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La diabetes es un problema de salud global con una tendencia franca de aumento de pacientes en el mundo. Lastecnologías de información y comunicación (TIC) pueden cumplir una función importante en este grupo de pacientes. Objetivo. Reportar el uso y percepciones hacia las TIC de pacientes con diabetes. Materiales y métodos. Durante el mes de agosto de 2008 se aplicó encuestas, previamente validadas, a pacientes con diabetes que acudieron a un hospital nacional. Resultados. La mayoría de los 200 pacientes con diabetes (mediana de edad: 60 años, 78,5 por cientomujeres) nunca usó una computadora (89,5 por ciento), correo electrónico (90 por ciento), Internet (92 por ciento) o el chat (91,5 por ciento). La mayoría de participantes (91,5 por ciento) nunca ha buscado información en salud en Internet. El 49 por ciento de los participantes realiza o recibellamadas por celular al menos una vez por semana, sin embargo, la mayoría (84,5 por ciento y 67 por ciento) nunca ha enviado o recibido mensajes de texto, respectivamente. Casi la totalidad de participantes desea recibir información sobre el cuidado dela diabetes. La mayoría de entrevistados (70,5 por ciento y 61,5 por ciento) expresó su interés de participar en un programa de soporte para su diabetes usando celulares e Internet, respectivamente. Conclusiones. A pesar de que el uso de las TIC esrelativamente bajo, la percepción hacia un sistema o programa usando celulares o Internet para el soporte de pacientescon diabetes es positiva. Es necesario desarrollar estudios que evalúen las razones por las que los pacientes no utilizan celulares o Internet, y evaluar posibles intervenciones a través de estos medios para el mejor manejo y soporte de pacientes con diabetes.

Diabetes is a global health problem with a growing number of individuals with diabetes mellitus in the world. Information and communication technologies (ICT) could play an important role in this group of patients. Objective. To report the useand perceptions regarding ICT in patients with diabetes. Material and methods. During August 2008, previously validated surveys were applied to patients with diabetes attending a national hospital in Peru. Results. Two hundred patients withdiabetes were surveyed (median: 60 years old, 78.5 per cent women). Most of them never used a computer (89.5 per cent), E-mail (90 per cent), Internet (92 per cent), or chat (91.5 per cent). Most of the participants (91.5 per cent) never sought health information on the Internet. Forty nine percent of participants make and/or receive calls using cell phones at least once a week. However, most of them (84.5 per cent and 67 per cent) never have sent or received text messages, respectively. Almost all of participants would liketo receive information about diabetes care. Most of them (70.5 per cent and 61.5 per cent) expressed their interest to participate in a program to support their diabetes using cell phones and the Internet, respectively. Conclusions. Besides use of ICT was relatively low, the perception towards a system or a program using cell phones or the Internet for diabetes supportis positive. It is necessary to further explore the reasons why patients do not use cell phones and/or the Internet, and to evaluate the feasibility of ICT interventions for better diabetes care.

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OBJECTIVE: To describe the clinical and laboratory characteristics of diabetic ketoacidosis (DKA) in adult Peruvian patients with type 2 diabetes mellitus. METHODS: In this cross-sectional analysis, we reviewed clinical charts of type 2 diabetic patients with DKA admitted to Cayetano Heredia Hospital between 2001 and 2005 for data on demographics, previous treatment, previous hospital admissions for DKA, family history of diabetes, precipitating factors, hospital course, mortality, and insulin use 3 and 6 months after the index DKA episode. Patients older than 18 years who had confirmed DKA were included. Patients with type 1 diabetes mellitus were excluded. RESULTS: We report on 53 patients with DKA for whom complete clinical and laboratory data were available. Of the 53 patients, 39 (74%) were men; mean age (+/- SD) was 45 +/- 12 years; and 22 (42%) had no previous diagnosis of type 2 diabetes. The following mean (+/- SD) laboratory values were obtained at DKA diagnosis: glucose, 457 +/- 170 mg/dL; pH, 7.15 +/- 0.14; bicarbonate, 7.73 +/- 6 mEq/L; and anion gap, 24.45 +/- 7.44 mEq/L. Of the 53 DKA episodes, 35 (66%) were severe (arterial pH <7.0 and/or serum bicarbonate <10 mEq/L). The following precipitating factors were discerned: discontinuation of treatment in 21 (40%), infections in 16 (30%), intercurrent illness in 3 (6%), and no identifiable cause in 13 (25%). Mortality rate was 0%. Three and 6 months after the index DKA episode, insulin was used by 65% and 56% of patients, respectively. CONCLUSION: In countries with a low incidence of type 1 diabetes, DKA is frequently reported in patients with type 2 diabetes. In this study, 42% of patients had new-onset disease. Most DKA episodes were severe and were related to infection or noncompliance with treatment.

