional treatment). Biosimilars are a safe and effective alternative approved for these diseases in patients who start treatment with infliximab. Nevertheless, there are people in treatment with the biological reference product (BRP), in whom the continuing therapy with a biosimilar biological product (BBP) must be evaluated. Objectives: To synthesize the best available evidence, calculate a preliminary financial impact and conduct technical discussions about the interchangeability into biosimilar in patients receiving treatment with original infliximab for medical conditions approved in EsSalud. Methodology: We carried out a systematic review of controlled clinical trials. Primary search was performed in Pubmed- MEDLINE, SCOPUS, WOS, EMBASE, TRIPDATABASE, DARE, Cochrane Library, NICE, AHRQ, SMC, McMaster-PLUS, CADTH, and HSE until June-2018. We used the Cochrane Collaboration tool to assess the risk of bias. Also, we implemented a preliminary financial analysis about the impact of biosimilar introduction on institutional purchasing budget. Moreover, technical meetings with medical doctors specialized in rheumatology, gastroenterology and dermatology were held for discussing findings. Results: In primary search, 1136 records were identified, and 357 duplicates were removed. From 799 records, we excluded 765 after title and abstract evaluation. From 14 full-text appraised documents, we included five clinical trials in the risk of bias assessment: four studies evaluated CTP-13 and one tested SB2. Two double-blind clinical trials reported no differences in efficacy and safety profiles between maintenance group (INF/INF) and interchangeability group in all diseases included (INF/CTP-13) and rheumatoid arthritis (CTP13 and SB2). In the other three studies, open-label extension of primary clinical trials, no differences were founded in efficacy and safety profiles between CTP-13/CTP-13 and INF/CTP-13 groups. In financial analysis, the inclusion of biosimilars implied savings around S/7´642,780.00 (1USD=S/3.30) on purchasing budget of EsSalud. In technical meetings, beyond certain concerns, specialists agreed with the findings. Conclusions: Evidence from clinical trials support that there are no differences in efficacy or safety of continuing the treatment with Infliximab BRP or exchanging into its biosimilar in patients with medical conditions approved in EsSalud. Financial analysis shows that the biosimilar introduction produce savings in purchasing institutional budget. Therefore, based on cost-opportunity principle, exchanging into biosimilar in patients receiving the original Infliximab, is a valid therapeutic alternative in the Peruvian Social Security.

Objective: To evaluate the association between dysnatremias or dyschloremias and mortality during hospitalization in patients with acute kidney injury (AKI) or chronic kidney disease (CKD) undergoing acute hemodialysis. Methods: We carried out a retrospective cohort study on adult patients undergoing acute hemodialysis with AKI or CKD diagnosis at a public hospital in Lima, Peru. Dysnatremias were categorized as hyponatremia (Na < 135mmol/L) or hypernatremia (Na > 145mmol/L), and dyschloremias were defined as hypochloremia (Cl < 98 mmol/L) or hyperchloremia (Cl > 109mmol/L). The outcome of interest was mortality during hospitalization. We performed generalized lineal Poisson family models with bias-corrected and accelerated non-parametric bootstrap to estimate the risk ratios at crude (RR) and adjusted analysis (aRR) by gender, age, HCO3 (for all patients) and Liaño score (only for AKI) with CI95%. Results: We included 263 patients (mean age: 54.3 years, females: 43%): 191 with CKD and 72 with AKI. Mortality was higher in patients with AKI (59.7%) than in patients with CKD (14.1%). In overall, patients with hypernatremia had a higher mortality during hospitalization compared to those who had normal sodium values (aRR: 1.82, 95% CI: 1.17-2.83); patients with hyponatremia did not have different mortality (aRR: 0.19, 95% CI: 0.69-2.04). We also found that hyperchloremia (aRR: 1.35, 95% CI: 0.83-2.18) or hypochloremia (aRR: 0.66, 95% CI: 0.30-14.78) did not increase mortality in comparison to normal chloride values. No association between dysnatremias or dyschloremias and mortality during hospitalization was found in CKD and AKI subgroups. Conclusions: In our exploratory analysis, only hypernatremia was associated with mortality during hospitalization among patients with AKI or CKD undergoing acute hemodialysis. Resumo Objetivo: Avaliar a associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar de pacientes com insuficiência renal aguda (IRA) ou doença renal crônica (DRC) submetidos a hemodiálise aguda. Métodos: O presente estudo de coorte retrospectiva incluiu pacientes adultos submetidos a hemodiálise aguda com diagnóstico de IRA ou DRC em um hospital público de Lima, Peru. Os distúrbios do sódio foram classificados como hiponatremia (Na < 135mmol/L) ou hipernatremia (Na > 145mmol/L), enquanto os distúrbios do cloro foram classificados como hipocloremia (Cl < 98 mmol/L) ou hipercloremia (Cl > 109mmol/L). O desfecho de interesse foi mortalidade hospitalar. Utilizamos modelos de Poisson da família de modelos lineares generalizados com bootstrap não-paramétrico e correção de viés acelerado para estimar os riscos relativos na análise bruta (RR) e ajustada (RRa) para sexo, idade, HCO3 (para todos os pacientes) e escore de Liaño (apenas para IRA) com IC 95%. Resultados: Foram incluídos 263 pacientes (idade média 54,3 anos; 43% do sexo feminino), 191 com DRC e 72 com IRA. A mortalidade foi mais elevada nos pacientes com IRA (59,7%) do que nos indivíduos com DRC (14,1%). No geral, os pacientes com hipernatremia tiveram mortalidade hospitalar mais elevada do que os indivíduos com valores normais de sódio (RRa: 1,82; IC 95%: 1,17-2,83). Os pacientes com hiponatremia não apresentaram mortalidade diferente (RRa: 0,19; IC 95%: 0,69-2,04). Também identificamos que hipercloremia (RRa: 1,35; IC 95%: 0,83-2,18) e hipocloremia (RRa: 0,66; IC 95%: 0,30-14,78) não elevaram a mortalidade em comparação a indivíduos com níveis normais de cloro. Não foi encontrada associação entre distúrbios do sódio ou do cloro e mortalidade hospitalar nos subgrupos com DRC e IRA. Conclusões: Em nossa análise exploratória, apenas hipernatremia apresentou associação com mortalidade hospitalar em pacientes com IRA ou DRC submetidos a hemodiálise aguda.