http://revistas.urp.edu.pe/index.php/RFMH/issue/feed Revista de la Facultad de Medicina Humana 2020-05-12T23:16:39+00:00 Dr. Jhony A. De La Cruz Vargas PhD, MCR, MD jhony.delacruz@urp.edu.pe Open Journal Systems <p><span id="result_box" class="" lang="en" tabindex="-1"><span class=""><span style="vertical-align: inherit;"><span style="vertical-align: inherit;">The "Revista de la Facultad de Medicina Humana" of the Ricardo Palma University (Rev. Fac. Med. Hum.) is the organ of scientific diffusion of the faculty and a publication for the medical community as a whole. This comunity includes students, graduates, academics, researchers and national and international institutions. It covers current issues, with original and unpublished articles, related to the various specialties of the biomedical and Public Health area.</span></span></span></span></p> http://revistas.urp.edu.pe/index.php/RFMH/article/view/2913 Protecting health personnel in the Covid-19 pandemic 2020-04-24T20:31:15+00:00 Jhony A. De La Cruz-Vargas jhony.delacruz@urp.edu.pe <p>The epidemic and pandemic of COVID-19 constitute an unprecedented public health emergency, it arrived in Latin America, first in Brazil, then in Ecuador; The first cases in Peru were registered as of March 6, 2020. The correct response of the Government of Peru decreed a state of national emergency and mandatory social isolation, initially for 14 days, with the aim of reducing the exposure and transmission of the Coronavirus. It assigned economic funds for 3 million poor families in Peru, during social isolation.<br><br>The repercussions of COVID-19 are huge, at a social, economic, cultural, and educational level, of course, on the country's health system and your staff. Borders, universities, shops, restaurants are closed. The Pension Fund Administrators (AFP for its acronym in Spanish) announced to be affected quickly, generating significant losses to users. All of this is unpredictable and, just the tip of the iceberg.</p> 2020-03-22T02:33:46+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2941 COVID-19 Pandemic: What else can I do? 2020-04-24T20:37:09+00:00 Lujhon G. Flórez G. lflorez@um.edu.mx <p>In these last weeks about by the COVID-19 pandemic, a phrase has become popular in Europe that, translated from its Italian antive says:&nbsp;<strong>“Remember that our grandparents were ordered to go to war; ¡all that is asked of us, is just to stay on the couch!”.</strong><br><br>Although scientists from different countries and organizations are working rapidly to develop an effective vaccine and to have drugs that help treat this disease, until now the best thing to do to prevent the rapid spread of the virus is through measures hygienic and preventive distancing. However, many of us wonder what else we can do besides avoiding or delaying infection? Is it possible to improve our chances of successfully dealing with this disease?</p> 2020-04-10T22:50:19+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2914 Adult Lymphoma / Leukemia T: Prevalent entity in South America 2020-04-24T20:40:01+00:00 Brady E. Beltran bgbrady@hotmail.com Jorge Castillo jhony.delacruz@urp.edu.pe <p>Adult T - lymphoma / leukemia is an aggressive T lymphoproliferative entity associated retrovirus HTLV-1- T.<br>HTLV-1 infection is endemic in Japan, the Caribbean, Africa, South America, and the Middle East. In South America, we have Peru, Brazil, Colombia and Chile.<br>Peru is endemic for this virus. The prevalence of retroviruses in Europe and the USA. USA It is less than 1% but in Peru it is estimated that around 3% of the healthy adult population is a carrier of the retrovirus.<br>From Chile, there have been several ATLL reports since 1992 by Dra. Cabrera et al.</p> 2020-03-25T02:03:10+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2940 Clinical - epidemiological characteristics of patients deceased by COVID-19 in a national hospital in Lima, Peru 2020-04-20T22:05:53+00:00 Gerson Escobar gem_esc@hotmail.com Javier Matta javimar_66@hotmail.com Waldo Taype-Huamaní wath96@hotmail.com Ricardo Ayala jag-mrng@hotmail.com Jose Amado jpamadot@gmail.com <p>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 PCR-TR 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.