RESUMEN Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el diagnóstico y tratamiento de la infección crónica por el virus de Hepatitis C en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de la infección crónica por el virus de Hepatitis C en EsSalud. Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas y metodólogos. El GEG formuló 4 preguntas clínicas. Se realizó búsquedas sistemáticas de revisiones sistemáticas y estudios primarios en PubMed y Central de Cochrane durante el 2019. Se seleccionó la evidencia para responder a las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). El GEG usó la metodología GRADE para revisar la evidencia y formular recomendaciones, los puntos de buena práctica clínica y el flujograma de tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 151-IETSI-ESSALUD-2019. Resultados: La presente GPC abordó 4 preguntas clínicas, divididas en cuatro temas: tamizaje, diagnóstico, estadiaje y tratamiento. En base a estas preguntas se formularon 13 recomendaciones (8 fuertes y 5 condicionales), 27 puntos de buena práctica clínica y 1 flujograma de manejo. Conclusión: El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y tratamiento de la infección crónica por el virus de Hepatitis C en EsSalud.

RESUMEN Introduction: This article summarizes the clinical practice guidelines (CPG) for the diagnosis and treatment of chronic infection of hepatitis viral C of the Peruvian Health Social Security (EsSalud). Objective: To provide clinical recommendations based on evidence for the diagnosis and treatment of chronic infection of hepatitis viral C in EsSalud. Methods: A guideline development group (GDG) was established, including medical specialists and methodologists. The GDG formulated 4 clinical questions to be answered in this CPG. Systematic searches of systematic reviews and primary studies (when pertinent) were conducted in PubMed, and Central (Cochrane) during 2019. The evidence was selected to answer each of the clinical questions. The accuracy of the evidence was evaluated 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 treatment flowchart. Finally, the CPG was approved with Resolution No. 151-IETSIESSALUD-2019. Results: The present CPG addressed 4 clinical questions of four topics: screening, diagnosis, staging and treatment. Based on these questions, 13 recommendations (8 strong recommendations and 5 weak recommendations), 27 points of good clinical practice, and 1 flowchart were formulated. Conclusion: This paper summarizes the methodology and evidencebased conclusions from the CPG for for the diagnosis and treatment of chronic infection of hepatitis viral C of the EsSalud.

Objective: To determine the prevalence and factors associated with the intention to vaccinate (ITV) against COVID-19 in Peru. Material and methods: Analytical cross-sectional study using the survey conducted by the University of Maryland, USA, on Facebook. The dependent variables were ITV. Crude and adjusted prevalence ratios (PR) were calculated, with their 95% confidence intervals (95% CI) using generalized linear models of the Poisson family, to evaluate the association of sociodemographic variables, compliance with community mitigation strategies, symptoms of COVID-19, mental health and acceptance of vaccination before the recommendation (AVR) by various actors and health authorities, with the ITV. Results: Data from 17,162 adults were analyzed. The overall prevalence of ITV was 74.9%. A lower prevalence of IDV was associated with the female sex, living in a town or rural area and the AVR of politicians, PR=0.95 (95%CI:0.94-0.96), PR=0.95 (95%CI:0.91-0.99), PR=0.90 (95%CI:0.86-0.93) and PR=0.89 (95%CI:0.87-0.91); respectively. Conversely, having COVID-19 symptoms, economic insecurity, fear of a family member getting sick from COVID-19, depressive symptoms, and the AVR of family and friends, healthcare workers, world health organization and government officials partnered with higher prevalence of ITV, PR=1.05 (95%CI:1.03-1.08), PR=1.03 (95%CI:1.01-1.06), PR=1.48 (95%CI:1.35-1.63), PR = 1.03 (95%CI:1.01-1.06), PR=1.10 (95%CI: 1.08-1.12), PR = 1.29 (95%CI: 1.26-1.32), PR=1.34 (95%CI: 1.29-1.40) and PR=1.18 (95%CI: 1.15-1.21); respectively. Conclusion: Three-quarters of the respondents manifest ITV. There are potentially modifiable factors that could improve vaccine acceptance.

