Background: This investigation compared the efficacy and safety of fexuprazan 40 mg and esomeprazole 40 mg in patients with acid reflux-related disorders, including erosive esophagitis (EE) and laryngopharyngeal reflux disease (LPRD). Methods: A systematic search was conducted across five databases until January 2025. Primary outcomes included esophageal lesion healing, complete resolution of symptoms (CRS), and 24 h symptom-free days. Meta-analyses used random-effects models with the inverse variance method. The Risk of Bias 2.0 tool and the certainty of evidence (CoE) using GRADE methodology were assessed. Results: Three randomized controlled trials (n = 695) conducted in Asian countries were included. Fexuprazan may have little to no effect compared to esomeprazole on EE healing rate at 4 weeks (RR 1.02, 95% CI 0.93 to 1.12, I2 = 0%, n = 2 studies, CoE very low) and 8 weeks. No significant differences were found between treatments regarding CRS at 1 week (RR 1.29; 95% CI: 0.84 to 1.99; I2 = 0%; n = 2 studies; CoE very low) and 8 weeks, or in the 24 h symptom-free days at 1 week (MD 2.67 days, 95% CI -2.76 to 8.10, I2 = 41%, n = 2 studies, CoE very low) and 8 weeks. Fexuprazan also showed little to no effect on treatment-emergent adverse events (RR 1.00, 95% CI 0.83 to 1.20, I2 = 0%, n = 3 studies, CoE very low). Nonetheless, the evidence for all outcomes was rated as very uncertain. Conclusions: Fexuprazan 40 mg may provide similar efficacy compared to esomeprazole 40 mg in EE, with a comparable safety profile to esomeprazole in EE and LPRD patients. However, the evidence is highly uncertain, requiring further studies.
BACKGROUND:Osteoarthritis (OA) is a leading cause of disability worldwide. To standardize management, Peru's Social Health Insurance (EsSalud) approved its Clinical Practice Guideline (CPG) for OA in 2018, updated in 2024. However, adherence to these recommendations among physiatrists and physical medicine and rehabilitation (PM&R) residents is unknown. OBJECTIVE:To assess adherence and perceptions regarding the Peruvian OA CPG among physiatrists and PM&R residents. METHODS:A cross-sectional survey (May-July 2025) was conducted via two national WhatsApp groups. Sociodemographic and professional data were collected, along with agreement levels for 10 CPG recommendations using a 5-point Likert scale. For five prioritized recommendations, stages of implementation were assessed using the transtheoretical model. Factors associated with agreement on ≥6 recommendations were analyzed with Poisson regression and robust variance. RESULTS:Eighty-eight participants completed the survey; 55.7% were physiatrists and 44.3% residents. Awareness of the OA CPG was reported by 42.1%, and only 3.4% had received prior training. Agreement was highest for oral nonsteroidal anti-inflammatory drugs and avoidance of tramadol and lowest for avoidance of hyaluronic acid, prolotherapy, and acupuncture. Most respondents were in early stages of implementation. Employment in national specialized institutes was significantly associated with higher agreement (prevalence ratio, 2.53; 95% confidence interval: 1.20-5.36). Main reasons for disagreement included perceived clinical effectiveness and positive experience. Suggested strategies to improve adherence were workshops and educational meetings. CONCLUSIONS:Awareness and training on the Peruvian OA CPG are limited, with heterogeneous adherence across recommendations. Educational strategies are needed to enhance evidence-based OA management in Peru.
The global refugee population has nearly doubled in the last decade, and many of these populations face chronic displacement, often in neighbouring countries with limited resources. Emergency, short-term responses are being transitioned to longer term approaches, including a focus on inclusion through coverage in national health systems. However, analysis of empirical and comparative evidence on how to enact these approaches has been limited. In this article, we analyse the inclusion of refugees in six low and middle-income country (LMIC) health systems (Kenya, Kurdistan Region of Iraq (KRI), Mauritania, Pakistan, Peru and Zambia). Using a shared framework and tools, we collected data over 2023 to 2025, using document reviews, key informant interviews, focus group discussions and participatory workshops. Analysis was carried out separately for each setting, validated locally, and later compared for synthesis. We focus on key health system domains-governance, health financing, service delivery (including the health workforce) and health information systems-outlining the attributes of refugee inclusion and system integration in each, identifying patterns across the case studies and barriers and enablers. We identify leverage points for improving integration but highlight that inclusion of refugees into national health systems is complex and does not guarantee improved outcomes, especially when refugees previously benefited from a higher level of resources and are being included in strained host health systems. However, committed government leadership, coordinated international support, and multi-year investments in strengthening key components of the local health system, including enabling refugee health staff to engage effectively in it, can make the transition to an integrated system a beneficial one for both refugee and host communities.
ABSTRACT Introducción: Aunque el cáncer de vulva es cada vez más común, especialmente en países de altos ingresos, su epidemiología en las aseguradoras peruanas de EsSalud está mal caracterizada. Objetivos: Determinar la prevalencia, incidencia y mortalidad del cáncer de vulva en EsSalud, estratificado por grupo etario y región. Métodos: Se utilizaron las historias clínicas electrónicas de EsSalud 2019-2022 para realizar el correspondiente análisis retrospectivo, descriptivo y longitudinal. Resultados: Se estimó que EsSalud aseguró a 6,173,831 mujeres en 2022, incluidos 414 casos de cáncer de vulva, 236 casos nuevos y 27 muertes. Incidencia 3,82, frecuencia 6,71 y mortalidad 0,44 por 100.000 mujeres. Loreto (12,43 por 100.000 mujeres) y Madre de Dios (9,90) tuvieron la mayor prevalencia e incidencia. Conclusiones: en la aseguradora de salud más grande del Perú, este estudio arroja luz sobre la epidemiología del cáncer de vulva. Para optimizar la atención y la prevención, destaca las desigualdades regionales y los patrones demográficos y pide medidas específicas de salud pública y asignación de recursos.
La investigación científica constituye uno de los pilares fundamentales del progreso en las ciencias médicas. Es a través de la generación sistemática de evidencia que se optimizan las intervenciones clínicas, se racionaliza el uso de los recursos y se formulan políticas públicas basadas en datos objetivos. En este contexto, la Medicina de Emergencias y Desastres no puede concebirse únicamente como una especialidad asistencial de respuesta inmediata, sino también como un campo estratégico para la producción de conocimiento con impacto directo en la salud individual y colectiva.
