Revista de la Facultad de Medicina Humana

Protecting health personnel in the covid-19 pandemic

COVID-19 Pandemic: What Else Can I Do?

Adult lymphoma / Leukemia T: Prevalent entity in South America

Clinicoepidemiological characteristics of patients who died from COVID-19 at a National Hospital of Lima, Peru

RESUMEN Introducción: La pandemia debida a enfermedad por coronavirus 2019 (COVID-19) ha producido más de 70 mil muertes en el mundo. Objetivo: Describir las características de pacientes fallecidos por COVID-19 en un hospital terciario. Métodos: Estudio descriptivo realizado en el servicio de emergencia del hospital Rebagliati Lima-Perú, que incluye los pacientes fallecidos con resultado positivo a infección por SARS-CoV-2 mediante RT-PCR hasta el 4 de abril de 2020. Se revisó la historia clínica y registros hospitalarios buscando variables sociodemográficas, antecedentes, manifestaciones clínicas, radiológicas, tratamiento y evolución. Resultados: Se identificaron 14 casos, 78,6% de sexo masculino, edad promedio 73,4 años (rango 26 a 97). Adquirieron la infección en el exterior del país el 21,4% de casos. Se encontró factores de riesgo en 92,9% de pacientes (más frecuentes adulto mayor, hipertensión arterial y obesidad). Los síntomas más frecuentes fueron disnea, fiebre y tos, con tiempo de enfermedad 8 días (+/- 3,0); los signos polipnea y estertores respiratorios. Los hallazgos de laboratorio más frecuentes fueron proteína C reactiva elevada (promedio 22 mg/dL) e hipoxemia. La presentación radiológica predominante fue infiltrado pulmonar intersticial bilateral en vidrio esmerilado. Ingresaron a ventilación mecánica 78,6% (11 de 14 casos); recibió azitromicina 71,4%, hidroxicloroquina 64,3% y antibióticos de amplio espectro 57,1% de los casos; con estancia hospitalaria de 4,7 días (+/-2,4). Conclusión: Los fallecidos por COVID-19 presentaron neumonía grave bilateral, más frecuentes en varones, con factores de riesgo (adulto mayor, hipertensión arterial y obesidad), con alta necesidad de asistencia ventilatoria.

ABSTRACT Introduction: The COVID-19 pandemic has caused more than 70 thousand deaths worldwide. Objective: To describe the characteristics of COVID-19 patients who died in a tertiary hospital. Methods: A descriptive study was carried out in the emergency service of the Hospital Rebagliati in Lima, Peru, which includes deceased patients with a positive result for SARS-CoV-2 infection diagnosed by RT-PCR until April 4, 2020. The medical history was reviewed. and hospital records looking for sociodemographic variables, clinical characteristics, radiological manifestations, treatment and evolution. Results: 14 cases were identified, 78.6% were male, average age 73.4 years (range 26 to 97). 21.4% of cases acquired the infection out of Peru. Risk factors were found in 92.9% of patients (more frequent elderly, hypertension and obesity). The most frequent symptoms were dyspnea, fever and cough, with illness time 8 days (+/- 3); signs of polypnea and respiratory rales. The most frequent laboratory findings were elevated C-reactive protein (average 22 mg / dL) and hypoxemia. The predominant radiological presentation was bilateral interstitial pulmonary infiltration in ground glass. 78.6% (11 of 14 cases) entered mechanical ventilation; 71.4% of the cases received azithromycin, 64.3% hydroxychloroquine and 57.1% broad-spectrum antibiotics; with a 4.7 day hospital stay (+/- 2.4). Conclusion: Those who died from COVID-19 presented bilateral severe pneumonia, more frequent in men, with risk factors (elderly, hypertension and obesity), with a high need for ventilatory assistance.

Risk factors for infertility in women in a Peruvian Hospital

RESUMEN Introducción : La infertilidad se define como el no logro del embarazo posterior a 12 meses de relaciones sexuales sin protección, según la Organización Mundial de la Salud (OMS). Entre 60 a 80 millones de parejas anualmente sufren este problema. En el Perú no existen reportes actualizados que permitan conocer estas cifras y hay pocos estudios que permitan conocer las causas de esta afección. Objetivo : Determinar los factores asociados a infertilidad en pacientes mujeres atendidas en consultorios externos en el Servicio de Ginecología del Hospital Vitarte, periodo enero 2015 a abril del 2019. Métodos : Se realizó un estudio observacional, analítico, retrospectivo de casos y controles, considerando una muestra de 82 casos y 82 controles. Se consideraron factores asociados clínico, demográfico y de hábitos de consumo nocivo y, para medir la asociación, se utilizó los odds ratio crudos y ajustados, para lo cual se usó el paquete estadístico SPSS. Resultados : En base a los OR ajustados, se identificó a la dispareunia (OR:4.16, IC95% 1.56- 11.14), dismenorrea, (OR:4.22, IC95% 1.79-9.93), enfermedad pélvica infamatoria (OR:5.59, IC95% 2.11- 14.84), y el consumo de alcohol (OR:2.87, IC95% 1.10-7.49), como factores asociados estadísticamente significativos para el desarrollo de infertilidad. Conclusión : Los factores asociados a la infertilidad en el servicio de ginecología del Hospital Vitarte durante el periodo de enero 2015 a abril 2019 son la dispareunia, dismenorrea, el antecedente de enfermedad pélvica inflamatoria y, el consumo de alcohol.

ABSTRACT Introduction: We can define infertility as the failure to achieve pregnancy after 12 months of unprotected sex, according to the World Health Organization (WHO). Between 60 to 80 million couples annually suffer from this problem. In Peru, there are no updated reports that allow knowing these figures. In addition, few studies allow knowing the causes of this condition Objective: To determine the risk factors associated with infertility in female patients treated in outpatient offices in the Gynecology Service of the Vitarte Hospital, period January 2015 to April 2019. Methods: We conducted an observational, analytical, retrospective case-control study, considering a sample of 82 cases and 82 controls. Clinical, demographic and habits of harmful consumption factors were considered and, to measure the association, the crude and adjusted odds ratios were used, for which the statistical package SPSS was used. Results: Based on the adjusted OR, dyspareunia was identified (OR: 4.16, 95% CI 1.56-11.14), dysmenorrhea, (OR: 4.22, 95% CI 1.79-9.93), pelvic inflammatory disease (OR: 5.59, 95% CI 2.11-14.84), and alcohol consumption (OR: 2.87, 95% CI 1.10-7.49), as statistically significant risk factors for the development of infertility. Conclusion: The factors associated with infertility in the gynecology service of the Vitarte Hospital during the period from January 2015 to April 2019 are dyspareunia, dysmenorrhea, the history of pelvic inflammatory disease and alcohol consumption.

Predictor factors for multidrug-resistant tuberculosis among patients with pulmonary tuberculosis in Huánuco, Peru. 2010-2015

RESUMEN Introducción : En la ciudad de Huánuco se observa un crecimiento progresivo de casos de Tuberculosis y cada vez más frecuente la Tuberculosis multidrogorresistente, por esta razón fue necesario identificar factores predictores para desarrollar Tuberculosis multidrogorresistente. Objetivo : Determinar si la fiebre persistente, el patrón radiográfico cavitario y la baciloscopía positiva al primer mes de tratamiento son predictores de Tuberculosis multidrogorresistente en pacientes con Tuberculosis Pulmonar en cuatro establecimientos de salud de la ciudad de Huánuco, entre enero 2010 y diciembre 2015. Métodos : Estudio observacional, casos y controles. Se consideraron 37 casos y 111 controles. Los datos se recolectaron de las historias clínicas. Resultados : Los factores predictores encontrados en el análisis bivariado fueron la persistencia de la fiebre a las dos semanas (p=0, 001; OR 0,05; IC 0,01-0,5), el patrón radiográfico cavitario (p=0,000; OR 11,6; IC 4,6- 26,5), y la positividad de la baciloscopía al primer mes de tratamiento (p=0,00; OR 13,5; IC 4,1-44,6 al 95%). Estas fueron confirmadas con el análisis multivariado (p=0,08; p=0,002; p=0,00 respectivamente). Conclusión : La persistencia de la fiebre a las dos semanas, el patrón radiográfico cavitario y la baciloscopía positiva al primer mes de tratamiento mostraron asociación predictiva en forma independiente para el diagnóstico de Tuberculosis multidrogorresistente.