Objetivo: Determinar la prevalencia y factores asociados a la intención de vacunación (IDV) contra la COVID-19 en el Perú. Material y métodos: Estudio transversal analítico utilizando la encuesta realizada por Universidad de Maryland, EUA, en Facebook. Las variables dependientes fueron la IDV. Se calcularon razones de prevalencia (RP) crudas y ajustadas, con sus intervalos de confianza al 95% (IC95%), mediante modelos lineales generalizados de la familia Poisson, para evaluar la asociación de variables sociodemográficas, cumplimiento de estrategias comunitarias de mitigación, síntomas de COVID-19, salud mental y aceptación de la vacunación ante la recomendación (AVR) por diversos actores y autoridades sanitarias, con la IDV. Resultados: Se analizaron los datos de 17.162 adultos. La prevalencia general de IDV fue de 74,9%. Se asoció a menor prevalencia de IDV el sexo femenino, vivir en un pueblo o zona rural y la AVR de políticos, RP=0,95 (IC95%:0,94-0,96), RP=0,95 (IC95%:0,91-0,99), RP=0,90 (IC95%:0,86-0,93) y RP=0,89 (IC95%:0,87-0,91); respectivamente. Contrariamente, tener síntomas de COVID-19, inseguridad económica, miedo a que un familiar enferme de COVID-19, síntomas depresivos y la AVR de familiares y amigos, trabajadores de la salud, organización mundial de la salud y funcionarios del gobierno se asociaron con mayor prevalencia de IDV, RP=1,05 (IC95%:1,03-1,08), RP=1,03 (IC95%:1,01-1,06), RP=1,48 (IC95%:1,35-1,63), RP=1,03 (IC95%:1,01-1,06), RP=1,10 (IC95%:1,08-1,12), RP=1,29 (IC95%:1,26-1,32), RP=1,34 (IC95%:1,29-1,40) y RP=1,18 (IC95%:1,15-1,21); respectivamente. Conclusión: Tres cuartas partes de los encuestados manifiestan IDV. Existen factores potencialmente modificables que podrían mejorar la aceptación de la vacuna.

Objetivo: Determinar a prevalência e os fatores associados à intenção de vacinar (IDV) contra COVID-19 no Peru.Material e métodos: Estudo transversal analítico a partir de survey realizado pela University of Maryland, EUA, no Facebook. As variáveis ​​dependentes foram IDV. Foram calculadas razões de prevalência (RP) brutas e ajustadas, com seus intervalos de confiança de 95% (IC 95%), utilizando modelos lineares generalizados da família Poisson, para avaliar a associação de variáveis ​​sociodemográficas, adesão a estratégias de mitigação da comunidade, sintomas de COVID- 19, saúde mental e aceitação da vacinação antes da recomendação (AVR) por diversos atores e autoridades sanitárias, junto ao IDV.Resultados: Dados de 17.162 adultos foram analisados. A prevalência geral de IDV foi de 74,9%. A menor prevalência de IDV foi associada ao sexo feminino, residente em cidade ou zona rural e ao AVR de políticos, RP = 0,95 (IC95%: 0,94-0,96), RP = 0,95 (IC95%: 0,91-0,99) , RP = 0,90 (IC 95%: 0,86-0,93) e RP = 0,89 (IC 95%: 0,87-0,91); respectivamente. Por outro lado, ter sintomas de COVID-19, insegurança econômica, medo de um membro da família ficar doente por causa de COVID-19, sintomas depressivos e AVR de familiares e amigos, profissionais de saúde, organização mundial de saúde e funcionários do governo em parceria com maior prevalência de IDV, PR = 1,05 (IC 95%: 1,03-1,08), PR = 1,03 (IC 95%: 1,01-1,06), PR = 1,48 (IC 95%: 1,35-1,63), PR = 1,03 (IC 95%: 1,01-1,06 ), RP = 1,10 (IC 95%: 1,08-1,12), RP = 1,29 (IC 95%: 1,26-1,32), RP = 1,34 (IC 95%: 1,29-1,40) e RP = 1,18 (IC 95%: 1,15 -1,21); respectivamente.Conclusão: Três quartos dos entrevistados manifestam IDV. Existem fatores potencialmente modificáveis ​​que podem melhorar a aceitação da vacina.