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OBJECTIVE: We have carried out international comparisons of the metabolic syndrome using the International Diabetes Federation (IDF) and National Cholesterol Education Program-Adult Treatment Panel III (ATP III) definitions. This analysis could help to discern the applicability of these definitions across populations. RESEARCH DESIGN AND METHODS: Nondiabetic subjects aged 35-64 years were eligible for analysis in population-based studies from San Antonio (Mexican Americans and non-Hispanic whites, n = 2,473), Mexico City (n = 1,990), Spain (n = 2,540), and Peru (n = 346). Kappa statistics examined the agreement between metabolic syndrome definitions. RESULTS: Because of the lower cutoff points for elevated waist circumference, the IDF definition of the metabolic syndrome generated greater prevalence estimates than the ATP III definition. Prevalence difference between definitions was more significant in Mexican-origin and Peruvian men than in Europid men from San Antonio and Spain because the IDF definition required ethnic group-specific cutoff points for elevated waist circumference. ATP III and IDF definitions disagreed in the classification of 13-29% of men and 3-7% of women. In men, agreement between these definitions was 0.54 in Peru, 0.43 in Mexico City, 0.62 in San Antonio Mexican Americans, 0.69 in San Antonio non-Hispanic whites, and 0.64 in Spain. In women, agreement between definitions was 0.87, 0.89, 0.86, 0.87, and 0.93, respectively. CONCLUSIONS: The IDF definition of the metabolic syndrome generates greater prevalence estimates than the ATP III definition. Agreement between ATP III and IDF definitions was lower for men than for women in all populations and was relatively poor in men from Mexico City.

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BACKGROUND: The metabolic syndrome (MS) has been shown to predict mortality due to cardiovascular disease. Currently, no population-based data on the prevalence of the MS is available in Peru. This study was aimed to assess the prevalence of the MS in urban Peruvian Mestizos, in the coastal districts of Lima, the capital of Peru. METHODS: A cross-sectional, epidemiological survey was undertaken, including 612 unrelated subjects aged 30-92 years (68.3% females). Prevalence of the MS was defined by the National Cholesterol Education Program Expert Panel on Detection Evaluation, and Treatment of High Blood Cholesterol in Adults (ATPIII) criteria. Insulin resistance was estimated by the homeostasis model assessment (HOMA). RESULTS: Age and sex standardized prevalence of the MS was 14.9% (13.2% in males, 16.5% in females). The MS was significantly more prevalent in females aged 45-59 years old (20.2% vs. 6.7%, p = 0.019). In individuals with the MS, the prevalence of insulin resistance (IR) was 45% in males/42% in females. Abdominal obesity (80% in males/92.8% in females), and low HDL cholesterol (55% males/75.4% females), but neither hypertriglyceridemia (85% in males/81.2% females) nor high fasting glucose (55% in males/36.2 % females) were more common in females. Prevalence of arterial hypertension was similar in both sexes. CONCLUSIONS: In this Mestizo Peruvian population, prevalence of the MS is relatively low as compared to other ethnic groups; the higher prevalence in females is likely due to a higher prevalence of abdominal obesity. Overall, abdominal obesity and hypertriglyceridemia were the predominant combination of metabolic disorders in individuals fulfilling criteria for the diagnosis of the MS.