ABSTRACT Introduction: In the city of Huánuco and around the world, there is a progressive increase in cases of Tuberculosis and multidrug-resistant Tuberculosis, for this reason it was necessary to identify predictors to develop multidrug-resistant Tuberculosis. Objective: To determine if persistent fever, cavitary radiographic pattern and positive smear microscopy at the first month of treatment, are predictors of multidrug-resistant Tuberculosis in patients with Pulmonary Tuberculosis, in four health facilities in the city of Huánuco, between January 2010 and December 2015. Methods: Case and control study. We considered 37 cases and 111 controls. Data were collected from medical records. Results: The predictive factors found in the bivariate analysis were persistence of fever at 2 weeks (p = 0.001, OR 0.05, CI 0.01-0.5), cavitary radiographic pattern (p = 0.000, OR 11.6, 95%IC 4.6-26.5), and smear microscopy positivity at the first month of treatment (p = 0.00, OR 13.5, 95%CI 4.1-44.6). These were confirmed by multivariate analysis (p = 0.012, p = 0.00, p = 0.00 respectively). Conclusion: The persistence of fever at two weeks, cavitary radiographic pattern and positive smear microscopy at the first month of treatment were predictive factors associated independently for the diagnosis of multidrug-resistant Tuberculosis.

Contraceptive attitudes among hmong young adults in rural california

ABSTRACT Introduction : While different contraceptive attitudes have been reported among different ethnic groups in the US, little if any research has been conducted to understand the reproductive health needs and attitudes among Hmong young adults. To our knowledge, this is the first study to investigate the relationship among contraceptive perception of this community. Objective : The purpose of this research was to identify attitudes that influence Hmong college students’ contraceptive practices. Methods : A campus-wide online survey was used as part of the data collection at a midsize institution in Central California. The questionnaire was a 32-items scale instrument called Contraceptive Attitude Scale (CAS), developed by Dr. Black. Results : Three hundred and forty-four students successfully completed the 32-items scale instrument CAS, which measured general contraceptive attitudes among Hmong young adults in rural California. The data reveals a high prevalence of unmarried (85%) Hmong college students reporting being sexually active (67%), with 62% having at least one sexual partner over the past 12 months; however, only 36% reported to use condom compared to 58% who did not use condoms during the last time of sexual intercourse. Conclusion : The findings indicated statistically significant differences between groups on the characteristics of sexual partners, contraceptive methods, marital status, birthplace, primary language spoken at home, years spent in college and years lived in the United States. The findings greatly contribute to the understanding of factors that influence contraceptive choices among the Hmong college population. More importantly, the information is crucial in designing programs to promote contraceptive knowledge and practices that are specific to the Hmong.

RESUMEN Introducción : Si bien se informaron diferencias en las actitudes anticonceptivas entre los diferentes grupos étnicos en los EE. UU., Se ha realizado poca o ninguna investigación para comprender las necesidades y actitudes de salud reproductiva entre los adultos jóvenes hmong. Hasta donde sabemos, este es el primer estudio que investiga la relación entre la percepción anticonceptiva de esta comunidad. Objetivo : El propósito de esta investigación fue identificar actitudes que influyen en las prácticas anticonceptivas de los estudiantes universitarios de Hmong. Métodos : Se utilizó una encuesta en línea en todo el campus como parte de la recopilación de datos en una institución mediana en California Central. El cuestionario era un instrumento a escala de 32 ítems llamado Escala de Actitud Anticonceptiva (CAS), desarrollado por la Dra. Black. Resultados : Trescientos cuarenta y cuatro estudiantes completaron con éxito el instrumento CAS de escala de 32 ítems, que midió las actitudes anticonceptivas generales entre los adultos jóvenes Hmong en las zonas rurales de California. Los datos revelan una alta prevalencia de estudiantes universitarios Hmong solteros (85%) que informan ser sexualmente activos (67%), con 62% teniendo al menos una pareja sexual en los últimos 12 meses; sin embargo, solo el 36% informó usar condón en comparación con el 58% que no usó condón durante la última vez que tuvo relaciones sexuales. Conclusión : Los resultados indicaron diferencias estadísticamente significativas entre los grupos en cuanto a las características de las parejas sexuales, los métodos anticonceptivos, el estado civil, el lugar de nacimiento, el idioma principal que se habla en el hogar, los años que pasaron en la universidad y los años que vivieron en los Estados Unidos. Los hallazgos contribuyen en gran medida a la comprensión de los factores que influyen en las elecciones de anticonceptivos entre la población universitaria de Hmong. Más importante aún, la información es crucial en el diseño de programas para promover el conocimiento y las prácticas anticonceptivas que son específicos del Hmong.

Comparative histopathological study of the phrenic nerve from corpses with chronic obstructive pulmonary disease and without this condition

RESUMEN Introducción : Los cambios funcionales resultantes de la evolución de la enfermedad pulmonar obstructiva crónica (EPOC) son progresivos e irreversibles, lo que provoca un aumento del trabajo del diafragma debido a la hiperinflación. Los nervios frénicos promueven la inervación del diafragma y pueden verse comprometidos en la condición de EPOC. Objetivo : Comparar la morfología de los nervios frénicos de los cadáveres con y sin EPOC, mediante microscopía óptica. Métodos : Estudio descriptivo, transversal y comparativo de muestras, tanto de los pulmones como de los nervios frénicos de 38 cadáveres, con diagnóstico de EPOC y sin esta condición. Las muestras de tejido fueron fijadas y procesadas por histología convencional con láminas histológicas de hematoxilina-eosina. Las muestras fueron compuestas por pacientes con EPOC (EPOC) y sin EPOC (CTR). Esta clasificación se realizó después del análisis histológico. Las láminas histológicas se analizaron mediante microscopía óptica por un patólogo, que fue un evaluador ciego al estudio. Resultados : De acuerdo con los criterios de inclusión, se incluyeron 31 cadáveres en el grupo de EPOC y 7 cadáveres en el grupo CTR. En el análisis de los nervios frénicos, 8 cadáveres, es decir 25.8% del grupo de EPOC, tuvieron cambios histopatológicos como edema perineural (75%, n=6), atrofia nerviosa (12.5%, n=1) e infiltrado eosinofílico perineural (12.5%, n=1). Conclusiones : Los nervios frénicos de los cadáveres con EPOC tienen tendencia a alteraciones histopatológicas, siendo el edema perineural la principal modificación encontrada.

ABSTRACT Introduction : Functional changes resulting from the evolution of chronic obstructive pulmonary disease (COPD) are progressive and irreversible, causing increased diaphragm work due to pulmonary hyperinflation and airway obstruction. Phrenic nerves have promoted innervation of the diaphragm and may have been compromised in COPD condition. Objective : To compare the morphology of the phrenic nerves of the cadavers with COPD and without COPD by optical microscopy. Methods : An exploratory descriptive studio conducted on the Death Verification Service in Alagoas. Pulmonary and phrenic nerve biopsies will be bilaterally taken from the 38 cadavers after a necropsy with the diagnosis of COPD. Tissue samples were fixed and processed by conventional histology for hematoxylin-eosin (HE) histological slides. Biopsies are divided into experimental groups, one composed by patients with COPD and the other with patients without COPD (control - CTR). This classification was realized after the histological analysis, when typical halls of COPD were found. Histological slides were analyzed by optical microscopy by a pathologist, who was able to assess the study. Results : According to the inclusion and exclusion criteria of the study, if it includes 38 cadavers in the initial evaluation, of which 31 are included in the COPD group and 7 in the CTR group. In the analysis of the phrenic nerves, 8 cadavers, 25.8%, of the COPD group had histopathological changes: perineural edema (75%, n=6), nervous atrophy (12.5%, n=1) and perineural eosinophilic infiltrate (12.5%, n=1). The CTR group does not present histopathological alterations of the phrenic nerves. Conclusions : Given the hallmarks of the biopsies performed on the phrenic nerves of the corpses with COPD, we can infer that there is a tendency for nerve alteration, with perineural edema, to be the major modification found.