ABSTRACT Objective: The aim of this study was to develop a risk prediction model for major postoperative infection (MPI) after pediatric heart surgery and to validate the model of the Society of Thoracic Surgeons (STS). Materials and methods: We analyzed a retrospective cohort of 1,025 children who underwent heart surgery with cardiopulmonary bypass (CPB) from 2000 to 2010. We used a logistic regression model, which was validated. Results: Of the 1,025 patients, 59 (5.8%) had at least one episode of MPI (4.8% had sepsis, 1% had mediastinitis, 0% had endocarditis). Hospital mortality (63% vs. 13%; p < 0.001), as well as duration of postoperative ventilation (301.6 vs. 34.3 hours; p < 0.001) and intensive care unit stay (20.9 vs. 5.1 days; p < 0.001) were higher in patients with MPI. The predictive factors found were age, sex, weight, cyanotic heart disease, RACHS-1 3-4, Ross-modified functional class IV, previous hospital stay, and previous history of mechanical ventilation. The proposed model had a c-statistic of 0.80 (95% CI: 0.74-0.86) and was considered as clinically useful. The STS model showed a c-statistic of 0.78 (95% CI: 0.71-0.84) and a Hosmer-Lemeshow of 18.2 (P = 0.020). A comparison between the two models was made using an accurate Fisher test. Conclusion: A model with good performance and calibration was developed to preoperatively identify children at high risk for severe infection after cardiac surgery with CPB. The STS model was also validated and was found to have a moderate discrimination performance.

RESUMEN Objetivo: Desarrollar un modelo de predicción de riesgo para infección posoperatoria mayor (IPM) a cirugía cardiaca pediátrica y validar el de la Society of Thoracic Surgeons (STS). Materiales y métodos: Se analizó una cohorte retrospectiva de 1025 niños sometidos a cirugía cardiaca con circulación extracorpórea (CEC) del 2000 al 2010. Se empleó un modelo de regresión logística y se validó el modelo. Resultados: De los 1025 pacientes, 59 (5,8%) tuvieron al menos un episodio de IPM (4,8% sepsis, 1% mediastinitis, 0% endocarditis). La mortalidad hospitalaria (63% vs. 13%; p<0,001), al igual que la duración de la ventilación posoperatoria (301,6 vs. 34,3 horas; p<0,001) y la estancia en la unidad de cuidados intensivos (20,9 vs. 5,1 días; p <0,001) fueron mayores en los pacientes con IPM. Los factores predictores fueron: edad, sexo, peso, cardiopatía cianótica, RACHS-1 3-4, clase funcional IV modificada por Ross, estancia hospitalaria previa y antecedente de ventilación mecánica. El modelo tuvo un c-estadístico de 0,80 (intervalo de confianza [IC] al 95%: 0,74-0,86) y es clínicamente útil. El modelo de la STS mostró un c-estadístico de 0,78 (IC 95%: 0,71-0,84) y Hosmer-Lemeshow de 18,2 (p = 0,020). Se realizó una comparación entre ambos modelos empleando una prueba exacta de Fisher. Conclusión: Se desarrolló un modelo para identificar preoperatoriamente a niños con alto riesgo de infección grave después de una cirugía cardiaca con CEC con buen desempeño y calibración. Asimismo, se validó el modelo de la STS con moderada discriminación.