</p> 2020-04-11T00:39:29+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2840 Risk factors for infertility in women in a Peruvian Hospital 2020-03-27T04:19:07+00:00 Sheyla Briggith Villanueva Ccoyllo sheyla.villanueva.c@gmail.com Luis Roldan-Arbieto jhony.delacruz@urp.edu.pe <p><strong>Introduction:</strong> Infertility is defined 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 to know these figures and there are few studies that allow to know the causes of this condition</p> <p><strong>Objective:</strong> 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.</p> <p><strong>Methods:</strong> An observational, analytical, retrospective case-control study was conducted, 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. <strong>Results:</strong> 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.</p> <p><strong>Conclusion:</strong> 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.</p> <p>&nbsp;</p> <p><strong>Keywords:</strong> Infertility, Pelvic Inflammatory Disease, ectopic pregnancy (Source: DeCS BIREME).</p> 2020-03-25T00:26:18+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2711 Predictor factors for multidrug-resistant tuberculosis among patients with pulmonary tuberculosis in Huánuco, Peru. 2010-2015 2020-03-27T04:19:07+00:00 Anghella Valdivia-Gómez anghell_4@hotmail.com Noelia Zavala-Lazo noelia_0402@hotmail.com Bernardo Dámaso-Mata bernardocristobal@gmail.com Vicky Panduro-Correa vpanduro@unheval.edu.pe Edinho Segama-Fabian rolandosegama@gmail.com Kovy Arteaga-Livias farteaga@unheval.edu.pe <p><strong>Introduction</strong>: 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.</p> <p><strong>Objective</strong>: 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.</p> <p><strong>Methods</strong>: case and control study. We considered 37 cases and 111 controls. Data were collected from medical records.</p> <p><strong>Results</strong>: 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).</p> <p><strong>Conclusions</strong>: 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.</p> 2020-03-25T00:27:33+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2915 Contraceptive Attitudes among Hmong Young Adults in Rural California 2020-05-12T23:16:39+00:00 Chia Thao chiathao@mail.fresnostate.edu Miguel A. Perez mperez@csufresno.edu Tou Thao jhony.delacruz@urp.edu.pe Kau Vue jhony.delacruz@urp.edu.pe <p>Introduction: While different contraceptive attitudes have been reported among different ethnic groups in<br>the US, little if any research has been conducted to understand the reproductive health needs and attitudes<br>among Hmong young adults. To our knowledge, this is the first study to investigate the relationship among<br>contraceptive perception of this community. Objective: The purpose of this research was to identify attitudes<br>that influence Hmong college students’ contraceptive practices. Methods: A campus-wide online survey was<br>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.</p> 2020-03-25T02:12:40+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2785 Comparative histopathological study of the phrenic nerve from corpses with chronic obstructive pulmonary disease and without this condition 2020-04-11T23:22:30+00:00 Fernanda Mayara Santos-Santana jhony.delacruz@urp.edu.pe Byron Martins-Lucena jhony.delacruz@urp.edu.pe Tales Lyra de Oliveira tales.oliveira@prof.uscs.edu.br Tácio Nertan Cartaxo de Souza jhony.delacruz@urp.edu.pe Lysien Ivania-Zambrano jhony.delacruz@urp.edu.pe Ana Rose de Carvalho-Araujo jhony.delacruz@urp.edu.pe Ana Lúcia de Gusmão-Freire jhony.delacruz@urp.edu.pe <p><strong>Introduction: </strong>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. <strong>Objective:</strong> To compare the morphology of the phrenic nerves of the cadavers with COPD and without COPD by optical microscopy. <strong>Materials and methods:</strong> An exploratory descriptive studio conducted on the Death Verification Service in Alagoas. Pulmonary and phrenic nerve biopsies will be bilaterally taken from the 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. <strong>Results:</strong> 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. <strong>Conclusions:</strong> 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.