ABSTRACT Introduction: Functional changes resulting from the evolution of chronic obstructive pulmonary disease (COPD) are progressive and irreversible, causing increased diaphragm work due to pulmonary hyperinflation and airway obstruction. Phrenic nerves have promoted innervation of the diaphragm and may have been compromised in COPD condition. Objective: To compare the morphology of the phrenic nerves of the cadavers with COPD and without COPD by optical microscopy. Methods: An exploratory descriptive studio conducted on the Death Verification Service in Alagoas. Pulmonary and phrenic nerve biopsies will be bilaterally taken from the 38 cadavers after a necropsy with the diagnosis of COPD. Tissue samples were fixed and processed by conventional histology for hematoxylin-eosin (HE) histological slides. Biopsies are divided into experimental groups, one composed by patients with COPD and the other with patients without COPD (control - CTR). This classification was realized after the histological analysis, when typical halls of COPD were found. Histological slides were analyzed by optical microscopy by a pathologist, who was able to assess the study. Results: According to the inclusion and exclusion criteria of the study, if it includes 38 cadavers in the initial evaluation, of which 31 are included in the COPD group and 7 in the CTR group. In the analysis of the phrenic nerves, 8 cadavers, 25.8%, of the COPD group had histopathological changes: perineural edema (75%, n=6), nervous atrophy (12.5%, n=1) and perineural eosinophilic infiltrate (12.5%, n=1). The CTR group does not present histopathological alterations of the phrenic nerves. Conclusions: Given the hallmarks of the biopsies performed on the phrenic nerves of the corpses with COPD, we can infer that there is a tendency for nerve alteration, with perineural edema, to be the major modification found.

Saturation and overcrowding of the emergency service of an urban hospital

RESUMEN Introducción : La saturación y hacinamiento de pacientes un problema en el servicio de emergencia. Objetivos : Describir las características de la demanda de atención médica al servicio de emergencia de un hospital urbano y evaluar su hacinamiento. Métodos : Estudio observacional realizado en el hospital Rebagliati, primer trimestre 2019. Se evaluaron variables sociodemográficas, de tiempo e indicadores de emergencia del sistema estadístico institucional. Se realizó estadística descriptiva con IBM SPSS 24. Resultados : De 51294 atenciones en pacientes entre 14 y 102 años (mediana 60), 56,7% de sexo femenino. Un 18% registró más de una atención en el trimestre. El día de mayor demanda fue el lunes y el horario entre 08 y 13 horas. Las atenciones de prioridad III y IV fueron el 83,5% del total. En los tópicos de medicina y de alivio se realizaron el 63% de atenciones. En unidad de trauma-shock se realizaron el 3% de las atenciones. Se admitieron en las salas de observación el 13% de las atenciones de emergencia. Los diagnósticos más frecuentes fueron insuficiencia respiratoria, infecciones y accidentes cerebrovasculares. El 88% de las admisiones se realizaron en salas comunes con una estancia entre 4,4 y 7,0 días. Falleció el 0,8% de los atendidos, se realizó intervención quirúrgica en el 0,7% y se transfirió a otro establecimiento al 0,1% respectivamente. Conclusión : La demanda al servicio de emergencia es principalmente por problemas médicos (de prioridad 3 y 4), predominando pacientes adultos mayores y de sexo femenino. Se admitió al 13% de los atendidos con estancia prolongada, baja mortalidad, muy pocas transferencias y alta tasa de retorno.

ABSTRACT Introduction : The saturation and overcrowding of patients are problem in the emergency service. Objective : To describe the characteristics of the demand for medical attention to the emergency service of an urban hospital and to assess its overcrowding. Methods : Observational study carried out at the Rebagliati hospital, first quarter 2019. Sociodemographic variables, time and emergency indicators of the institutional statistical system were evaluated. Descriptive statistics were performed with IBM SPSS 24. Results : Of 5,1244 attentions in patients between 14 and 102 years (median 60), 56.7% were female. 18% recorded more than one service in the quarter. The day of greatest demand was Monday and the hours between 08 and 13 hours. Priority care III and IV were 83.5% of the total. In the topics of medicine and relief, 63% of care was performed. In the trauma-shock unit, 3% of the care was performed. 13% of emergency care were admitted to observation rooms. The most frequent diagnoses were respiratory failure, infections and strokes. 88% of admissions were made in common rooms with a stay between 4.4 and 7.0 days. 0.8% of those seen died, surgery was performed in 0.7%, and 0.1% was transferred to another facility, respectively. Conclusion : The demand to the emergency service is mainly due to medical problems (priority 3 and 4), predominantly elderly and female patients. 13% of those attended were admitted with a long stay, low mortality, very few transfers and a high rate of return.

ABSTRACT Introduction: The saturation and overcrowding of patients are problem in the emergency service. Objective: To describe the characteristics of the demand for medical attention to the emergency service of an urban hospital and to assess its overcrowding. Methods: Observational study carried out at the Rebagliati hospital, first quarter 2019. Sociodemographic variables, time and emergency indicators of the institutional statistical system were evaluated. Descriptive statistics were performed with IBM SPSS 24. Results: Of 5,1244 attentions in patients between 14 and 102 years (median 60), 56.7% were female. 18% recorded more than one service in the quarter. The day of greatest demand was Monday and the hours between 08 and 13 hours. Priority care III and IV were 83.5% of the total. In the topics of medicine and relief, 63% of care was performed. In the trauma-shock unit, 3% of the care was performed. 13% of emergency care were admitted to observation rooms. The most frequent diagnoses were respiratory failure, infections and strokes. 88% of admissions were made in common rooms with a stay between 4.4 and 7.0 days. 0.8% of those seen died, surgery was performed in 0.7%, and 0.1% was transferred to another facility, respectively. Conclusion: The demand to the emergency service is mainly due to medical problems (priority 3 and 4), predominantly elderly and female patients. 13% of those attended were admitted with a long stay, low mortality, very few transfers and a high rate of return.

Risk perception of skin cancer at a high-altitude hospital

RESUMEN Objetivo : Determinar el nivel de percepción de riesgo de cáncer de piel en una población de Cusco. Métodos : El estudio es observacional de tipo transversal descriptivo y se llevó a cabo en una campaña de despistaje de cáncer de piel en la ciudad de Cusco. El cuestionario aplicado fue diseñado y validado por Morales-Sánchez M y Cols, y mide la percepción de riesgo de cáncer de piel. El valor de alfa de Cronbach reportado es de 0,824. Resultados : La mayoría de pacientes fue de sexo femenino (64,7%), de edad promedio fue de 44,9 años (DS: 14,2) y de grado de educación superior (51,0%). La mediana de horas de exposición solar fue de 4 (IC95%: 1 - 6), la procedencia más frecuente fue del Cusco (77,6%) y con una percepción normal del cáncer de piel (65,8%). Conclusión : La percepción de riesgo de cáncer de piel fue normal en la mayoría de la población.

ABSTRACT Objective: To determine the level of risk perception of skin cancer in a population from Cusco. Methods: It is an observational descriptive cross-sectional study and was aplied in a skin cancer screening campaign in Cusco. The applied questionnaire was designed and validated by Morales-Sánchez M and Cols, and it measures the risk perception of skin cancer. The reported Cronbach's alpha value is 0.824. Results: The majority of patients were female (64.7%), average age was 44.9 years (SD: 14.2) and the 51.0% had higher education level. The median hours of sun exposure was 4 (95% CI: 1-6), the most frequent origin was from Cusco (77.6%) and most of the population have normal risk perception of skin cancer (65.8%). Conclusion: The risk perception of skin cancer was normal in the majority of the population.

Factors associated with tobacco consumption in university students of lima metropolitan

RESUMEN Introducción : El consumo de tabaco es perjudicial para la salud, según la Organización Mundial de la Salud (OMS) el tabaquismo es la causa de muerte de aproximadamente 8 millones de personas cada año. Objetivo : El propósito de la investigación fue determinar los factores asociados al consumo de tabaco en estudiantes universitarios de Lima Metropolitana. Métodos : La muestra estuvo conformada por 447 estudiantes de diferentes universidades de Lima, se aplicó una encuesta previamente validada: Test de Fagerstrom para medir el consumo de tabaco. Posteriormente los datos fueron analizados utilizando tablas de distribución, frecuencias y contingencia. Además, se aplicó la prueba estadística regresión para obtener las razones de prevalencias (RP) de las variables de estudio tanto en el análisis bivariado como en el multivariado, con un intervalo de confianza al 95% (IC al 95%). Resultados : Se evidenció que existe asociación significativa entre el sexo masculino y el hábito de fumar (p=0,01), con un RP = 1,67 e IC al 95% = (1,03 - 2,23). También se pudo observar que tener padres fumadores estuvo estadísticamente asociado al hábito tabáquico en los universitarios, con un valor de p=0,00, y un RP = 2,53 con IC al 95% = (1,62 - 3,52). No se encontró asociación significativa entre las variables edad y presión social. Conclusión : Las variables sexo y padres fumadores tienen asociación significativa con el consumo de tabaco enfatizando que tanto nuestro entorno familiar como académico merece ser seguro, saludable y libre del humo de tabaco.