ABSTRACT Objective: The aim of this study was to develop a risk prediction model for major postoperative infection (MPI) after pediatric heart surgery and to validate the model of the Society of Thoracic Surgeons (STS). Materials and methods: We analyzed a retrospective cohort of 1,025 children who underwent heart surgery with cardiopulmonary bypass (CPB) from 2000 to 2010. We used a logistic regression model, which was validated. Results: Of the 1,025 patients, 59 (5.8%) had at least one episode of MPI (4.8% had sepsis, 1% had mediastinitis, 0% had endocarditis). Hospital mortality (63% vs. 13%; p < 0.001), as well as duration of postoperative ventilation (301.6 vs. 34.3 hours; p < 0.001) and intensive care unit stay (20.9 vs. 5.1 days; p < 0.001) were higher in patients with MPI. The predictive factors found were age, sex, weight, cyanotic heart disease, RACHS-1 3-4, Ross-modified functional class IV, previous hospital stay, and previous history of mechanical ventilation. The proposed model had a c-statistic of 0.80 (95% CI: 0.74-0.86) and was considered as clinically useful. The STS model showed a c-statistic of 0.78 (95% CI: 0.71-0.84) and a Hosmer-Lemeshow of 18.2 (P = 0.020). A comparison between the two models was made using an accurate Fisher test. Conclusion: A model with good performance and calibration was developed to preoperatively identify children at high risk for severe infection after cardiac surgery with CPB. The STS model was also validated and was found to have a moderate discrimination performance.

RESUMEN Objetivo: Desarrollar un modelo de predicción de riesgo para infección posoperatoria mayor (IPM) a cirugía cardiaca pediátrica y validar el de la Society of Thoracic Surgeons (STS). Materiales y métodos: Se analizó una cohorte retrospectiva de 1025 niños sometidos a cirugía cardiaca con circulación extracorpórea (CEC) del 2000 al 2010. Se empleó un modelo de regresión logística y se validó el modelo. Resultados: De los 1025 pacientes, 59 (5,8%) tuvieron al menos un episodio de IPM (4,8% sepsis, 1% mediastinitis, 0% endocarditis). La mortalidad hospitalaria (63% vs. 13%; p<0,001), al igual que la duración de la ventilación posoperatoria (301,6 vs. 34,3 horas; p<0,001) y la estancia en la unidad de cuidados intensivos (20,9 vs. 5,1 días; p <0,001) fueron mayores en los pacientes con IPM. Los factores predictores fueron: edad, sexo, peso, cardiopatía cianótica, RACHS-1 3-4, clase funcional IV modificada por Ross, estancia hospitalaria previa y antecedente de ventilación mecánica. El modelo tuvo un c-estadístico de 0,80 (intervalo de confianza [IC] al 95%: 0,74-0,86) y es clínicamente útil. El modelo de la STS mostró un c-estadístico de 0,78 (IC 95%: 0,71-0,84) y Hosmer-Lemeshow de 18,2 (p = 0,020). Se realizó una comparación entre ambos modelos empleando una prueba exacta de Fisher. Conclusión: Se desarrolló un modelo para identificar preoperatoriamente a niños con alto riesgo de infección grave después de una cirugía cardiaca con CEC con buen desempeño y calibración. Asimismo, se validó el modelo de la STS con moderada discriminación.

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.

Abstract 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 Objetivos: Analisar a associação entre os níveis glicêmicos quando da admissão dos pacientes à unidade de terapia intensiva pediátrica e a mortalidade entre pacientes hospitalizados. Métodos: Estudo retrospectivo de coorte conduzido em pacientes de uma unidade de terapia intensiva, admitidos ao Instituto Nacional de Salud del Niño entre 2012 e 2013. Utilizou-se um modelo de regressão de Poisson com variância robusta para qualificar a associação. Foi feita avaliação do desempenho do exame diagnóstico, para descrever sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e razão de verossimilhança para cada faixa de glicemia. Resultados: Incluíram-se no total 552 pacientes (idade mediana de 23 meses; faixa de variação entre 5 meses e 79,8 meses). O nível glicêmico médio quando da admissão foi de 121,3mg/dL (6,73mmol/L). Faleceram durante a hospitalização 92 (16,6%) pacientes. Na análise multivariada, encontraram-se associações significantes entre glicemia < 65mg/dL (3,61mmol/L) (RR: 2,01; IC95% 1,14 - 3,53), glicemia > 200mg/dL (> 11,1mmol/L) (RR: 2,91; IC95% 1,71 - 4,55), desnutrição (RR: 1,53, IC95% 1,04 - 2,25), ventilação mecânica (RR: 3,71, IC95% 1,17 - 11,76) e mortalidade durante a hospitalização. Ocorreram baixa sensibilidade (entre 17,39% e 39,13%) e alta especificidade (entre 49,13% e 91,74%) para diferentes níveis glicêmicos de corte. Conclusão: Ocorreu maior risco de óbito entre os pacientes que desenvolveram hipoglicemia e hiperglicemia por ocasião da admissão à unidade de terapia intensiva pediátrica. Certas faixas de glicemia (> 200mg/dL (> 11,1mmol/L) e < 65mg/dL (3,61mmol/L)) tiveram uma alta especificidade como preditores de óbito.

