Search

Objective. To evaluate the effectiveness of percutaneous balloon valvuloplasty (PBV) in pulmonary valvular stenosis (PS) in pediatrics and its results during follow-up. Methods. Eighty patients with PE who underwent PBV between January 2014 and December 2019 were studied. Demographic, echocardiographic and hemodynamic characteristics of the procedure are detailed through descriptive statistics while parametric and non-parametric statistical tests were used in the follow-up in relation to pulmonary insufficiency and restenosis. Results. The age range was 2 years (interquartile range RIQ 10.5 - 72 months), the predominant sex was male with 56.2%. The transvalvular pulmonary gradient decreased from 61.7 ± 21.2 mmHg to 17 mmHg (RIQ: 11 - 26 mmHg). The immediate BPV success rate was 90%. The median follow-up time was 21 months (RIQ: 5-47.5 months). All patients at follow-up showed some degree of pulmonary insufficiency at each cut-off point, 17% of the cases at the end of follow-up were found to have severe insufficiency. Three cases of long-term restenosis were found (3.8%) and 6 cases (7.5%) were admitted to the operating room for plasty or pulmonary valve replacement. Reported complications reached 10% of cases, of which two patients were admitted to surgery during the procedure for major complications. A significant association was found with severe pulmonary insufficiency at the end of follow-up and the annulus/balloon ratio. Conclusions. BPV is an effective technique in the treatment of pulmonary valve stenosis, with reported complications, but with good results during follow-up. Objetivo. Evaluar la efectividad de la valvuloplastia percutánea con balón (VPB) en estenosis valvular pulmonar (EP) en pediatría y sus resultados durante el seguimiento. Métodos. Se estudiaron 80 pacientes con EP a quienes se les realizaron VPB entre enero de 2014 y diciembre de 2019. Las características demográficas, ecocardiográficas y hemodinámicas del procedimiento se detallan a través de una estadística descriptiva en tanto que en el seguimiento se utilizó pruebas estadísticas paramétricas y no paramétricas con relación a insuficiencia pulmonar y reestenosis. Resultados. El rango de edad fue de 2 años (rango intercuartil RIQ 10,5 - 72 meses), el sexo predominante fue masculino con 56,2%. La gradiente transvalvular pulmonar disminuyó de 61,7 ± 21,2 mmHg a 17 mmHg (RIQ: 11 - 26 mmHg). La tasa de éxito inmediato de la VPB se situó en el 90%. La mediana del tiempo de seguimiento fue de 21 meses (RIQ: 5-47,5 meses). Todos los pacientes en el seguimiento mostraron algún grado de insuficiencia pulmonar en cada punto de corte, en el 17% de los casos al final de su seguimiento se encontró insuficiencia severa. Se encontró tres casos de reestenosis a largo plazo (3,8%) y 6 casos (7,5%) que ingresaron a sala de operaciones para plastia o recambio valvular pulmonar. Las complicaciones reportadas alcanzaron 10% de casos, de los cuales dos pacientes ingresaron a cirugía durante el procedimiento por complicaciones mayores. Se encontró asociación significativa con insuficiencia pulmonar severa al final del seguimiento y la relación anillo/balón. Conclusiones. La VPB es una técnica efectiva en el tratamiento de la estenosis valvular pulmonar, con complicaciones reportadas, pero con buenos resultados durante el seguimiento.