ABSTRACT Introduction: Tobacco use is harmful to health, according to the World Health Organization (WHO) smoking is the cause of death for approximately 8 million people each year. Objective: The purpose of the research was to determine the factors associated with tobacco consumption in university students from Metropolitan Lima. Methods: The sample consisted of 447 students from different universities in Lima, a previously validated survey was applied: Fagerstrom test to measure tobacco consumption. Subsequently, the data was analyzed using distribution, frequency and contingency tables. In addition, regression statistical test was applied to obtain the prevalence ratios (PR) of the study variables in both bivariate and multivariate analyzes, with a 95% confidence interval (95% CI). Results: It was evidenced that there is a significant association between male sex and smoking (p = 0.01), with an RP = 1,67 and 95% CI = . It was also observed that having smoking parents was statistically associated with smoking in university students, with a value of p=0.00, and an RP=2,53 with a 95% CI = . No significant association was found between the variables age and social pressure. Conclusion: The variables sex and smoking parents have a significant association with tobacco consumption, emphasizing that both our family and academic environment deserve to be safe, healthy and free of tobacco smoke.

Prevalence and factors associated with depressive symptomatology in older adults of the “Micaela Bastidas” Health Center, Lima-Peru

RESUMEN Objetivo : Evaluar los factores asociados a la sintomatología depresiva en adultos mayores residentes del centro de salud asistentes al centro de salud “Micaela Bastidas” de Lima-Perú. Métodos : Estudio transversal analítico en adultos mayores de 60 años residentes de una zona urbano marginal de Lima. Se evaluó la variable dependiente usando la escala de depresión geriátrica de 15 ítems, se consideró la presencia de sintomatología depresiva con un puntaje ≥ 6. Los factores asociados a la sintomatología depresiva, se calcularon usando razones de prevalencia crudas y ajustadas con intervalos de confianza al 95% (IC 95%) mediante regresiones de poisson con varianza robusta. Resultados : De los 142 adultos mayores (edad 70,4 ± 8,14 años), la prevalencia de la presencia de sintomatología depresiva fue 55,6% (mujeres: 39,6% y hombres; 53,4%). El no tener escolaridad (RPa: 1,40; IC 95%: 1,04 - 1,88) y no estar trabajando (RPa: 1,50; IC 95%: 1,09 - 2,05) fueron factores asociados que aumentaban la prevalencia de sintomatología depresiva. Conclusión : La prevalencia de presencia de sintomatología depresiva en adultos mayores de una zona urbano marginal de Perú fue alta. Los adultos mayores que no completaron su escolaridad y no trabajaban presentaron más probabilidades de presentar sintomatología depresiva.

ABSTRACT Objective: To evaluate the factors associated with depressive symptomatology in older adults attending to “Micaela Bastidas” health center from Lima, Peru. Methods: Cross-sectional analytical study in adults over 60 in a marginal urban area from Lima. We evaluated the dependent variable using the geriatric depression scale of 15 items. We considered the presence of depressive symptomatology with a score ≥ 6. We calculated the factors associated with depressive symptomatology using raw and adjusted prevalence ratios with 95% confidence intervals (95% CI) using poisson regressions with robust variance. Results: Of the 142 older adults (age 70.4 ± 8.14 years old), the prevalence of the presence of depressive symptomatology was 55.6% (women: 39.6% and men: 53.4%). The lack of schooling (RPa: 1.40, 95% CI: 1.04 - 1.88) and not working (RPa: 1.50, 95% CI: 1.09 - 2.05) were risk factors that increased the prevalence of depressive symptomatology. Conclusion: The prevalence of presence of depressive symptomatology in older adults from a marginal urban area of Peru was high. Older adults who did not complete their schooling and did not work were more likely to develop depressive symptomatology.

University characteristics associated with the award of places for midwives in the Peruvian Rural Service

RESUMEN Objetivo : Determinar las características universitarias asociadas a la adjudicación de plazas para obstetras en el Servicio Rural y Urbano Marginal en Salud (SERUMS), 2019. Métodos : Análisis de base secundaria obtenida del Ministerio de Salud peruano, donde se seleccionaron 506 licenciados de obstetricia que rindieron el Examen Nacional de Obstetricia (ENAOBS) y que hayan postulado al SERUMS en la convocatoria 2019-2. Se evaluaron las características de las universidades de donde procedían los obstetras, el puntaje obtenido en el examen nacional y universitario y si fue apto para el SERUMS. Para el análisis bivariado se utilizaron las pruebas de T de Student, ANOVA y Correlación de Pearson, mientras que para ajustar el modelo se realizó una regresión logística, considerando un nivel de confianza del 95%. Resultados : El egresado de obstetricia proviene en su mayoría de una universidad privada (66.01%), de la región Lima (41.7%) y postula a la modalidad remunerada (99.41%). Se halló que el 49.61% [IC95%:45.23-53.98] fueron aptos para el SERUMS. La calificación universitaria promedio fue de 13.87±1.35 y la del ENAOBS de 10.93±2.02, las cuales mostraron una correlación significativa (p<0.001) que tuvo una mayor pendiente en egresados de universidad pública (R=0.56). El pertenecer a una universidad pública (OR=2.62) y estudiar en Lima (OR=1.49) se asociaron significativamente (p<0.01) al estar apto para realizar el SERUMS en obstetricia. Conclusión : Ser egresado en obstetricia de una universidad pública y estudiar en Lima brinda mayor probabilidad de ser apto para adjudicar una plaza en el SERUMS.

ABSTRACT Objective: To determine the university characteristics associated with the allocation of place for obstetricians in the Rural and Urban Marginal Service in Health (SERUMS), 2019. Methods: Secondary base analysis obtained from the Peruvian Ministry of Health, where 506 obstetrics licenses were selected who submitted the National Obstetrics Exam (ENAOBS) and who have applied to SERUMS in the 2019-2 call. The characteristics of the universities where the obstetricians come from, the score obtained in the national and university exam and if it is suitable for SERUMS were evaluated. For the bivariate analysis it will be used in the Student's T, ANOVA and Pearson's Correlation tests, while to adjust the model a logistic regression was performed, a 95% confidence level. Results: The obstetrics graduate visited mostly from a private university (66.01%), from the Lima region (41.7%) and applied for the paid modality (99.41%). It was found that 49.61% (95% CI: 45.23-53.98) were suitable for SERUMS. The average university qualification was 13.87 ± 1.35 and that of the ENAOBS was 10.93 ± 2.02, which had a significant correlation (p <0.001) that had a greater slope in graduates of public university (R = 0.56). Belonging to a public university (OR = 2.62) and studying in Lima (OR = 1.49) were significantly associated (p <0.01) to be able to perform SERUMS in obstetrics. Conclusion: Being a graduate in obstetrics from a public university and studying in Lima gives you a better chance of being able to award a place in the SERUMS.

Patient complaints in the adult emergency department of a tertiary referral hospital

RESUMEN Introducción : La condición crítica del paciente que acude a emergencia genera la necesidad de otorgar una atención oportuna, segura y cálida. No cubrir estas expectativas desencadena en la insatisfacción del paciente, reflejada mediante reclamaciones, las cuales en su mayoría resultan justificadas, generando oportunidades de mejora y medidas correctivas. Objetivo : Analizar las reclamaciones presentadas por el paciente y sus familiares en el servicio de emergencia adultos del Hospital Nacional Edgardo Rebagliati Martins. Métodos : Diseño no experimental, descriptivo, de corte transversal. La muestra estuvo conformada por 109 reclamaciones durante el periodo comprendido de mayo a noviembre 2019. Se utilizó una ficha de recolección de datos con la información del Libro de Reclamaciones en Salud. Resultados : Se identificaron 187 motivos de reclamaciones. Los resultados mostraron que 47,7% fueron presentadas por familiares directos y que 43% correspondieron al área de medicina interna. En la dimensión inadecuado trato por parte del personal asistencial, 13,9% de pacientes mostraron disconformidad frente al trato descortés y grosero; en la dimensión demora en la atención, 12,8% manifestaron encontrarse descontentos por la falta de atención oportuna y, en la dimensión desacuerdo del usuario con la atención o tratamiento recibido, 10,2% quedaron insatisfechos con la atención recibida. 60,6% de reclamaciones se resolvieron satisfactoriamente dentro del plazo exigido en la norma. Conclusión : La mayor cantidad de reclamaciones correspondieron al tipo prestacional, asociadas a la atención directa del paciente.