ABSTRACT Objectives: To analyze the association between glycemia levels upon pediatric intensive care unit admission and mortality in patients hospitalized. Methods: A retrospective cohort of pediatric intensive care unit patients admitted to the Instituto Nacional de Salud del Niño between 2012 and 2013. A Poisson regression model with robust variance was used to quantify the association. Diagnostic test performance evaluation was used to describe the sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios for each range of glycemia. Results: In total, 552 patients were included (median age 23 months, age range 5 months to 79.8 months). The mean glycemia level upon admission was 121.3mg/dL (6.73mmol/L). Ninety-two (16.6%) patients died during hospitalization. In multivariable analyses, significant associations were found between glycemia < 65mg/dL (3.61mmol/L) (RR: 2.01, 95%CI 1.14 - 3.53), glycemia > 200mg/dL (> 11.1mmol/L) (RR: 2.91, 95%CI 1.71 - 4.55), malnutrition (RR: 1.53, 95%CI 1.04 - 2.25), mechanical ventilation (RR: 3.71, 95%CI 1.17 - 11.76) and mortality at discharge. There was low sensitivity (between 17.39% and 39.13%) and high specificity (between 49.13% and 91.74%) for different glucose cut-off levels. Conclusion: There was an increased risk of death at discharge in patients who developed hypoglycemia and hyperglycemia upon admission to the pediatric intensive care unit. Certain glucose ranges (> 200mg/dL (> 11.1mmol/L) and < 65mg/dL (3.61mmol/L)) have high specificity as predictors of death at discharge.

ResumoIntrodução:No Peru, existem diferentes locais e currículos de ensino para a formação de especialistas em Nefrologia.Objetivo:Avaliar a percepção dos médicos que frequentam esse tipo de formação.Métodos:Análise descritivo-transversal sobre médicos que estavam nos últimos dois anos de formação em Nefrologia em fevereiro de 2012 e os que se formaram nos anos 2010 e 2011, em nível nacional. Utilizou-se um questionário autoaplicável desenvolvido com base em normas internacionais, juntamente com a Sociedade Peruana de Nefrologia. Este questionário explorou as seguintes áreas: ensino, treinamento clínico, procedimentos, rotações externas, pesquisa e percepção global.Resultados:Foram obtidas 40 respostas de um total de 49 médicos. 82,5% tinham tutores, 22,5% deles disseram que o apoio destes era deficiente. 27,5% descreveram a sua formação teórica como deficiente. A formação prática, é percebida como aceitável, no entanto sugerem melhoras na formação em diálise peritoneal, transplante renal e análise de biópsias. Um 90% tem rotações externas nacionais e 65% relataram ter uma rotação internacional. Quando se avaliou seu desempenho na área de pesquisas, 77,5% o considerou deficiente. Além disso, 82,5% acreditam que a residência deve durar quatro anos. No entanto, 60% informaram que sua residência é boa. Existe uma diminuição da percepção positiva dos aspectos estudados entre os residentes com relação aos graduados.Conclusão:A formação geral na especialização em Nefrologia é considerada boa para os residentes; no entanto, a área de tutoria, as atividades acadêmicas e de pesquisa são deficientes.