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Las encuestas demográficas de salud y población del Perú indican que las tasas globales de fecundidad, la proporción de adolescentes embarazadas y la mortalidad maternoinfantil son más altas en la selva que en otras zonas del país. Las parasitosis intestinales endémicas agravan el riesgo de anemia ya generalmente presente en las embarazadas por deficiencias de hierro, ácido fólico y otros nutrientes. En muchos países latinoamericanos, esa es la complicación más frecuente del embarazo y está asociada con partos pretérmino, bajo peso al nacer y mortalidad perinatal. Los estudios realizados sobre este tema en la selva peruana son escasos y no se dispone de estimaciones confiables de la prevalencia de anemia durante la gestación. Los autores se propusieron determinar la prevalencia de anemia en mujeres gestantes que acudían al Hospital Regional de Pucallpa, en la selva del Perú, entre enero de 1993 y junio de 1995. El estudio de corte transversal se basó en los registros de control prenatal y de parto de 1 015 embarazadas y permitió estudiar la asociación entre la prevalencia de anemia y variables como edad cronológica, escolaridad, número de gestaciones previas y peso de la madre al inicio del embarazo. También se compararon los valores de la hemoglobina materna con el peso de los recién nacidos. La prevalencia de anemia en la población de gestantes fue de 70,1%, valor que no se modificó por efecto de la edad materna, la escolaridad ni el intervalo intergenésico. La prevalencia de anemia se asoció directamente con el número de gestaciones e inversamente con la ganancia de peso durante el embarazo. La tasa de mortalidad perinatal fue de 37,7 por 1 000 nacidos. Ni esta tasa ni el peso de los recién nacidos resultaron asociados con el grado de anemia de la madre. El análisis de regresión multivariado muestra que el peso de la madre al inicio de la gestación (P = 0,0001), el peso ganado durante la gestación (P = 0,0001) y el número de gestaciones...

Population based health surveys in Peru show that the general fertility rates, proportion of pregnant adolescents, and maternal and child morbidity are higher in the jungle regions than in other parts of the country. Endemic intestinal parasitic diseases increase the risk of anemia in pregnant women already suffering from iron, folic acid, and other nutritional deficiencies. This is the most common complication of pregnancy in many Latin American countries and is often associated with premature labor, low birthweight, and perinatal mortality. There are very few studies on this subject based on jungle populations and no reliable estimates of the prevalence of anemia in local pregnant women. The present study was designed to determine the prevalence of anemia in pregnant women attending the Regional Hospital in Pucallpa, located in the Peruvian jungle, from January 1993 to June 1995. This cross-sectional study, which was based on the registries of prenatal and childbirth services encompassing 1 015 pregnant women, looked into the potential association between anemia and such variables as the mother's chronological age, schooling, previous pregnancies, and weight at the beginning of pregnancy. Maternal hemoglobin levels were compared with the newborns' weight at birth. The prevalence of anemia in this population sample was 70.1%. This value was not modified when adjusted for maternal age, schooling, or interval between births. Anemia prevalence was directly related to the number of previous pregnancies and inversely related to weight gain during pregnancy. The perinatal mortality rate was 37.7 per 1 000 births. Neither this rate nor the birthweights were associated with the mother's degree of anemia. A multivariate regression analysis showed that maternal body weight at the start of pregnancy (P = 0.0001), weight gain during pregnancy (P = 0.0001), and the number of pregnancies (P = 0.008) are predictors of birthweight. Results showed that...