ABSTRACT Introduction : The critical condition of the patient who presents to an emergency department creates a need to provide timely, safe and warm care. Failing to meet these expectations causes patient dissatisfaction, reflected by complaints, which are mostly justified and lead to opportunities for improvement and corrective measures. Objective : To analyze complaints presented by patients and their relatives at the Adult Emergency Department of the Edgardo Rebagliati Martins National Hospital. Methods : Nonexperimental, descriptive, cross-sectional study. Our sample was comprised of 109 complaints between May and November 2019. We used a data collection sheet based on the information in the complaints book for health care services. Results : We identified 187 reasons for complaints. Our results show that direct relatives filed 47.7%; 43% involved Internal Medicine consultations. In the dimension “inadequate treatment by healthcare workers,” 13.9% of patients complained about impolite and rude treatment. In the dimension “delay in care”, 12.8% were discontent due to the lack of timely care. In the dimension “user disagreement with care or treatment received,” 10.2% were dissatisfied with the care they were provided. 60.6% of complaints were satisfactorily resolved within the period specified by current regulations. Conclusion : Most complaints were related to the direct care of the patient.

ABSTRACT Introduction: The critical condition of the patient who presents to an emergency department creates a need to provide timely, safe and warm care. Failing to meet these expectations causes patient dissatisfaction, reflected by complaints, which are mostly justified and lead to opportunities for improvement and corrective measures. Objective: To analyze complaints presented by patients and their relatives at the Adult Emergency Department of the Edgardo Rebagliati Martins National Hospital. Methods: Nonexperimental, descriptive, cross-sectional study. Our sample was comprised of 109 complaints between May and November 2019. We used a data collection sheet based on the information in the complaints book for health care services. Results: We identified 187 reasons for complaints. Our results show that direct relatives filed 47.7%; 43% involved Internal Medicine consultations. In the dimension “inadequate treatment by healthcare workers,” 13.9% of patients complained about impolite and rude treatment. In the dimension “delay in care”, 12.8% were discontent due to the lack of timely care. In the dimension “user disagreement with care or treatment received,” 10.2% were dissatisfied with the care they were provided. 60.6% of complaints were satisfactorily resolved within the period specified by current regulations. Conclusion: Most complaints were related to the direct care of the patient.

Factors associated with the performance of self-care activities in diabetic patients in three Ucayali Hospitals

RESUMEN Objetivo : Determinar cuáles son los factores asociados a la realización de actividades de autocuidado en pacientes diabéticos en tres hospitales de la región de Ucayali durante el 2017. Métodos : Estudio transversal analítico, realizado en tres hospitales en Ucayali en el 2017. La encuesta autoadministrada contó con tres secciones que evaluaban las características generales de los pacientes, los conocimientos a través del Diabetes Knowledge Questionnaire 24 (DKQ-24), la actitud del paciente frente a su enfermedad mediante la Diabetes Attitude Scale (DAS-3) y Summary of Diabetes Self Care Activities Measure (SDSCA) para medir las prácticas de autocuidado. Resultados : La población de estudio estuvo conformada por 572 pacientes, el 50,87% correspondía al sexo femenino, la mediana de la edad fue de 47 años, el 37,57% tenía grado universitario. Se presentaron actividades de autocuidado inadecuadas con respecto al control glucémico y ejercicio con 83,87% y 77,87% respectivamente. Se observó que quienes contaron con un adecuado conocimiento y tuvieron un control estricto contaron con una adecuada adherencia respecto a la dieta de los pacientes diabéticos. Con respecto a realizar ejercicio se pudo determinar que existía una correlación negativa respecto al tiempo de enfermedad del paciente. Asimismo, se determinó que los pacientes con estudios secundarios, técnicos y universitarios presentaban una correlación negativa respecto al control glucémico. Conclusión : Más de la mitad de los pacientes realizaban actividades de autocuidado inadecuados. Además, un adecuado nivel de conocimiento y un control estricto sobre su enfermedad influencian en la adherencia a una buena dieta del paciente.

ABSTRACT Objective: To determine which are the factors associated with self-care activities in diabetic patients in three hospitals in the Ucayali region during 2017. Methods: Analytical cross-sectional study, carried out in three hospitals in Ucayali in 2017. The survey self-administered had three sections that assess the general characteristics of the patients, knowledge through the diabetes knowledge questionnaire 24 (DKQ-24), the patient's attitude towards their disease using the diabetes attitude scale (DAS - 3) and Summary of Diabetes Self-Care Activities Measurement (SDSCA) to measure self-care practices. Results: The study population consisted of 572 patients, 50.87% were female, the median age was 47 years old, 37.57% had a university degree. Inadequate self-care activities with respect to glycemic control and exercise were performed with 83.87% and 77.87% respectively. We consider that those who have adequate knowledge and have strict control to have adequate adherence to the diet of diabetic patients. Regarding exercise, it was possible to determine that there is a negative correlation with respect to the patient's illness time. Likewise, it was determined that patients with secondary, technical and university studies had a negative correlation with respect to glycemic control. Conclusion: More than half of the patients carried out inadequate self-care activities. Furthermore, an adequate level of knowledge and strict control over their disease influence the patient's adherence to a good diet.

Knowledge and habits of solar exposure in street traders of a market in Chiclayo, Peru

RESUMEN Objetivo : Determinar los conocimientos y hábitos de exposición solar en comerciantes ambulantes alrededor de un mercado de Chiclayo Métodos : Se aplicó un cuestionario a 291 comerciantes ambulantes ubicados alrededor del mercado Modelo de Chiclayo, que evaluaron los hábitos de exposición solar, medidas de foto protección, antecedentes de quemaduras solares y cáncer de piel, asi como conocimientos de radiación ultravioleta y fuentes de información. Resultados : Las edades fueron, 18-25 (42,3%), 36-54 (38,1%), 55 -78 (19,6%). En nivel de educación, el 13,1% tiene primaria completa, el 32.6% tiene secundaria completa y el 8,2% superior completa. Al momento del estudio el 71,9% llevaban más de 3 años trabajando como comerciantes ambulantes. Los fototipo de los participantes fueron fototipo I (0,3%), fototipo II (4,5%), fototipo III (24,7%), fototipo IV (48,8%), fototipo V (19,6%), fototipo VI (2,15). Un 90 ± 3.5% reconoce que causa cáncer de piel, un 53,6% reconoce que una característica del envejecimiento de la piel por radiación son las manchas y verrugas, un 56% respondió que la radiación solar causa cataratas, un 52,92% respondió que la gente de piel blanca es más sensible a los rayos del sol. Un 48.5% de ellos declararon exponerse más de 6 horas a los rayos solares, un 24,7% se expone de 3 - 6 horas al día, mientras que el 8,6% registraron el menor tiempo de exposición solar (0 - 2 horas). El 75,3% no utiliza bloqueador solar. Conclusión : Los conocimientos y hábitos de exposición solar en los comerciantes ambulantes son de regular a adecuado y los hábitos deficientes.

ABSTRACT Objective : To determine the knowledge and habits of solar exposure in street vendors around a Chiclayo market. Methods : A questionnaire were applied to 291 street vendors located around the Chiclayo Model market, who evaluated the habits of sun exposure, photo protection measures, a history of sunburn and skin cancer, as well as knowledge of ultraviolet radiation and sources of information. Results : The ages were, 18-25 (42.3%), 36-54 (38.1%), 55 -78 (19.6%). At the educational level, 13.1% have a complete primary, 32.6% have a complete secondary and 8.2% have a complete superior. At the time of the study, 71.9% had been working as street vendors for more than 3 years. The phototypes of the participants were phototype I (0.3%), phototype II (4.5%), phototype III (24.7%), phototype IV (48.8%), phototype V (19.6%) , phototype VI (2.15). 90 ± 3.5% recognize that it causes skin cancer, 53.6% acknowledge that a characteristic of skin aging by radiation is spots and warts, 56% answered that solar radiation causes cataracts, 52.92% He replied that white-skinned people are more sensitive to the sun's rays. 48.5% of them declared that they were exposed to sunlight for more than 6 hours, 24.7% were exposed to 3-6 hours a day, while 8.6% had the shortest time of sun exposure (0 - 2 hours). 75.3% do not use sunscreen. Conclusion : The knowledge and habits of sun exposure in street traders are from fair to adequate and poor habits.