AbstractIntroduction:In Peru there are different hospitals and university programs for training of specialists in nephrology.Objective:To assess the perception of physicians who attend such programs.Methods:We carried out a descriptive cross-sectional national-level study in physicians who were in the last two years of nephrology training during February 2012 and who had graduated from it in 2010 and 2011. A self-applied questionnaire was developed along with the Peruvian Society of Nephrology based on international standards. The questionnaire evaluated: mentoring, clinical training, procedures, external rotations, research and global perception.Results:Forty doctors were surveyed nationwide. 82.5% had tutors, 22.5% of them said their support was poor. A 27.5% described their theoretical formation as deficient. The practical training was perceived as acceptable globally; however, improvements in training on peritoneal dialysis and reading kidney transplant biopsies are necessary. A 90% have national external rotations and 65% reported to have an international rotation. In the assessment of research, 77.5% thought this is deficient. In addition, 82.5% believed that residency should last four years. However, 60% reported that their residency training was good. There is a decrease in the positive perception of the aspects studied among residents regarding graduates.Conclusion:The overall perception of nephrology residency training was considered good; however, areas of tutoring, and academic and research activities on average were deficient.

Resumo Introdução: O Ministério da Saúde do Peru não tem um programa nacional de hemodiálise e os hospitais que oferecem este tipo de tratamento apresentam problemas de cobertura que podem resultar em aumento da mortalidade. Objetivo: Avaliar a mortalidade da população incidente em hemodiálise em um hospital de Lima. Métodos: Análise da população acima de 18 anos que iniciou o tratamento entre 1 de janeiro de 2012 e 31 de dezembro de 2013, com data de corte final do acompanhamento em 31 de março de 2014. Foi realizada regressão logística bivariada e multivariada dos fatores associados com a mortalidade e usadas as curvas de Kaplan-Meier para determinar a probabilidade de sobrevivência durante o acompanhamento. Resultados: Foram incluídos 235 pacientes para estudo, com idade média de 56,4 ± 15,8 anos. A mediana de acompanhamento foi 0,6 anos (IQR 0,3 a 1,5). A pesquisa mostra que 50% dos pacientes abandonaram o tratamento durante o estudo por falta de vagas ou recursos econômicos. No final do terceiro mês, a mortalidade foi 37,7% (IC 95% 29,3 a 48,5) e 49,5% (IC 95% 38,8 a 61,4) ao sétimo mês. A mortalidade foi menor quando o paciente tinha mais de seis meses com diagnóstico de doença insuficiência renal crônica (OR = 0,39 [IC 95% 0,12-1,27]) e quando o paciente ingressava à diálise programada (OR = 0,28 [IC 95% 0,01 a 2,28]). Conclusão: Metade dos pacientes foi a óbito no sétimo mês de seguimento. Ter ingressado com diálise programada e ter mais tempo de diagnóstico foi associado à menor mortalidade.

Abstract Introduction: The Peruvian Ministry of Health does not have a national program of hemodialysis and hospitals that offer it have coverage problems, which may result in increased mortality. Objective: We evaluated mortality of a population with incident hemodialysis in a Peruvian public hospital as well as its associated factors. Methods: Retrospective and descriptive study of a population over 18 years-old who started treatment between January 1, 2012 and December 31, 2013 with the final follow-up day on31 March 2014. We used bivariate and multivariate logistic regression models to evaluate factors associated with mortality and Kaplan Meier curves were used to determine the probability of survival. Results: We included 235 patients with a mean age of 56.4 ± 15.8 years. Median follow-up was 0.6 years (IQR 0.3 to 1.5). 50% of years withdrew from therapy during the study for lack of financial resources or space available. The third month mortality was 37.7% (95% CI 4.7 to 48.5) and 49.5% (95% CI 5.8 to 61.4) at 7 months. There was a trend towards lower mortality when patients had more than 6 months with a diagnosis of chronic kidney disease (CKD) (OR = 0.39 [95% CI 0.12 to 1.27]) and when the patient was admitted with scheduled dialysis (OR = 0.28 [95% CI 0.01 to 2.28]). Conclusion: Half of patients died within seven months of follow-up. Scheduled dialysis and having longer time with CKD diagnosis tend to be associated with lower mortality

Introduction: Clinical work can influence time spent on scientific research among physicians training in Nephrology. Objective: To describe scientific research practices among medical residents and specialists in Nephrology recently graduated in Peru. Material and Methods: We carried out a cross-sectional study on residents of nephrology of the last two years and specialists graduated from the past two years at the national level through a self-administered validated questionnaire. Results: We obtained 40 responses of which 50% were residents. 68% of respondents never conducted research during residency training. None of the respondents who performed some research work published their research. Almost all considered deficient their research training received and studies done in their hospitals. Conclusion: Scientific research practices among nephrology resident training in Peru are deficient. Strategies are needed to promote and develop it.

