Revista Medica Herediana

Academic evaluation of surgical resident programs through the MEDUCPG14 program

RESUMEN Objetivos : Determinar la validez y confiabilidad de los resultados del instrumento MEDUCPG14 y describir los resultados de la evaluación docente en los programas quirúrgicos de residentado médico de una universidad privada. Material y métodos : Estudio de tipo transversal de validación del instrumento MEDUCPG14. El instrumento fue aplicado a 77 médicos residentes de los programas quirúrgicos de residentado médico de la Universidad Peruana Cayetano Heredia (UPCH) y se evaluaron a 41 profesores. Resultados : Se obtuvo un coeficiente de confiabilidad de 0,959. Se encontraron dos dominios: Enseñanza y evaluación y retroalimentación (EER) (11 ítems) con confiabilidad de 0,957 y Trato respetuoso a pacientes y equipo de salud (TR) (3 ítems) con confiabilidad de 0,923. El porcentaje de respuesta fue mayor al 90%. No hubo diferencias significativas en los puntajes promedio por sexo, edad, especialidad y sede docente. Conclusión : El instrumento MEDUCPG-14 tiene una adecuada validez y confiabilidad en los programas quirúrgicos del residentado médico. Se requieren 4 o más evaluaciones por docente; no hubo diferencias en la evaluación de los docentes quirúrgicos en relación al sexo, sede docente y especialidad quirúrgica del médico residente.

SUMMARY Objectives : To determine the validity and reliability of results obtained using the MEDUCPG14 instrument as well as to describe the results of the academic evaluation of surgical resident programs of a private university. Methods : A cross- sectional study was performed; the instrument was applied to 77 residents of surgical programs of Universidad Peruana Cayetano Heredia and to 41 professors. Results : A reliability coefficient of 0.959 was obtained. Two domains were found: teaching, feedback and evaluation (11 items) attained a coefficient of 0.957 and respectful treatment (3 items) attained a coefficient of 0.923. Answer rate was higher than 90%. No difference by age, gender and subspecialty was found. Conclusion : MEDUCPG-14 has adequate validity and reliability to evaluate academic performance in surgical resident programs. Four or more evaluations per professor are needed; no difference by age, sex and subspecialty was found.

Epidemiology of violence against adolescents in Brazil: Data analysis of the violence and accident surveillance system*

RESUMO Objetivo : Descrever as características da violência contra adolescentes notificados a partir do Sistema de Vigilância de Violência e Acidentes/VIVA, no Brasil. Material e métodos : Estudo descritivo, com dados do Sistema de Vigilância de Violência e Acidentes/VIVA, Brasil, no período de 2009 a 2016. As variáveis analisadas foram: idade, sexo, raça, local de ocorrência, vinculo do agressor com a vítima e suspeita de uso de álcool nos casos de violência física, psicológica/moral e sexual. Utilizou-se estatística descritiva e o teste de tendência de proporções no STATA. Resultados : A taxa de prevalência da violência física na faixa de 15-19 anos alcançou 104,4 por 100 000 casos, e a prevalência da violência sexual na faixa de 10-14 anos foi de 38,5 por 100 000 casos. A violência sexual alcançou nas meninas a prevalência de 52,0 por 100 000 casos, enquanto que, nos meninos, de 4,5 por 100 000 casos. Houve tendência crescente significativa de violência física na faixa de 15-19, e de violência sexual na faixa de 10-14 anos. Ambos tipos de violência atingiram as raças parda e indígena, acontecendo na residência da vítima, sendo o agressor o namorado. No caso de violência sexual, cresceu a suspeita de uso de álcool pelo agressor. A variação percentual na violência física e psicológica aumentou em mais de 400%. Conclusões: Houve aumento de todos os tipos de violência nestes oito anos. Foram mais frequentes as notificações de violência física e sexual, atingindo principalmente as meninas, na residência, sendo o amigo/conhecido ou namorado da vítima os principais agressores.

SUMMARY Objective: To describe the characteristics of violence against adolescents in Brazil reported from the Violence and Accident Surveillance System (VIVA). Methods: A descriptive study, based on data from the VIVA, Brazil, from 2009 to 2016. The variables analyzed were age, gender, race, place of occurrence, bond between the aggressor and the victim, and suspected of alcohol use in cases of physical, psychological/moral and sexual violence. Descriptive statistics and tends proportion test with STATA were used. Results : The prevalence rate of physical violence in the 15-19 years age bracket reached 104.4 per 100,000 cases, and the prevalence of sexual violence in the 10-14 years age bracket was 38.5 per 100,000 cases. Sexual violence reached 52.0 per 100,000 cases in girls, compared to 4.5 per 100,000 in boys. There was a significant upward trend in physical violence in the 15-19 years age bracket, and in sexual violence in the 10-14 years age bracket. Both types of violence affecting more frequently brown and indigenous races, and happening at the victim’s home, with the perpetrator being the adolescent’s boyfriend. In cases of sexual violence, the suspicion of alcohol use by the aggressor has grown. The percentage change in physical and psychological violence increased by more than 400%. Conclusions : Regardless of the type of violence, there was an increase in the eight years. Notifications of physical and sexual violence were more frequent, affecting mainly girls, in their residence, being a friend/acquaintance or boyfriend of the victim the main aggressors.