ABSTRACT Objective: To determine the knowledge and habits of solar exposure in street vendors around a Chiclayo market. Methods: A questionnaire were applied to 291 street vendors located around the Chiclayo Model market, who evaluated the habits of sun exposure, photo protection measures, a history of sunburn and skin cancer, as well as knowledge of ultraviolet radiation and sources of information. Results: The ages were, 18-25 (42.3%), 36-54 (38.1%), 55 -78 (19.6%). At the educational level, 13.1% have a complete primary, 32.6% have a complete secondary and 8.2% have a complete superior. At the time of the study, 71.9% had been working as street vendors for more than 3 years. The phototypes of the participants were phototype I (0.3%), phototype II (4.5%), phototype III (24.7%), phototype IV (48.8%), phototype V (19.6%) , phototype VI (2.15). 90 ± 3.5% recognize that it causes skin cancer, 53.6% acknowledge that a characteristic of skin aging by radiation is spots and warts, 56% answered that solar radiation causes cataracts, 52.92% He replied that white-skinned people are more sensitive to the sun's rays. 48.5% of them declared that they were exposed to sunlight for more than 6 hours, 24.7% were exposed to 3-6 hours a day, while 8.6% had the shortest time of sun exposure (0 - 2 hours). 75.3% do not use sunscreen. Conclusion: The knowledge and habits of sun exposure in street traders are from fair to adequate and poor habits.

Albumin and neutrophil to lymphocyte ratio as predictors of tumor stage in patients with gastric cancer

RESUMEN Introducción : El cáncer gástrico es un problema de salud pública a nivel mundial. Objetivo: Determinar la asociación entre albumina, marcadores inflamatorios y el estadío tumoral de los pacientes con cáncer gástrico en un Hospital Nacional del Perú. Métodos : Estudio de tipo observacional, analítico y retrospectivo correspondiente a los años 2017 y 2018. Se evaluaron las frecuencias y distribucion de las variables de estadío clínico según el AJCC 2018, albúmina como indicador de nutricion e Índice-Neutrófilo Linfocito (INL) como indicador de respuesta inflamatoria-inmunológica. Se consideró 2,44 como el punto de corte para INL elevado. Resultados : Fueron incluidos 96 pacientes. La edad promedio fue de 63,5 años ±12,8, la relacion hombre:mujer fue de 1:1, 80,2% provenían de la region de la costa del Perú; 70,8% tuvieron un estadío clínico avanzado y 85,4% correspondió a tamaño tumoral T3 y T4. El 64% presento grado histológico indiferenciado y un 30,1 mostró evdiencia de metástasis. La media de INL fue 2,94 ± 1,7, y de albúmina fue 3,64 g/dl ± 0,6, En el análisis bivariado se encontró una asociación significativa entre el nivel elevado de INL y el estadío clínico avanzado (OR: 4,46 IC 95% 1,65-13,27 p<0,001), y entre los niveles bajos de albúmina sérica con estadio avanzado (OR: 13,02 IC 95% 1,78-5,36 p<0,005). Conclusión : Se encontró un diagnóstico tardío en el 70% de los pacientes. El INL elevado como indicador de respuesta inflamatoria y la albúmina baja como indicador de nutricion son factores predictivos de estadio clínico avanzado en cáncer gástrico.

ABSTRACT Introduction : Gastric cancer is a public health problem worldwide. Objective: To determine the association between albumin, inflammatory markers and tumor stage of gastric cancer patients in a National Hospital of Peru. Methods : An observational, analytical and retrospective study corresponding to the 2017 and 2018 years. The frequencies and distribution of the variables were evaluated: clinical stage according to the AJCC 2018, albumin as a nutrition indicator and Neutrophil Lymphocyte-Ratio (NLR) as an indicator of inflammatory and immune response. The value 2.44 was taken as the cut-off point for high NLR. Results : Were included 96 patients. The average age was 63.5 years ± 12.8, the male: female ratio was 1: 1, 80.2% came from the region of the coast of Peru; 70.8% had an advanced clinical stage and 85.4% corresponded to tumor size T3 and T4. 64% presented undifferentiated histological grade and 30.1 showed evidence of metastasis. The mean NLR was 2.94 ± 1.7, and albumin was 3.64 g / dl ± 0.6. In the bivariate analysis, a significant association was found between the high level of NLR and the advanced clinical stage (OR: 4.46 95% CI 1.65-13.27 p <0.001), and between low levels of serum albumin with advanced stage (OR: 13.02 95% CI 1.78-563.36 p <0.005). Conclusion : A late diagnosis was found in 70% of the patients. High NLR as an indicator of inflammatory response and low albumin as an indicator of nutrition are predictors of advanced clinical stage in gastric cancer.

ABSTRACT Introduction: Gastric cancer is a public health problem worldwide. Objective: To determine the association between albumin, inflammatory markers and tumor stage of gastric cancer patients in a National Hospital of Peru. Methods: An observational, analytical and retrospective study corresponding to the 2017 and 2018 years. The frequencies and distribution of the variables were evaluated: clinical stage according to the AJCC 2018, albumin as a nutrition indicator and Neutrophil Lymphocyte-Ratio (NLR) as an indicator of the inflammatory and immune response. The value 2.44 was taken as the cut-off point for high NLI. Results: were included 96 patients. The average age was 63.5 years ± 12.8, the male: female ratio was 1: 1, 80.2% came from the region of the coast of Peru; 70.8% had an advanced clinical stage and 85.4% corresponded to tumor size T3 and T4. 64% presented undifferentiated histological grade and 30.1 showed evidence of metastasis. The mean NLR was 2.94 ± 1.7, and albumin was 3.64 g / dl ± 0.6. In the bivariate analysis, a significant association was found between the high level of NLR and the advanced clinical stage (OR: 4.46 95% CI 1.65-13.27 p <0.001), and between low levels of serum albumin with advanced stage (OR: 13.02 95% CI 1.78-563.36 p <0.005). Conclusion: A late diagnosis was found in 70% of the patients. High NLR as an indicator of inflammatory response and low albumin as an indicator of nutrition are predictors of the advanced clinical stage in gastric cancer.

Will for the study and academic work in students of a private university of Lima

RESUMEN Introducción : La voluntad para el estudio es una variable de interés de estudio por parte de toda institución educativa, ya que obedece a la política de mejorar la calidad del servicio educativo que brinda de forma constante. Objetivo : Identificar y comparar los niveles de voluntad para el estudio, considerando género y carrera de estudios en estudiantes de una universidad privada. Métodos : Estudio de tipo descriptivo comparativo, mediante la administración de la Escala de voluntad para el estudio, en una muestra de 762 estudiantes universitarios varones y mujeres de las carreras de Medicina humana, Psicología, Derecho, Ingeniería civil, Administración y gerencia, que cursan el IV, V y VI semestre de estudio. Resultados : Se encuentran diferencias significativas según género, en el sentido que las mujeres presentan mejores niveles de voluntad para el estudio en comparación con los varones. Se ha encontrado que en los alumnos de la carrera de Ingeniería hay menos voluntad para el estudio que en las otras carreras. Conclusión : Existen diferencias significativas en los niveles de voluntad para el estudio considerando género y tipo de carrera profesional de estudio.

ABSTRACT Introduction: Willingness to learn is an important study variable for any educational institution, since it is consistent with institutional policy of improving quality to the provided educational services. Objective: The main objective is to identify and compare the different levels of Willingness to Learn, considering the gender and different academic programs or careers, among the students of a private university. Methods: Descriptive and comparative study, through the administration of the Willingness to Learn Scale, in a sample of 762 male and female university students of Medical School, Psychology, Law, Civil Engineering, Administration and Management School (IVth, Vth and VIth academic semester). Results: We found significant differences considering gender; women show better or higher levels of Willingness to Learn , compared to men. Students of Engineering program showed a lower level of Willingness to Learn. Conclusion: We found significant differences among levels of Willingness to Learn ,considering gender and academic program or career.