Introducción: La labor asistencial puede condicionar pobre dedicación a actividades de investigación científica en médicos que realizan la especialización de nefrología. Objetivo: Describir las prácticas de investigación científica entre los médicos residentes en nefrología y especialistas recién egresados en Perú. Material y métodos: Se realizó un estudio descriptivo de corte transversal sobre la totalidad de médicos residentes de nefrología de los dos últimos años y especialistas egresados de los dos últimos años a nivel nacional, mediante un cuestionario autoaplicado. Resultados: Se obtuvieron 40 respuestas, de las cuales el 50% correspondían a residentes. El 67.5% de los encuestados nunca realizó investigación durante la residencia. Ningún encuestado que haya realizado algún trabajo de investigación lo publicó. Casi todos consideraron a su sede hospitalaria como deficiente en investigación. Conclusión: La investigación científica entre residentes de nefrología en Perú es deficiente. Se requieren estrategias que la promuevan a este nivel.

Objective: To determine the frequency of interruption of the dialysis therapy from January 2012 until July 2013 of patients the National Hospital "2 de Mayo" -nephrology services. Material and methods: Monitoring was performed. Of 190 patients evaluated in our monitoring 84 (44.21 %) abandoned. Results: Dialysis interruption was related to a prescription of dialysis start of less than 6 months OR: 6.27 (p= 0.011). Conclusions: We conclude that the frequency of dialysis interruption is high, possibly associated to the lack of dialysis vacancies.

Objetivo: Determinar la frecuencia de interrupción de la terapia de diálisis desde Enero del 2012 hasta Julio 2013 de los pacientes del servicio de nefrología del Hospital Nacional 2 de Mayo. Material y métodos: Se realizó un seguimiento de los mismos. Se evaluó a 190 pacientes, de los cuales se retiraron 84 (44,21%). Resultados: El retiro de diálisis se relacionó con una indicación de inicio de diálisis de menos de 6 meses OR: 6,27 (p= 0,011). Conclusiones: Se concluye que la frecuencia de retiro de diálisis es alta, posiblemente asociada a falta de cupos de diálisis.

Information about resistance profile of darunavir (DRV) is scarce in Brazil. Our objectives were to estimate the prevalence of DRV resistance mutations in patients failing protease inhibitors (PI) and to identify factors associated with having more DRV resistance mutations. All HIV-infected patients failing PI-based regimens with genotyping performed between 2007 and 2008 in a referral teaching center in São Paulo, Brazil, were included. DRV-specific resistance mutations listed by December 2008 IAS-USA panel update were considered. Two Poisson regression models were constructed to assess factors related to the presence of more DRV resistance mutations. A total of 171 HIV-infected patients with available genotyping were included. The number of patients with lopinavir, saquinavir, and amprenavir used in previous regimen were 130 (76%), 83 (49%), and 35 (20%), respectively. The prevalence of major DRV resistance mutations was 50V: 5%; 54M: 1%; 76V: 4%; 84V: 15%. For minor mutations, the rates were 11I: 3%; 32I: 7%; 33F: 23%; 47V: 6%; 54L: 6%; 74P: 3%; 89V: 6%. Only 11 (6%) of the genotypes had > 3 DRV resistance mutations. In the clinical model, time of HIV infection of > 10 years and use of amprenavir were independently associated with having more DRV resistance mutations. In the genotyping-based model, only total number of PI resistance mutations was associated with our outcome. In conclusion, the prevalence of DRV mutations was low. Time of HIV infection, use of amprenavir and total number of PI resistance mutations were associated with having more DRV mutations.