Objetive: To issue contextualized recommendations for the management of type 2 diabetes mellitus in patients with heart failure. Materials and methods: GPC published in the last 3 years were systematically searched in databases, repositories, and guideline development organizations. Those that achieve a score >60% in the overall evaluation with the AGREE-II instrument were selected. From each guide, the recommendations with their respective clinical question were extracted. The acceptability and applicability of the recommendations to the Peruvian context were evaluated by medical specialists from different institutions in the country (MINSA, EsSalud and armed forces) using the ADAPTE matrix. The final version of the document was approved by a directorial resolution in the “Daniel Alcides Carrión” National Hospital. Results: Of 26 GPC, 3 met the requirements: Diabetes Canada 2018, SIGN 2017 and ESC/EASD 2019. Nine recommendations were adopted. SGLT-2 inhibitors were first choice in treatment, then GLP-1 and DPP4 inhibitors, finally insulin and metformin. Both thiazolidinedions, saxagliptins and sulfonylureas are contraindicated. Conclusions: Through a process of adoption and contextualization, a GPC was developed for the management of type 2 diabetes mellitus in patients with heart failure. Objetivo: Emitir recomendaciones para el manejo de la diabetes en pacientes con falla cardiaca, contextualizadas al Hospital Nacional Daniel Alcides Carrión (HNDAC) del Callao, Perú. Material y métodos: Se buscó sistemáticamente las GPC publicadas en los últimos 3 años en bases de datos, repositorios y organismos elaboradores. Se seleccionó aquellas que alcancen un puntaje >60% en la evaluación global con el instrumento AGREE-II. De cada guía se extrajeron las recomendaciones con sus respectivas preguntas clínicas. La aceptabilidad y aplicabilidad de las recomendaciones al contexto del HNDAC fueron evaluadas por médicos especialistas mediante la matriz ADAPTE. La dirección del HNDAC emitió una resolución directoral de la GPC con la versión final del documento. Resultados: De 26 GPC, 3 cumplieron requisitos: Diabetes Canadá 2018, SIGN 2017 y ESC/EASD 2019. Se adoptaron 9 recomendaciones. Los Inhibidores SGLT-2 fueron de primera elección, luego los GLP-1 e inhibidores DPP4, por último, insulina y metformina. Tanto tiazolidinedionas, saxagliptinas y sulfonilureas están contraindicadas. Conclusiones: Mediante un proceso de adopción y contextualización, se elaboró una GPC para el manejo de la diabetes mellitus tipo 2 en pacientes con falla cardiaca.

We carried out an observational, retrospective and descriptive study in order to identify the clinical and epidemiological characteristics of children with SARS-CoV-2 infection admitted to a Peruvian national referral hospital. We included patients from one month old to fourteen years old hospitalized between March and August 2020. A total of 125 patients with SARS-CoV-2 infection were admitted, 18.4% (n = 23) had critical illness and 16.8% (n = 21) had multisystem inflammatory syndrome (MIS-C). The absence of comorbidities and previous history of epidemiological contact were more frequent in patients with MIS-C. Patients in critical condition and patients with MIS-C had lower lymphocyte and platelet counts, and higher C-reactive protein, ferritin and D-dimer values than patients who did not have said conditions. Six (4.8%) out of 125 children died, as well as 3 (13%) children from the group of patients in critical condition. None of the children with MIS-C died. Revisión por pares

ADDRESSING BARRIERS IN NON-VERBAL COMMUNICATION DURING TELECONSULTATION IN THE ERA OF COVID-19. SYSTEMATIC REVIEW Question: ¿What are the barries of non-verbal communication in telemedicine? Introduction: Since the COVID 19 pandemic began, the use of technology has become more relevant in the health sector. Technical aspects are currently being reformed to ensure greater equity in the provision of health services. Despite the progress made, it is difficult to equate it with an in-person consultation; due to the loss of non-verbal communication skills and the lack of strategies to improve it Searching: From the beginning of time until August 2020. The following electronic bibliographic databases will be searched to identify relevant studies: MEDLINE, PubMed, Ovid, APA, EBSCO, Web Of Science, Scielo. No language restrictions will be applied. All racial groups will be included In addition, a manual search will be carried out to supplement the electronic search, and the reference lists of relevant studies will also be screened for any further material for inclusion. Selection criteria:All the patients that have been attended through telemedicine in aspects that include promotion, prevention, treatment and rehabilitation attentions by any health workers will be included. All studies that focus on non-verbal communication in telemedicine and the barriers identified Will be included cross-sectional, retrospective and prospective cohorts and cases series. Will be excluded review articles clinical trials, abstracts of meeting, case reports, letters, editorials, and systematic reviews. Principal outcomes The primary outcome of interest in this systematic review is to describe and categorize the barriers of non-verbal communication in telemedicine. Additional outcomes Satisfaction, treatment, adherence, clinical improvement and strategies used in patients attended through telemedicine Data extraction Two reviewers/authors (GOC and GVE) will assess the eligibility of the studies retrieved during the searches independently using the inclusion and exclusion criteria. The following data will be extracted from the studies selected and recorded in the Excel file: first author and year, study design, sample, intervention, studies groups, and outcomes. The results will be checked by two reviewers (GOC and GVE) and disagreements will be resolved by a third reviewer (PTI). We may also contact the original authors for additional relevant information. Quality assessment A reviewers/authors (PTI) will independently evaluate the quality of the trials through assessing the risk of bias using the following tools, when appropriate: For observational study, we will use the Newcastle-Ottawa Scale and The Murat tool's for clinical cases. Any disagreements will be resolved through discussions between these two reviewers/authors (GOC and GVE), involving at least one additional reviewer/author (PTI) until the consensus is achieved. We will illustrate the potential biases within each of the included studies by presenting a ’risk of bias’ table, graph and summary. Synthesis of information. This study is a systematic review without meta-analysis. All information collected will be categorized on basis on non-verbal communication dimensions proposed. key words: Telemedicine, Non-verbal communication, barriers