Gastroesophageal reflux disease as a factor associated with bronchial asthma in the pediatric population

RESUMEN Objetivos : Determinar la relación entre enfermedad por reflujo gastroesofágico y asma bronquial en población pediátrica en el hospital Nacional del niño entre los años 2017-2018. Métodos : Se realizó un estudio observacional analítico tipo casos y controles no emparejado de razón 1 caso para 2 controles, con un total de 45 casos y 90 controles, se realizó un muestreo probabilístico aleatorio simple, con una recolección retrospectiva para las variables asma bronquial, ERGE, esofagitis inducida por ERGE, Prematuridad, lactancia materna interrumpida, sexo y edad. Se realizó un modelo de regresión logística bivariado y múltiple para la obtención del Odds Ratio para la fuerza de asociación. Resultados : Siendo 33.33% y 11.11% de ERGE para los casos y controles, se encontró una diferencia estadísticamente significativa (p=0.002), así como para lactancia interrumpida (p=0.013), por análisis de regresión logística múltiple ERGE (OR 4.27, p=0.003, IC 1.64-10.92) y lactancia materna interrumpida (OR 2.74, P=0.011, IC 1.26-5.97) presentaron relación para asma bronquial. Conclusión : Se encontró una relación entre ERGE y Asma bronquial la cual puede ser extrapolada a la población pediátrica de la ciudad de Lima, este es el primer artículo publicado al respecto a nivel nacional, se recomiendan estudios prospectivos para determinar causalidad.

ABSTRACT Objective: To determine the relationship between gastroesophageal reflux disease and bronchial asthma in the pediatric population of the National Children's Hospital Breña headquarters between the years 2017-2018. Methods: An analytical observational study of cases and controls was not matched, with a ratio of 1 case to 2 controls, with a total of 45 cases and 90 controls, a simple random probability sampling was performed, with a retrospective collection for the variables bronchial asthma, GERD, GERD-induced esophagitis, prematurity, interrupted breastfeeding, sex and age. A bivariate and multiple logistic regression model was performed to obtain the Odds Ratio for the strength of association. Results: A statistically significant difference was found for GERD (p = 0.002), being 33.33% and 11.11% for cases and controls, as well as for interrupted lactation (p = 0.013); by multiple logistic regression analysis the variables GERD (OR 4.27, p = 0.003, CI 1.64-10.92) and interrupted breastfeeding (OR 2.74, P = 0.011, CI 1.26-5.97 ) presented a relationship for bronchial asthma. Conclusion: A relationship was found between GERD and bronchial asthma which can be extrapolated to the pediatric population of the city of Lima, this is the first article published in this regard at the national level, prospective studies are recommended to determine causality.

Exclusive breastfeeding and associated factors in mothers who attend health establishments of Lima, Peru

RESUMEN Introducción : La lactancia materna es un proceso biológico natural que es de suma importancia durante el desarrollo de los neonatos. Objetivo : Encontrar la asociación entre la lactancia materna exclusiva y diversos factores en espacios de tiempo diferentes: durante la gestación, durante el parto y en el puerperio en madres que acuden a centros de salud de la DIRIS Lima Centro. Métodos : Se utilizó una encuesta para conocer los factores asociados a la lactancia materna exclusiva como el número de controles prenatales, asistencia a controles pre natales, y si había dado de lactar a su hijo en los últimos 6 meses. Los datos obtenidos fueron procesados estadísticamente obteniendo los valores de Odss Ratio y las variables de asociación. Resultados : De las 140 madres encuestadas con menos de 12 meses de lactancia, 77,85% manifestó haber acudido a seis controles prenatales, esta actitud tuvo relación estadísticamente significativa con la Lactancia Materna Exclusiva (p: 0,012). Se observó que el parto vaginal tiene asociación significativa con la Lactancia Materna. Sin embargo, el uso de fórmulas lácteas podría presentarse como factor de riesgo (p < 0,001). Conclusión : Se encontraron tres factores asociados a la LME: asistencia a seis controles pre natales, parto vaginal y como factor de riesgo, el uso de fórmulas lácteas, uno en cada espacio de tiempo, antes, durante y después del parto.

ABSTRACT Introduction: Breastfeeding is a natural biological process that is of utmost importance during the development of newborns. Objective: To find the association between exclusive breastfeeding and various factors at different times: during gestation, during birth and in the puerperium in mothers who come to DIRIS Lima Centro health centers. Methods: A survey was used to find out the factors associated with exclusive breastfeeding, such as the number of prenatal check-ups, talks given, and whether she had breastfed her child in the last 6 months. The data obtained were statistically processed to obtain the values of Odss Ratio and association variables. Results: Of the 140 mothers surveyed with less than 12 months of lactation, 77.85% stated that they had attended six prenatal controls, this attitude had a statistically significant relation with Exclusive Breastfeeding (p: 0.012). Vaginal delivery was found to be significantly associated with Breastfeeding. However, the use of milk formula could be a risk factor (p < 0.001). Conclusion: Three factors were found to be associated with SCI: attendance to six pre-natal controls, vaginal delivery and as a risk factor, the use of milk formula, one in each time period, before, during and after delivery.

Leukemia / Lymphoma T of the adult HTLV1, a challenge for the clinic

RESUMEN La leucemia / linfoma de células T en adultos (LLTA) es una enfermedad agresiva de células T maduras activadas causada por el virus linfotrópico de células T humano tipo 1 (HTLV-1). ATL tiene un mal pronóstico debido a la quimiorresistencia intrínseca y la inmunosupresión severa. Las formas agresivas de LLTA, aguda y linfoma, se tratan con quimioterapia asociada con agentes antirretrovirales (AZT / IFN). Sin embargo, no han logrado lograr un impacto en la supervivencia, que oscila entre 8 y 10 meses, respectivamente. Los pacientes con formas de LLTA crónicas y latentes tienen un mejor pronóstico, pero la supervivencia a largo plazo también es deficiente, tanto cuando estos pacientes se manejan con una política de espera vigilante o con quimioterapia. Aparentemente, las costuras AZT / IFN benefician a estos pacientes. Mientras tanto, la prevención de la diseminación del HTLV-1 es imprescindible en las políticas de salud pública, tanto por tamizaje del virus en bancos de sangre como a mujeres embarazadas para reducir / evitar la transmisión vertical del virus.

ABSTRACT Adult T-cell leukemia/lymphoma (ATL) is an aggressive disease of mature activated T cell caused by human T-cell lymphotropic virus type 1 (HTLV-1). ATL carries a bad prognosis due to intrinsic chemoresistance and severe immunosuppression. The aggressive ATL forms, acute and lymphoma, are treated with chemotherapy associated with antiretroviral agents (AZT/IFN) the acute form. However, they have failed to achieve an impact on survival, that ranges from 8-10 months, respectively. Patients with chronic and smoldering ATL forms, have a better prognosis, but long term survival is poor as well, when these patients are managed with a watchful waiting policy or with chemotherapy. Apparently, AZT/IFN seams to benefit these patients. Meanwhile, prevention of dissemination of HTLV-1, is a must in public health policies, performing screening in blood banks and a screening to pregnant women to reduce/avoid vertical transmission of the virus.

Human space medicine: physiological performance and countermeasures to improve the astronaut's health

RESUMEN Se presenta este Artículo de Revisión con base en la evidencia científica actual sobre medicina espacial enfocada en fisiología humana y sus contramedidas. Por lo cual se realizó una búsqueda bibliográfica no sistemática de artículos científicos y libros de investigación en inglés-español de los últimos 7 años, que detallan su aplicación en seres humanos, modelos murinos y experimentos in vitro. Se tomaron en cuenta las condiciones del ambiente espacial como microgravedad y radiación que producen considerables cambios fisiológicos en el sistema cardiovascular (redistribución de líquidos, remodelación cardiovascular, arritmias); nervioso (sensitivomotores, neurosensoriales, neurovestibulares); respiratorio (cambios de volúmenes y capacidades); renal (litiasis); musculo-esquelético (atrofia muscular, osteoporosis); hematológico (anemia); inmunológico (desregulación inmune) y digestivo (alteración de la microbiota intestinal). Además, existen procesos biológicos, moleculares y genéticos aún por explorar, para conocer y mitigar los mecanismos inciertos desencadenados en ambientes extremos y peligrosos. Por lo tanto, es una prioridad desarrollar e implementar contramedidas para reducir los efectos nocivos en la salud, con el objetivo de garantizar la adaptación, seguridad y performance del astronauta durante futuros viajes espaciales.