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The present study was designed to determine if symptoms of acute mountain sickness are presented within six hours after arrival at high altitude. Seventeen male subjects, 23-30 years, were studied. The subjects were professional soccer players, life-long residents at low altitudes except one player who was playing soccer in a team at 3400 m (512 mm Hg of Barometric Pressure) during an entire year in 1995. The players were transported by a commercial airline from Lima (150 m) to Cusco (3400 m). The trip lasted 1 hour. Heart rate and arterial oxygen saturation were measured at rest in Lima (150 m), at the time of arrival at Cusco, and at 4 and 6 hours after arrival at 3400 m. On day 6 at high altitude, the physical performance during a soccer game was assessed. The symptoms of acute mountain sickness (AMS) were assessed 6 hours after arrival at Cusco with a self-administered questionnaire, and thereafter each 24-hours up to 5 days of exposure to high altitude. The following symptoms were assessed: headache, gastrointestinal symptoms, dizziness, fatigue, and sleep abnormalities. AMS was defined by a Lake-Louise score ⩾4 (self-assessment only). Thirty five percent of the soccer players developed AMS within 6 hours after arrival by air at 3400 m altitude. Arterial oxygen saturation at arrival was higher in those player who developed AMS within 6 hours after arrival (94.3 ± 0.94% vs 90.8 ± 2.36; P < 0.001). From arrival to 6 hours of exposure to altitude, there was a significant fall in arterial oxygen saturation in those men who developed AMS than in those who did not. Results from the stepwise multiple regression (R2 = 0.59; P < 0.04) and logistic regression (R2 = 0.48; P < 0.0019) analyses showed that the difference between arterial oxygen saturation at sea level and at arrival at Cusco was a predictor for the development of AMS within 6 hours upon arrival at altitude. This suggests that the lower the difference between arterial oxygen saturation at sea level and at arrival, the higher the probability to develop AMS within 6 hours after arrival at 3400 m. The presentation of AMS, however, does not predict low performance in physical activity at high altitude. Am. J. Hum. Biol. 10:669-677, 1998. © 1998 Wiley-Liss, Inc.

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En la presente revisión se describen los conceptos de aclimatación y adaptación a la altura. Se enumeran las distintas ciudades de Perú y de La Paz ubicados a diferentes alturas con el fin de precisar la presión parcial de oxígeno en la atmósfera, en el aire inspirado, y la presión barométrica en cada una de ellas. Se describen los fenómenos de ventilación y saturación arterial de oxígeno antes la exposición aguda a la altura, observándose un incremento de la ventilación y disminución de la saturación arterial de oxígeno. Se definen los tipos de ajuste durante la exposición aguda a la altura: acomodación, aclimatación y adaptación ; así como, el mal de montaña agudo y el mal de montaña crónico.

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A continuación detallamos una serie de estudios realizados en el Perú, principalmente en el Instituto de Investigaciones de la Altura, y en el Instituto de Biología Andina, así como aquellos desarrollados en el extranjero sobre el efecto de la exposición aguda a la altura sobre las funciones del organismo, particularmente los hormonales y metabólicos, los hematológicos, cardiovasculares, y respiratorios.

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El presente estudio ha sido diseñado para analizar la información del Censo Nacional de Perú, 1993 y la Encuesta Demográfica de Población, 1991-1992 reralizada en el Perú (Perú, 1994; ENDES, 1992) para determinar la población que habita en la alturas de Perú y la tasa Global de fecundidad (TGF).El estudio ha sido diseñado para investigar en poblaciones que viven al nivel del mar y en la altura, la edad de menarquia, la edad de menopausia, la prevalencia de embarazos en la adolescencia, el porcentaje de embarazos durante la lactancia materna en mujeres que nunca utilizaron contraceptivos, y los niveles de prolactina sérica durante los tres primeros meses posteriores al parto en mujeres que dan lactancia materna exclusiva. La duración de la vida reproductiva fue mayor al nivel del mar que en la altura, donde a mayor altitud de residencia menor es la duración de la vida reproductiva. Exceptuando a Arequipa, las poblaciones de las regiones administrativas ubicadas en la altura tienen un mayor TGF que las localidades en la costa del Perú (La Libertad, Grau y Lima). Las tres regiones localizada en la selva tienen también una alta TGF. La TGF según regiones naturales fue de 2.1 niños por mujer en Lima Metropolitana, 3.3 en el resto de la costa, 4.9 en la altura, y 5.1 en la selva. En 224 madres que nunca usaron métodos contraceptivos, el intervalo entre hijos fue menor en Cerro de Pasco (2.7 +/- 0.15 años) que en Cusco (3.1 +/- 0.29 años) o Lima (3.8 +/- 0.36 años). El porcentaje de mujeres que se embarazaron durante la lactancia aumentó conforme aumentó la altitud de residencia. Los niveles de prolactina sérica fueron significativamente mayores en las lactantes de nivel del mar que en la altura (P menor que 0.01). En conclusión nuestros datos sugieren que en la altura hay más eficiencia reproductiva

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