</p> 2020-03-25T00:28:45+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2709 Saturation and overcrowding of the emergency service of an urban hospital 2020-03-27T04:19:07+00:00 Waldo Taype-Huamaní wath96@hotmail.com Lino Castro-Coronado linuscas@hotmail.com Delcio Miranda-Soler delcio_6miranda@hotmail.com Jose Amado jpamadot@gmail.com <p>Over-demand and overcrowding is a problem in the emergency department of our environment.</p> <p>Objective: to determine the characteristics of the demand for medical care at the emergency department of a tertiary social security hospital.</p> <p>Methodology: observational study at Rebagliati hospital, first quarter 2019. Sociodemographic, time and emergency indicators of the institutional statistical system, descriptive statistical statistics with IBM SPSS 24.00 were evaluated.</p> <p>Results: 51294 patient care between 14 and 102 years (median 60), 56.7% female sex, 18% recorded more than one visit in the quarter. Monday was the day of greatest demand and the schedule between 8 and 13 hours. Priority attention 3 and 4 corresponded to 60.8 and 20.8% of the total. The topics of medicine, relief and surgery performed 41, 22 and 20% of attentions respectively. In the shock trauma unit, 3% of attentions were performed. 13% attention was 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 treated died, 0.7% performed surgery and 0.1% transferred to another hospital.</p> <p>Conclusion: the demand to the emergency department is mainly due to medical problems (priority 3 and 4), predominantly elderly and female patients. 13% of attention were admitted, with long stay, low mortality, very few transfers, high return rate and low supply of hospital beds.</p> 2020-03-25T00:32:10+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2895 Risk Perception of Skin Cancer at a High-Altitude Hospital 2020-03-27T04:19:07+00:00 Nuria Leticia Huanca Huirse nuriahuancahuirse@gmail.com Joel Sack Roque Roque sackroque@gmail.com Verónica Nélida Laurel Vargas laurelvveronica@gmail.com Alan Wenceslao Quispe Sancho alqui_vir9989@hotmail.com <p>Objective: To determine the level of risk perception of skin cancer in a population from Cusco.</p> <p>Materials and 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.</p> <p>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%).</p> <p>Conclusion: The risk perception of skin cancer was normal in the majority of the population.</p> <p>Keywords: Skin Neoplasms, Perception, Health Behavior, Attitude</p> 2020-03-25T00:33:07+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2872 Factors associated with tobacco consumption in university students of Lima metropolitan 2020-04-06T16:34:45+00:00 Lucy E. Correa-López lucy.correal@gmail.com Andrea M. Morales Romero jhony.delacruz@urp.edu.pe Jesús E. Olivera Ruiz jhony.delacruz@urp.edu.pe Carmen L. Segura Márquez jhony.delacruz@urp.edu.pe Lucy Cedillo Ramirez jhony.delacruz@urp.edu.pe Consuelo Luna-Muñoz jhony.delacruz@urp.edu.pe <p><strong>Introduction: </strong>The consumption of tobacco is very harmful to people’s health. According to WHO, smoking is the cause of death of 8 million people a year. <strong>Objetive: </strong>The purpose of the research was to determine the factors associated with the consumption of tobacco in university students in Metropolitan Lima.<strong> Methods: </strong>The sample consisted of 447 students from Lima universities, the survey was applied: Fagerstrom test. Subsequently the data was analyzed using tables of: distribution, frequency, contingency. <strong>&nbsp;Results: </strong>It was evidenced through the X<sup>2</sup> statistical test that there is a significant association between the variables sex and smoking habit, OR = 1.93, IC 95%[1.29-6,519]. It was also observed that having smoking parents is significantly associated with the habit of smoking by the children, with a value p =0,000 of X<sup>2</sup> and the OR 3.31, IC 95%[2,145 - 5,116].