ABSTRACT This Review Article is presented based on current scientific evidence on space medicine focused on human physiology and its countermeasures. Therefore, a non-systematic bibliographic search of scientific articles and research books in English-Spanish of the last 7 years was carried out, detailing their application in humans, murine models and in vitro experiments. The conditions of the space environment such as microgravity and radiation that produce considerable physiological changes in the cardiovascular system (redistribution of fluids, cardiovascular remodeling, arrhythmias) were taken into account; nervous (sensorivomotor, neurosensory, neurovestibular); respiratory (volume and capacity changes); renal (lithiasis); musculoskeletal (muscular atrophy, osteoporosis); hematological (anemia); immunological (immune dysregulation) and digestive (intestinal microbiota disorder). In addition, there are biological, molecular and genetic processes still to be explored, in order to know and mitigate the uncertain mechanisms triggered in extreme and dangerous environments. Therefore, it is a priority to develop and implement countermeasures to reduce the harmful effects on health, with the aim of guaranteeing the astronaut's adaptation, safety and performance during future space flights.

Atypical presentation of abdominal pain and fever in positive patient for COVID19. Case report and literature review

RESUMEN Se presenta el caso clínico de una paciente femenino de 38 años de edad, vista en emergencia en un hospital de New York, que consulta por dolor abdominal, fiebre y astenia. Los estudios complementarios muestran linfopenia y leve alteracion de transaminasas. Por TAC abdominopelvica, se visuliza imágenes en bases pulmonares, de tipo reticulonodular. Se le tomó muestra para COVID-19. Fue manejada en emergencias con hidratacion parenteral, antipireticos, se le indica antibioticos por via oral y se instruye medidas sociales de aislamiento. Dos dias despues, cosulta nuevamente, confirmadose COVID-19 positivo. Es seguida de manera ambulatoria, una semana despues con buena evolucion clinica. Adicionalmente se muestra una revision clínica y explicacion fisiopatologica del compromiso del tubo digestivo por el virus y la forma atipica de presentacion con dolor abdominal.

ABSTRACT The clinical case of a 38-year-old female patient, seen in an emergency room in a New York hospital, who consults for abdominal pain, fever and fatigue is presented. Complementary studies show lymphopenia and slight alteration of transaminases. Abdominopelvic CT scan visualizes images in the lung bases, reticulonodular type. A sample was taken for COVID-19. She was managed in emergencies with parenteral hydration, antipyretics, oral antibiotics are indicated and social isolation measures are instructed. Two days later, it cost again, confirming positive COVID-19. It is followed on an outpatient basis, one week later with good clinical evolution. Additionally, a clinical review and pathophysiological explanation of the involvement of the digestive tract by the virus and the atypical form of presentation with abdominal pain are shown.

Fox - fordyce disease, A case report

RESUMEN Se presenta un caso infrecuente de enfermedad de Fox-Fordyce en region vulvar, una dermatosis inflamatoria no infecciosa, infrecuente, de glándulas apocrinas, caracterizada por una erupción papular pruriginosa que involucra vulva, axila y región perianal, a predominio del sexo femenino, del cual no hay reportes nacionales. Se presenta una paciente de 53 años de edad, evaluada en consulta de Gineco-Obstetricia, por presentar desde hace 5 meses, erupción papular en zona vulvar, asociado a prurito intermitente. Se tomó una biopsia de la lesión, y se envió al Servicio de Anatomía Patológica, recibiéndose un fragmento de tejido de color pardo oscuro, de 0.3 x 0.2 x 0.1cm, en la cual se evidenció glándulas apocrinas dilatadas, con secreción espesa constituida por mucina, en su luz. Cumpliendo con los criterios histopatológicos se estableció el diagnóstico de Enfermedad de Fox - Fordyce.

ABSTRACT Fox-Fordyce disease is a non-infectious, infrequent inflammatory dermatosis of apocrine glands, isolated by a pruritic papular rash that usually begins frequently at puberty, and which may involve vulva, armpit and perianal region. It affects women more frequently, approximately in a 9 to 1 ratio, compared to men. In the presentation of the case of a female patient, 53 years old, in consultation of Gynecology-Obstetrics, of the General Maria Auxiliadora Hospital, for presenting for 5 months, papular eruption in vulvar area, associated with intermittent pruritus. A biopsy of the lesion was requested, and it was sent to the Pathological Anatomy Service, receiving a fragment of dark brown tissue, 0.3 x 0.2 x 0.1cm, which was automatically processed, obtaining a histological sheet, in which evidence dilated apocrine glands, which show a thick secretion made up of mucin, in its light. The patient met the histopathological criteria for the diagnosis of Fox - Fordyce disease. Consider the case presentation because of the infrequent nature of this disease.

Case Report: Exposed midfoot fracture due to traffic accident in HIV/AIDS patient

RESUMEN Actualmente hay una alta incidencia de accidentes de tránsito en el mundo, muchos de ellos provocan una discapacidad grave en las personas. Estas lesiones en las extremidades provocan alta morbilidad llegando incluso a una amputación. Esto se agrava en pacientes VIH/SIDA, sobre todo en el tratamiento y la evolución. Se presenta un caso clínico de un paciente con lesión severa del mediopie que termina en amputación y se hace una revisión del manejo quirúrgico del paciente traumatológico con VIH/SIDA.

ABSTRACT Currently there is a high incidence of traffic accidents in the world, many of them cause severe disability in people. These limb injuries cause high morbidity even reaching an amputation. This is aggravated in HIV/ AIDS patients, especially in treatment and evolution. A clinical case of a patient with severe midfoot injury that ends in amputation is presented and a surgical management review of the trauma patient with HIV/ AIDS is made.

Ulnar nerve injury after radial extracorporeal shock wave therapy identified with high-resolution ultrasonography: Case Report

RESUMEN Mujer de 49 años fue evaluada por desarrollar dolor súbito a nivel de los epicóndilos mediales conjuntamente con entumecimiento y sensación de hormigueo en el cuarto y quinto dedos después de recibir terapia de ondas de choque extracorpóreas radiales (rESWT) como tratamiento para epicondilitis medial bilateral. El examen neurológico reveló signo de Tinel positivo, parestesia y una prueba de discriminación de dos puntos alterada sobre la región cubital del cuarto y quinto dedos. La ultrasonografía de alta resolución demostró hallazgos de lesión nerviosa periférica tales como hipoecogenicidad y aumento del diámetro de ambos nervios cubitales. La paciente mejoró únicamente tras recibir tratamiento conservador, demostrando así una aparente neuropatía compresiva bilateral aguda como resultado de la terapia. ESWT se utiliza como una alternativa prometedora para el tratamiento de diversos trastornos musculoesqueléticos; sin embargo, existe evidencia limitada con respecto a sus efectos secundarios, en particular la mononeuropatía periférica. Según el conocimiento de los autores, este es el primer reporte que demuestra un daño nervioso estructural después de rESWT con el uso de ultrasonografía de alta resolución.

ABSTRACT A 49-year old woman was evaluated for developing bilateral acute medial elbow pain, numbness, and tingling sensation in the fourth and fifth fingers after receiving radial extracorporeal shock wave therapy (rESWT) for bilateral medial epicondylitis. Neurologic examination revealed the presence of Tinel’s sign, paresthesia and impaired two-point discrimination testing over the ulnar side of the fourth and fifth fingers bilaterally. High-resolution ultrasonography demonstrated findings of nerve injury, such as hypoechogenicity and increased diameter of both ulnar nerves. After conservative treatment, the patient improved her condition demonstrating an apparently acute compressive nerve injury as a result of the therapy. ESWT is used as a promising alternative for the treatment of various musculoskeletal disorders; however, there is limited evidence regarding its side effects, in particular peripheral mononeuropathy. To the authors’ knowledge, this is the first report demonstrating structural damage of a nerve after rESWT with the use of high-resolution ultrasonography.

COVID 19: Without distinction of race, sex or socioeconomic position; no one is safe