Initial evaluation of the outpatient reference and counter-reference system (ORCR) of DIRIS Lima Norte from maternal-child centers

RESUMEN Desde julio 2018 se implementa el SRCR de consulta ambulatoria en IPRESS de DIRIS Lima-Norte utilizando el aplicativo REFCON; incluye cinco sub-procesos, tres de ellos ocurren en IPRESS de destino. Objetivo : Caracterizar las referencias emitidas en las IPRESS I-4 que tuvieron como IPRESS de destino a los hospitales de la DIRIS Lima Norte, y el tiempo de citas de las mismas. Material y métodos : Estudio cuantitativo observacional de tipo transversal, que incluyó las referencias emitidas en el periodo mayo-octubre 2019, por siete IPRESS I-4. Se analizaron las referencias por IPRESS, sexo, etapa de vida, especialidad y tiempos hasta la cita. Se estimó medidas de tendencia central y dispersión; y chi-cuadrado para el análisis bivariado, usando Stata v.16. Resultados : Hubo 19 951 referencias de siete IPRESS de origen. La población más referida fue de 30-59 años (39,22%) y mujeres (67,04%). Se excluyó del análisis de tiempos 2 714 referencias por información incompleta. El tiempo de aceptación en IPRESS de destino mostró gran variabilidad, solo 23,14% fueron aceptadas en menos de 24 horas. El subproceso de aceptación hasta la cita mostró que la mitad de pacientes demoraron entre 80-85 días en ser atendidos. Solo se reportaron 110 contrarreferencias; de ellas, 48 (43,6%) fueron a Juan Pablo II. Conclusiones : Se evidencia una incipiente implementación, ausencia de normatividad, irregular capacitación de personal y limitación de personal que se traduce en alto porcentaje de rechazos y retrasos en aprobación de referencias. Y tiempos mayores de 80 días desde el registro de la referencia hasta la cita, para el 50% de las mismas, desconociendo el porcentaje de citas atendidas.

SUMMARY Starting in July 2018 the ORCR was implemented in the IPRESS-DIRIS Lima Norte using the REFCON instrument that includes five processes, three of which occur in the IPRESS of destiny. Objective : To characterize the references of IPRESS I-4 whose destiny were DIRIS Lima Norte and time to appointment of the encounters. Methods : A cross- sectional study was carried-out from May to October 2019 including seven IPRESS I-4. References by age, sex and specialty were analyzed as well as time to appointment. Statistics for means and proportions were calculated using Stata v.16. Results : A total of 19,951 references from seven IPRESS were included in the analysis. The most common age group was 30-59 years (39.22%): women accounted for 67.04%. We excluded from the final analysis 2,714 references for not having information on time to appointment. Only 23.14% of referrals were accepted in less than 24 hours. Half of patients had to wait between 80-85 days to have an appointment. Only 110 counter-references were reported, 43.6% went to Juan Pablo II. Conclusions : We observed a clearly inefficient system with long delays in making appointments and high rate of referral rejections, these findings are the result of lack of regulation, lack of manpower and poor training of the existing personnel.

Propylthiouracil induced ANCA positive vasculitis. A case report

RESUMEN La vasculitis asociada a propiltiouracilo (PTU) y ANCA es una enfermedad rara con una incidencia de 0,47-0,71 casos por cada 10 000 pacientes. Afecta principalmente a los vasos de menor calibre. Piel, riñones y pulmones son los más afectados. El diagnóstico requiere alta sospecha clínica y se apoya en estudios histopatológicos de las lesiones en piel y serología positiva para ANCA. La suspensión del medicamento suele bastar como manejo de la enfermedad. Mujer de 45 años de edad, con historia de consumo de PTU durante 2 años, desde su diagnóstico de hipertiroidismo; presentando placas purpúricas dolorosas en ambos miembros inferiores.