Supplemental material, Supplementary_materials for Prevalence of Diabetes Mellitus and Its Associated Unfavorable Outcomes in Patients With Acute Respiratory Syndromes Due to Coronaviruses Infection: A Systematic Review and Meta-Analysis by Isabel Pinedo-Torres, Magaly Flores-Fernández, Marlon Yovera-Aldana, Claudia Gutierrez-Ortiz, Paolo Zegarra-Lizana, Claudio Intimayta-Escalante, Cristian Moran-Mariños, Carlos Alva-Diaz and Kevin Pacheco-Barrios in Clinical Medicine Insights: Endocrinology and Diabetes

BACKGROUND: New information for potential treatments against SARS-CoV-2 is rapidly increasing. As a result, countries and organizations have begun to release therapeutic guidelines. OBJECTIVE: To provide a synopsis of the recommendations supported in evidence-based guidelines for therapeutic options with potential activity against SARS-CoV-2. METHOD: Rapid systematic review of guidelines and/or protocols that provide interim clinical guidance for COVID-19 disease were extracted from PubMed/Medline, Web of Science, Scopus, Scielo, Google Scholar, and a general Google search. Duplicates were removed and a summary of the proposed interventions was included. A benefit risk analysis was then conducted. RESULTS: Twenty guidelines and/or protocols were selected; the majority of which came from Europe and Latin America. Seventeen interventions were identified and classified into 6 pharmacological groups. Antimalarials, lopinavir/ritonavir and remdesivir were the only agents recommended and supported by clinical trials. The remaining interventions were recommended based on indirect evidence, observational studies, or in vitro studies. CONCLUSIONS: Antimalarials have shown results against COVID-19 with surrogate outcomes and the presence of serious adverse events. We recommend active monitoring of agents with potential efficacy against SARS-CoV-2 and incorporating the results in national guidelines and protocols. Clinical trials should be conducted to show direct benefit with clinically relevant outcomes in various populations. ANTECEDENTES: La nueva información de terapias contra el SARS-CoV-2 crece rápidamente. Como resultado, los países y organizaciones han comenzado a publicar pautas terapéuticas. OBJETIVO: Proporcionar una sinopsis de las recomendaciones soportadas en guías basadas en evidencia de las opciones terapéuticas con actividad potencial contra el SARS-CoV-2. MÉTODO: Revisión sistemática rápida de guías o protocolos que dan orientación clínica provisional para la enfermedad COVID-19 de PubMed/Medline, Web Of Science, Scopus, Scielo, Google Scholar y una búsqueda general en Google. Los duplicados se eliminaron y se incluyó un resumen de las intervenciones propuestas. Luego se realizó un análisis de riesgos y beneficios. RESULTADOS: Veinte guías o protocolos se seleccionaron, la mayor parte provino de Europa y Latinoamérica. Diecisiete intervenciones se identificaron y clasificaron en seis grupos farmacológicos. Los antimaláricos, lopinavir/ritonavir y remdesivir fueron los únicos agentes recomendados y respaldados por ensayos clínicos. Las intervenciones restantes se recomendaron con base en evidencia indirecta, estudios observacionales o estudios in vitro. CONCLUSIONES: Los antimaláricos han mostrado resultados contra COVID-19 con desenlaces sustitutos y eventos adversos graves. Recomendamos la vigilancia activa de agentes con eficacia potencial contra el SARS-CoV-2 incorporando los resultados en las guías y protocolos nacionales. Deben realizarse ensayos clínicos que muestren un beneficio directo con desenlaces clínicamente relevantes en diversas poblaciones.