Ray Ticse

Diabetic Peripheral Neuropathy in Ambulatory Patients with Type 2 Diabetes in a General Hospital in a Middle Income Country: A Cross-Sectional Study

Aim We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting. Methods Cross-sectional study, data was gathered at Perus Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (<10 vs. ≥10 years), glycaemic control (HbA1c <7% vs. ≥7%), microalbuminuria, retinopathy, and current pharmacological treatment. Multivariable analysis was performed using Poisson analysis to calculate prevalence ratios. Results DPN was observed in 73/129 (56.6%) patients. In multivariable analysis adjusted by age and sex, the prevalence ratio of neuropathy was 1.4 times higher (95% CI 1.07–1.88) in patients who took insulin plus metformin compared to patients who used one treatment alone, and 1.4 higher (95% CI 1.02–1.93) in patients with ≥10 years of disease compared to those with a shorter duration of disease. Also we found some characteristics in foot evaluation associated to neuropathy such as deformities (p<0.001), onychomycosis (p = 0.012), abnormal Achilles reflex (p<0.001), pain perception (p<0.001) and vibration perception (p<0.001). Conclusion DPN is highly frequent among patients with diabetes in a national specialized facility from Peru. Associated factors to DPN included being a diabetic patient for over ten years, and receiving insulin plus metformin

Type 2 diabetes and cardiac autonomic neuropathy screening using dynamic pupillometry.

To determine if changes in pupillary response are useful as a screening tool for diabetes and to assess whether pupillometry is associated with cardiac autonomic neuropathy.

Vasculitis secundaria a infección por Fasciola hepática

Se presenta el caso de un paciente varon de 38 anos, procedente de una zona endemica para fascioliasis hepatica en el Peru. Fue hospitalizado por presentar un cuadro de cuatro semanas de evolucion; con fiebre, mialgias intensas, lesiones eritematosas y dolorosas en las regiones de extension de las extremidades. La electromiografia y la velocidad de conduccion nerviosa mostraron una miopatia inflamatoria global. La biopsia de piel evidencio una vasculitis de tipo poliarteritis nodosa. En el proceso de evaluacion previa a la terapia inmunosupresora, se hallaron huevos de Fasciola hepatica en el examen coproparasitologico. El diagnostico de fascioliasis se confirmo con fas2-ELISA: 0,46 (VN <0,20). El cuadro clinico remitio luego del tratamiento con ticlabendazol. Se mantuvo contacto con el paciente durante un ano y no se evidencio recurrencia de la enfermedad, manteniendose asintomatico

Evaluación de una intervención para el uso de tromboprofilaxis basada en el envío de alertas electrónicas a médicos residentes de primer año de dos hospitales de Lima, Perú

Objectives. To assess the implementation of an intervention based on the sending of text messages and e-mails to internal medicine residents in order to achieve an increase in the prescription of thromboprophylaxis according to Clinical Practice Guidelines (CPG). Materials and methods. A quasi-experimental study was conducted in the inpatient units of internal medicine at two general hospitals in Lima, Peru: one selected to implement the intervention and the other as control. The unit of analysis was the therapeutic order sheet. It was considered that the intervention should increase the order of thromboprophylaxis according to CPG with respect to the initial assessment and also in relation to the control hospital. Results. Atotal of 394 therapeutic order sheets, 227 (57.4%) from the intervention hospital and 167 (42.4%) from the control, were evaluated. In the intervention hospital, 64.5% initially had an order of thromboprophylaxis according to CPG, which decreased to 54.4% after the intervention; overuse increased from 13.6 to 26.8%. Conclusions. Intervention based on sending text messages and e-mails had no impact, showing a tendency to overuse of thromboprophylaxis post-intervention.

PRESENTACIÓN ATíPICA DE PIOMIOSITIS TROPICAL DIFUSA DE PSOAS POR Staphylococcus aureus METICILINO RESISTENTE

Diffuse tropical primary pyomyositis is an infrequent entity in our country, with few cases associated to communityacquired Methicillin- resistant Staphylococcus aureus. There are no reported cases of Community-Acquired Methicillin- Resistant Staphylococcus aureus (CA- MRSA) in Peru. We present the case of a 70 year old male with a previous diagnosis of type 2 diabetes mellitus, receiving irregular treatment, who was admitted to the hospital with a history of 10 days of low back pain radiating to the left leg, fever and forced flexion of the right hip due to pain during movement. The diagnosis of diffuse pyomyositis of both psoas muscles was performed with MRI and culture of a posterior paravertebral collection, from which Staphylococcus aureus resistant to oxacillin, penicillin and dicloxacillin was isolated.