<strong> Conclusion: </strong>The variables sex and parental background have a significant association with tobacco consumption, emphasizing that our family environment deserves to be safe, healthy and free of tobacco smoke</p> 2020-03-25T00:34:33+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2881 Prevalence and factors associated with depressive symptomatology in older adults of the “Micaela Bastidas” health center, Lima-Peru 2020-04-06T06:25:37+00:00 Christian Ponce christianfpt01@gmail.com Luigui Viteri-Condori jhony.delacruz@urp.edu.pe Pablo Ramos-Martínez jhony.delacruz@urp.edu.pe Wendy Nieto-Gutiérrez jhony.delacruz@urp.edu.pe Jesus Cueva-Velazco jhony.delacruz@urp.edu.pe <p><strong>Objective</strong>: To evaluate the factors associated with depression in older adults in a marginal urban area of ​​Peru. <strong>Material and methods</strong>: &nbsp;It is a cross-sectional analytical study in adults over 60 years of age in a marginal urban area of ​​Lima. The dependent variable was evaluated using the geriatric depression scale of 15 items, the presence of depression with a score ≥ 6 was considered. The factors associated with depression were calculated using raw and adjusted prevalence ratios with 95% confidence intervals (95% CI) using poisson regressions with robust variance. <strong>Results</strong>: Of the 142 older adults with an average age and standard deviation was 70.4 ± 8.14.&nbsp;The prevalence of the presence of depression 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 presence of depression. <strong>Conclusion</strong>: The prevalence of depression in older adults in 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 depression.</p> 2020-03-25T00:36:51+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2897 University characteristics associated with the award of places for midwives in the peruvian rural service 2020-03-27T04:19:08+00:00 Elizabeth Llanos-Najarro elizabeth.llanos@unmsm.edu.pe Dulce Villafuerte-Cooban mvillafuerte.cooban@gmail.com Victor Hugo Moquillaza-Alcántara victor.moquillaza@upch.pe <p><strong>Objective:</strong> To determine the university characteristics associated with the allocation of place for obstetricians in the Rural and Urban Marginal Service in Health (SERUMS), 2019. <strong>Material and Methods:</strong>&nbsp; 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&nbsp;have applied to SERUMS in the 2019-2 call. The characteristics of the&nbsp;universities where the obstetricians come from, the score obtained in the&nbsp;national and university exam and if it is suitable for SERUMS were evaluated.&nbsp;For the bivariate analysis it will be used in the Students&nbsp; T, ANOVA and&nbsp;Pearsons Correlation tests, while to adjust the model a logistic regression was&nbsp;performed, a 95% confidence level. <strong>Results:</strong> The obstetrics&nbsp; graduate visited&nbsp;mostly from a private university (66.01%), from the Lima region (41.7%) and&nbsp;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&nbsp;significant correlation (p&lt;0.001) that had a greater slope in graduates of public&nbsp;university (R=0.56). Belonging to a public university (OR=2.62) and studying&nbsp;in Lima (OR=1.49) were significantly associated (p&lt;0.01) to be able to&nbsp;perform SERUMS in obstetrics. Conclusions: Being a graduate in obstetrics&nbsp;from a public university and studying in Lima gives you a better chance of being&nbsp;able to award a place in the SERUMS.</p> 2020-03-25T00:37:30+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2916 Patient complaints in the adult emergency department of a tertiary referral hospital 2020-03-27T04:19:08+00:00 Isabel J. Alamo-Palomino isabel.alamo7@gmail.com Juan P. Matzumura-Kasano jhony.delacruz@urp.edu.pe Hugo F. Gutiérrez-Crespo jhony.delacruz@urp.edu.pe <p>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.