SUMMARY ANCA vasculitis associated to propylthiouracil (PTU) is a rare condition with an incidence of 0.47-0.71 cases per 100,000 patients. It affects mainly minor caliber blood vessels. The skin, kidneys and lungs are the organs most affected. To make the diagnosis it is necessary to have a high index of suspicion and rely on histopathologic findings of skin lesions plus a positive ANCA test. Stopping the inducing drug is usually necessary to manage this condition. We report the case of a 45-year-old woman who consumed PTU for two years for the treatment of hyperthyroidism presenting with painful purpuric plaques in the lower limbs.

Implementing a therapeutic intervention in pre-sport and adapted recreative activities in children with disabilities. The experience of Instituto Nacional de Rehabilitacion

RESUMEN Se reporta el caso de la implementación de un programa de deporte adaptado en niños con discapacidad realizada en el Instituto Nacional de Rehabilitación con la finalidad de dar a conocer las facilidades, oportunidades, limitaciones y dificultades que se presentaron. Se inició con la elaboración de guías del programa de deporte hasta su aplicación.

SUMMARY We report the case of implementing an adapted sport program in children with disabilities in the Instituto Nacional de Rehabilitacion to make aware the opportunities, facilities, limitations and difficulties in its implementation. We started making guidelines of the sport program follow by its implementation.

Osteogenesis imperfecta: Diagnosis and management of an orphan disease in a Peruvian regional hospital. A case report

RESUMEN La osteogénesis imperfecta es una enfermedad rara de herencia autosómica dominante en la cual existen anomalías en la síntesis o degradación del colágeno que afecta al tejido conectivo ocasionando múltiples fracturas. Neonato femenino, a término 38 semanas, nacido por cesarea, procedente de Pichari, ingres6 por cuadro de dificultad respiratoria instalada durante atención inmediata. Al examen físico se palpa crepitaciones en articulaciones. La paciente fue diagnosticada de osteogénesis imperfecta en base a los hallazgos clínicos y de imágenes, al carecer de evaluaciones genéticas.

SUMMARY Osteogenesis imperfecta is a rare autosome dominant disease in which there are anomalies in the synthesis of collagen affecting the connective tissue leading to multiple fractures. We present the case of a 38-week newborn from Pichari born of a cesarean section who presented respiratory failure. The patient presented crackles on the joints and was diagnosed on clinical grounds of osteogenesis imperfecta.

Calcitonin negative neuroendocrine thyroid carcinoma: Case report and literature review

SUMMARY Medullary thyroid carcinoma (MTC) is a relatively rare neuroendocrine tumor that originates in the parafollicular C cells of the thyroid gland. It is characterized by the synthesis and secretion of calcitonin. Usually, serum calcitonin is used as part of the diagnosis and follow-up of these patients. Few cases of MTC with negative calcitonin have been reported worldwide, whose diagnosis is a clinical challenge.

RESUMEN El carcinoma medular de tiroides (MTC) es un tumor neuroendocrino relativamente raro que se origina en las células C para foliculares de la glándula tiroides. Se caracteriza por la síntesis y secreción de calcitonina. Por lo general, la calcitonina sérica se utiliza como parte del diagnóstico y seguimiento de estos pacientes. Se han notificado pocos casos de MTC con calcitonina negativa en todo el mundo, cuyo diagnóstico es un desafío clínico.

Mesenteric ischaemia: the endovascular management

RESUMEN La isquemia mesentérica es una condición que puede volverse muy grave y ser letal, más aún en los casos agudos. Un tratamiento precoz es muy importante. Se presentaron cuatro casos consecutivos tratados por nuestro equipo con trombosis, o disección o aneurismas de arterias mesentérica superior y tronco celíaco, se revisaron las indicaciones y se evaluaron los tratamientos llevados a cabo. Se utilizaron procedimientos endovasculares en todos, técnicamente en forma exitosa, evitando que progrese a un desenlace peligroso. Hubo diversidad de técnicas endovasculares adaptándolas a cada caso. En ningún paciente se requirió un acceso quirúrgico abierto para completar el tratamiento realizando las intervenciones prontas. El manejo endovascular de las lesiones mesentéricas es factible y replicable, y en nuestros casos podría haber prevenido una necrosis intestinal así como la necesidad de cirugías resectivas.

SUMMARY Mesenteric ischaemia is a condition that may be very severe and potentially lethal particularly in the acute presentation. Early treatment is crucial. We present four consecutive cases managed by our team with thrombosis or dissection or aneurysm of the superior mesenteric artery and the celiac trunk reviewing indications and treatment implemented. Multiple successful endovascular procedures were used in all cases avoiding progression to lethal consequences. None of the patients required an open surgical procedure. Therefore, endovascular procedures are feasible in these patients avoiding intestinal necrosis as well as the need for open surgeries.

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