</p> 2020-03-25T02:24:33+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2902 Factors associated with the performance of self-care activities in diabetic patients in three Ucayali hospitals 2020-03-27T04:19:08+00:00 Jennifer Vilchez-Cornejo j.vilchezcornejo@gmail.com Luccio Romani luccioromani@gmail.com Silvia Reategui silvia_reategui_vega@hotmail.com Elice Gomez-Rojas giane92@hotmail.com Claudia Silva ccristina.sb@gmail.com <p><strong>OBJECTIVES:</strong> To determine the levels and assessment of self-care in diabetic patients in three hospitals in Ucayali during 2017. <strong>MATERIALS AND METHODS:</strong> Analytical cross-sectional study, conducted in three hospitals in Ucayali during 2017 with a sample size of 572 participants through a stratified random sampling. A self-administered survey was applied that evaluated the general characteristics, the Diabetes Knowledge Questionnaire 24 (DQK-24), the patient's attitude by the Diabetes Attitude Scale (DAS-3) and Summary of Diabetes Self Care Activities Measure (SDSCA) which mediates self-care practices. <strong>RESULTS:</strong> From 572 patients, 50.8% being women, with the median age of 47 years (RIQ: 35-56). Hypertension (22.4%) was the most frequent comorbidity. Also, having an adequate knowledge about their disease (RPa: 2.47; 95% CI: 13.5-4.50), strict control (RPa: 1.34; 95% CI: 1.09-1.65) predispose adherence in their diet. The need for some special training (RPa: 1.23; 95% CI: 1.03-1.47), the perception of the severity in their illness (RPa: 1.25; 95% CI: 1.02-1.55) and have autonomy (RPa: 1.35; 95% CI : 1.12-1.64) predisposed to taste your blood sugar. <strong>CONCLUSIONS:</strong> More than half of the patients performed inadequate self-care activities, knowledge about their disease and strict control influence the patient's diet, as well as special training, perceive the severity of their disease and be autonomous drives the realization of taste blood sugar.</p> 2020-03-25T00:38:33+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2899 Knowledge and habits of solar exposure in street traders of a market in Chiclayo, Peru 2020-04-06T16:54:01+00:00 Sherly Raquel Sempértegui-Ruiz jhony.delacruz@urp.edu.pe Carol Jennifer del Milagro Nuñez-Campos jhony.delacruz@urp.edu.pe Maxi Andrea Bustios-Ahumada jhony.delacruz@urp.edu.pe Andrés Eduardo Arenas-Piscoya jhony.delacruz@urp.edu.pe Cynthia Lizeth Estela-Moreto jhony.delacruz@urp.edu.pe Winston Maldonado-Gómez jhony.delacruz@urp.edu.pe Sebastian Iglesias-Osores sebasiglo@gmail.com Alain Monsalve-Mera jhony.delacruz@urp.edu.pe <p><strong>Background:</strong> people who work outdoors are exposed to long periods of ultraviolet radiation; such is the case of street vendors. Objectives: determine the knowledge and habits of solar exposition in itinerant traders around a Chiclayo market. Materials and methods: A questionnaire were applied to 291 itinerant merchants located around the Mercado Modelo of Chiclayo, who evaluated sun exposure habits, photo protection measures, a history of sunburn and skin cancer, as well as knowledge of ultraviolet radiation and sources of information. <strong>Results:</strong> the following results were found: the age ranges were 18-25 (42.3%), 36-54 (38.1%), 55 -78 (19.6%). At the level of education, 13.1% have completed primary school, 32.6% have full secondary and 8.2% complete. At the time of the study, 71.9% had been working as street traders for more than 3 years. The phototype 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). A 90 ± 3.5 %% recognizes that causes skin cancer, 53.6% recognizes that a feature of skin aging by radiation are spots and warts, 56% responded that solar radiation causes cataracts, a 52,92 % replied that white-skinned people are more sensitive to the sun's rays. 59.5% of traders indicated that they go to work from Monday to Sunday, 39.4% work 5-6 days a week, and 4.1% work 4 or less days a week. A 48.5% of them declared to expose themselves more than 6 hours to the solar rays, 24.7% are exposed of 3 - 6 hours a day, while 8.6% registered the shortest time of solar exposure (0 - 2 hours). 75.3% did not use sunscreen, 24.7% of merchants used sunscreen at the time of being surveyed as a measure of photo protection; of them, 63.9% said that a family member recommended their use, 94.4% use it 1-2 times a day, 38.9% only apply it when they go to work, 52.8% use it on their face , neck, ears and hands, and half of them (50.0%) get it from a catalog. <strong>Conclusions:</strong> the knowledge and habits of solar exposition in itinerant traders were equal or inferior to that described in other studies. It was found that the knowledge is from regular to adequate and poor habits.</p> 2020-03-25T00:39:21+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2936 Albumin and neutrophil to lymphocyte ratio as predictors of tumor stage in patients with gastric cancer 2020-04-06T00:52:20+00:00 Manuel O. Huamán jhony.delacruz@urp.edu.pe Jorge Cerna-Barco jhony.delacruz@urp.edu.pe Lucy E. Correa-López jhony.delacruz@urp.edu.pe Brady Beltran-Garate jhony.delacruz@urp.edu.pe Jhony A. De La Cruz -Vargas jhony.delacruz@urp.edu.pe <p>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 &lt;0.001), and between low levels of serum albumin with advanced stage (OR: 13.02 95% CI 1.78-563.36 p &lt;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.</p> 2020-04-05T06:48:16+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2930 Will for the study and academic work in students of a private university of Lima 2020-04-07T00:31:13+00:00 Héctor Hugo Sánchez Carlessi jhony.delacruz@urp.edu.pe Elio Iván Rodríguez Chávez jhony.delacruz@urp.edu.pe Patricia Roxana Matos Ramírez jhony.delacruz@urp.edu.pe <p>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.</p> 2020-04-05T06:49:31+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2918 Gastroesophageal reflux disease as a factor associated with bronchial asthma in the pediatric population 2020-03-27T04:19:08+00:00 Rafael Ricra leonardo_13_92@hotmail.com Juan Carlos Roque juankmed26@gmail.com Joseph Alburqueque-Melgarejo jhony.delacruz@urp.edu.pe Pedro Ricra jhony.delacruz@urp.edu.pe Claudia Saldaña jhony.delacruz@urp.edu.pe <p>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, GERDinduced 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.</p> 2020-03-25T02:39:53+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2765 Exclusive Breastfeeding and associated factors in mothers who attend Health Establishments of Lima, Peru 2020-03-27T19:06:37+00:00 Carmen Villarreal Verde cvillarrealv@unmsm.edu.pe Maritza Dorila Placencia Medina mplacenciam@unmsm.edu.pe Violeta Alicia Nolberto Sifuentes vinolsi.biostatistics@gmail.com <p><strong>Objetivos</strong>: Determinar factores asociados a la práctica de la lactancia materna exclusiva, en tres espacios de tiempo: antes, durante y después del parto en madres que acuden a tres establecimientos de salud&nbsp; que pertenecen a la Dirección de Salud de Lima Centro. <strong>Métodos: </strong>Estudio descriptivo, transversal correlacional realizado en una muestra de 140 mujeres madres de niños entre 6 y 12 meses. El instrumento fue una cuestionario validado por juez experto y prueba piloto; los factores se clasificaron de acuerdo al momento en que ocurren: durante la gestación (antes del parto), en el proceso del parto y en el puerperio (periodo después del parto), la técnica fue la entrevista personal. <strong>Resultados: </strong>El&nbsp; análisis estadístico de los datos muestra que en la primera fase (antes del parto) de todos los factores que se consideraron durante a entrevista, el número de controles prenatales a las que la madre asistió tuvo asociación estadísticamente significativa (p:0,0120) entre los factores que se estudiaron para el periodo durante el parto, &nbsp;se encontró asociación significativa para el parto vaginal (p:0,0476); en la última fase posparto se observó &nbsp;asociación negativa con el uso de fórmulas lácteas en el periodo pos parto (p:0,0001). <strong>Conclusiones. </strong>La asistencia a un número mínimo de&nbsp; controles prenatales durante la gestación y el parto&nbsp; por vía vaginal favorecen la práctica&nbsp; de la lactancia materna por lo cual hay que promover estos dos factores, al mismo tiempo evitar el uso innecesario de fórmulas lácteas.</p> <p>&nbsp;</p> 2020-03-26T21:50:18+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2919 Leukemia / Lymphoma T of the adult HTLV1, a challenge for the clinic 2020-03-27T04:19:08+00:00 María Elena Cabrera mecabrera.1950@gmail.com Camila Peña jhony.delacruz@urp.edu.pe <p>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 watchfulwaiting 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.</p> 2020-03-25T02:45:25+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2920 Human space medicine: Physiological performance and countermeasures to improve the astronaut's health 2020-03-30T06:21:08+00:00 Milton V. Rivera vizariveramilton@gmail.com José Cornejo jhony.delacruz@urp.edu.pe Karen Huallpayunca jhony.delacruz@urp.edu.pe Aurora B. Diaz jhony.delacruz@urp.edu.pe Zhamanda N. Ortiz-Benique jhony.delacruz@urp.edu.pe Andrés D. Reina jhony.delacruz@urp.edu.pe Gustavo Jamanca Lino jhony.delacruz@urp.edu.pe Victor Ticllacuri jhony.delacruz@urp.edu.pe <p>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 (sensorimotor, 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.</p> 2020-03-25T02:50:09+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2934 Atypical presentation of abdominal pain and fever in positive patient for COVID19. Case report and literature review 2020-04-05T00:27:07+00:00 Mauricio González Arias jhony.delacruz@urp.edu.pe <p>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.</p> 2020-04-04T19:24:14+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2516 Fox - Fordyce Disease, a Case Report 2020-03-27T04:19:08+00:00 Katherine Luisa Contreras Gala katycl9@hotmail.com <p>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</p> 2020-03-25T00:45:40+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2928 Case report: Exposed midfoot fracture due to traffic accident in HIV/AIDS patient 2020-04-23T14:44:18+00:00 Freddy J. Fernández-Villacorta jhony.delacruz@urp.edu.pe Luis Sebastián-Castillo jhony.delacruz@urp.edu.pe Shakira Serrano- Díaz jhony.delacruz@urp.edu.pe Cristhian Solórzano-Rojas jhony.delacruz@urp.edu.pe Jorge Tandaypan-Agreda jhony.delacruz@urp.edu.pe Jorge Tantachuco- Ruiz jhony.delacruz@urp.edu.pe Patrick Tolentino-Gonzalez jhony.delacruz@urp.edu.pe Tony Chávez-Uceda jhony.delacruz@urp.edu.pe Esmeralda Torres-Soto jhony.delacruz@urp.edu.pe <p>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.</p> 2020-03-31T20:50:51+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2912 Ulnar nerve injury after radial extracorporeal shock wave therapy identified with high–resolution ultrasonography: Case Report. 2020-03-27T04:19:08+00:00 Paul German Terán paulteranmd@gmail.com Walter Enrique Insuasti walter_insuasti@hotmail.com Diana Maritza Martínez dianammartineza@hotmail.com Tania Marcela Platero tania.platero@gmail.com Sebastián Guillermo Ramos sebasg86@hotmail.com Sussan Llocclla sussan.lloccllad@gmail.com <p>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.&nbsp; 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.</p> 2020-03-25T00:48:15+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2929 COVID 19: Without distinction of race, sex or socioeconomic position; No one is safe. 2020-03-31T20:39:34+00:00 D. Tello-Majluf Daniela.Tello@downstate.edu <p>I have read with great pleasure and gratitude the article Protecting Health Personnel in the COVID- 19 Pandemic By Jhony De La Cruz, publish March, 21, 2020 in this prestigious journal.</p> <p>In response to this very informative article on the COVID-19 pandemic, I would like to express my sadness and share my experience of what we are living first hand here in the epicenter of the United States, New York city but first let me begin by giving you an idea of the timeline that has taken place to get us where we are today. As we all know, there was a whistleblower doctor in Wuhan, China, his name was Li Wenliang, he was an ophthalmologist. On December 31 st 2019,&nbsp; China confirmed the existence of the new virus initially called 2019-nCoV now referred to as SARS-CoV2, but Dr. Li Wenliang said he had observed many of his colleagues get very ill, fall sick, and observed 4 die from the virus in the 2 months prior to that.</p> 2020-03-31T20:39:34+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2281 Anemia in future medical generations 2020-03-27T04:19:09+00:00 Leyla Elena Rodas leyla.rodas.alvarado@gmail.com <pre id="tw-target-text" class="tw-data-text tw-text-large tw-ta" dir="ltr" data-placeholder="Traducción"><span lang="en" tabindex="0">Anemia has become a silent companion throughout academic life in medical students, which is the reason for the following document comments and verifies the prevalence in which it is found and the negative effects it would be causing.</span></pre> 2020-03-25T00:49:04+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2921 Fetal programmig, intrauterine toxic stress and consequences on the product 2020-03-27T04:19:09+00:00 M. Silva López jhony.delacruz@urp.edu.pe I. Hernández Patiño jhony.delacruz@urp.edu.pe <p>Dos décadas atrás Baker dio el concepto de Programación Fetal (PF), donde asociaba el ambiente prenatal y el desarrollo del feto. En consecuencia, la PF representaría “la inducción de las respuestas fetales debido al entorno uterino” que condicionará cambios funcionales y estructurales en el propio feto, con repercusión a corto y largo plazo. En consecuencia, si el ambiente prenatal es adverso en el desarrollo, tendremos posiblemente patologías en la vida extra uterina.</p> <p>Las evidencias señalan, que procesos implicados en el desarrollo de diversas funciones de los sistemas orgánicos complejos, se iniciarían mucho antes del nacimiento y conformarían problemáticas de salud a futuro.</p> 2020-03-25T02:54:56+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2295 Are infections induced by NSAI? 2020-03-27T04:19:09+00:00 Miguel Ángel Poma mapoma@pucp.pe Julio Gutarra-Mendez jhony.delacruz@urp.edu.pe <p>Los antiinflamatorios no esteroideos (AINE) constituye una familia farmacológica que comparten efectos antipiréticos, analgésicos y lógicamente anti inflamatorios a través de su capacidad para inhibir la producción de prostaglandina. El término no esteroideo refiere a sus efectos similares a los corticoides, pero sin las consecuencias secundarias que son característicos de los esteroides. Los fármacos que están incluidos son variados, siendo los más tradicionales el Ibuprofeno, AAS, ketoprofeno, ketorolaco, Naproxeno, entre otros</p> 2020-03-25T00:50:11+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2903 Early detection: Pap testing is always the best option? 2020-03-27T04:19:09+00:00 Franshesca Leonor Sedano Chiroque franshesca.sedano@gmail.com <p>This paper presents the detection ways for cervical cancer but mainly, the rol that plays the Liquid-Based Citology test in the early detection and also some aspects related to this.&nbsp;</p> 2020-03-25T00:51:35+00:00 ##submission.copyrightStatement## http://revistas.urp.edu.pe/index.php/RFMH/article/view/2906 Research and mental health in the medical profession 2020-03-27T04:19:09+00:00 Cristhian Alexander Rojas Miliano cristhianmiliano@outlook.com <p><span class="tlid-translation translation" lang="en"><span class="" title="">Research allows to acquire certain behaviors or aptitudes such as social skills, resilience, perseverance, etc.</span> <span class="" title="">Furthermore, it reduces the risk of dissatisfaction with professional and / or academic achievements in medical students.</span> <span class="" title="">For these reasons, research can have a positive impact on the mental health of those who practice it.</span> <span class="" title="">It is proposed that research is a relevant variable to be evaluated as a protective factor for the appearance of some mental health problems in Peruvian doctors and medical students.</span></span></p> 2020-03-25T01:20:28+00:00 ##submission.copyrightStatement##