Revista de la Facultad de Medicina Humana <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 It covers current issues, with original and unpublished articles, related to the various specialties of the biomedical and Public Health area.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> Universidad Ricardo Palma en-US Revista de la Facultad de Medicina Humana 1814-5469 <center> <p style="text-align: center;"><a href="" rel="license"><img style="border-width: 0;" src="" alt="Licencia Creative Commons"></a></p> <p><strong>This work is under a&nbsp;<a href="" rel="license">Creative Commons license Attribution 4.0 International (CC BY 4.0)</a>.</strong></p> </center> Research Progress: Instituto de Investigaciones en Ciencias Biomédicas (INICIB), Universidad Ricardo Palma <p>One of the essential functions of the university is to promote, support and strengthen research, as a source to generate new knowledge and as a scientific tool in search of practical solutions to everyday problems in society. The Universidad Ricardo Palma, represented by their dean as its highest authority, offers the university’s academic framework and the institution’s policies will in order to move forward in research policies.</p> Jhony A. De La Cruz-Vargas Elio Iván Rodríguez Chávez ##submission.copyrightStatement## 2021-07-02 2021-07-02 21 3 10.25176/RFMH.v21i3.4021 Launching of the special 100 x 100 URP program for contributing to scientific production <p>Research should be seen as the most appropriate way for the university to invest and allocate resources. Thanks to the vision, work and impetus of the Rector of the Universidad Ricardo Palma, we are pleased to present this special program today.</p> Jhony A. De La Cruz-Vargas Elio Iván Rodríguez Chávez ##submission.copyrightStatement## 2021-07-02 2021-07-02 21 3 10.25176/RFMH.v21i3.4022 Analysis of SARS-CoV-2 genomes samples from Peru <p><strong>Introduction:</strong>&nbsp;Genomic analysis of samples from documented COVID-19 cases can be used successfully to help track sources of Sars-Cov-2 infection, which can be quarantined to prevent the recurrent spread of the disease around the world.&nbsp;<strong>Objective:</strong>&nbsp;To describe the SARS-CoV-2 sequences isolated from Peruvian patients.&nbsp;<strong>Methods:</strong>&nbsp;All genomes published up to March 2021, uploaded in the GISAID and Nextstrain repository, were selected. All data is on the web in a public way; In addition, the information was filtered by continent, country, region, clade, lineage, and sex from March 2020 to February 2021.&nbsp;<strong>Results:</strong>&nbsp;It was evidenced that the region with the most isolated genomes was Lima, the most frequent clade is GR, the viral lineage B.1.1 is the most frequent and persistent in time and most of the genomes were isolated from people of the female sex.<strong>Conclusions:</strong>&nbsp;The clade GR is common to all South American countries and the European and Asian continents, followed by clades G and GH with greater frequency; on the other hand, the most persistent viral lineage in Peru is B.1.1, this being not common with other countries.</p> Johnny Leandro Saavedra Camacho Sebastian Iglesias-Osores Miguel Alcántara-Mimbela Lizbeth M. Córdova-Rojas ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3712 Evaluation of the discriminative capacity of anthropometric indicators and their predictive relationship of diabetes in health workers of the University Hospital of Guayaquil - Ecuador <p>Objective: To evaluate the discriminative ability to predict diabetes with anthropometric and biochemical indicators and medical history. Methods: The sampling carried out was census and the sample consisted of 104 workers. A longitudinal study was carried out to evaluate the discriminative ability to predict diabetes with the anthropometric, biochemical, and antecedent indicators, using two models, the analysis of the ROC curves and binary logistic regression. Results: By analyzing the ROC curves, the abdominal circumference obtained greater predictive discriminative power (AUC = 0.747; p &lt;0.001; CI: 0.624-0.870), compared to glycemia (AUC=0.749; p &lt;0.001; CI: 0.645-0.852) and the waist-height index (AUC=0.737; p=0.001; CI: 0.638-0.836). Personal medical history is included in the logistic regression equation P<sub>(Y=1)</sub>=(1+e<sup>0,693+1,897APP</sup>)<sup>-1</sup>&nbsp;to predict the risk of developing diabetes in the future. Conclusions: The abdominal circumference obtained the highest discriminative power, followed by the pathological history.</p> Janet del Rocio Gordillo Cortaza Fatima Feraud Ibarra Franklin Encalada Calero Juan Carlos Roque Quezada Rosa Quintana Columbus Jennifer Plaza Plaza Cinthya Falquez Garcia Dagmar Meza Solorzano Miguel Castro Mattos ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3758 Eating disorders in under 5 years old and their relationship with family functionality <p><strong>Introduction:</strong>&nbsp;Eating disorders under 5 years old may cause development and grow problems. Disorders in family functionality can be associated.&nbsp;<strong>Objective:</strong>&nbsp;To describe non-organic eating disorders in children under 5 years of age and their association with family functionality in a second-level hospital in Puebla.&nbsp;<strong>Methods:</strong>&nbsp;It was a descriptive, cross-sectional study. Children under 5 years old with non-organic eating disorders were included. A questionnaire to study eating disorders (IMFED) and other one to describe family functionality (FACES III) were applied to their parents who previously signed informed consent. Descriptive statistics and Spearman test were used.&nbsp;<strong>Results:</strong>&nbsp;105 patients were evaluated, 57 men and 48 women, medium age 3.042, minimum 2, maximum 60, ± 16.68 months old. Children 12-23 months old were more frequent. Parents reported chaotic family adaptability in 45.71%, and 39.04% related cohesion. The most frequent eating disorder was sensorial aversions to food. More than 60% had two or more eating disorders. Family adaptability and eating disorders were correlated in 0.248(p=0.011), and family cohesion and eating disorders 0.87 (p=0.38).&nbsp;<strong>Conclusion:</strong>&nbsp;Most frequent eating disorders were sensorial aversion to food and infant anorexia. They softly correlate with family adaptability. Children under 5 years old with 2 or more eating disorders are more frequent.</p> Arturo García-Galicia Álvaro José Montiel-Jarquín Blanca Paola Rivera-Zúñiga Diego Torres-Santiago Alejandra Aréchiga-Santamaría Akihiki Mizuki González-López Carlos Alberto López-Bernal ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3796 Classical Hodgkin Lymphoma in pathological anatomy department at Edgardo Rebagliati Martins National Hospital during 2015 to 2019 <p><strong>Introduction: </strong>Hodgkin lymphomas are B-cell lymphoid neoplasms histologically characterized by a mixed inflammatory cellular component and few Hodgkin/Reed-Sternberg neoplastic cells. Classical Hodgkin Lymphoma (CHL) represents 10% of all lymphoma cases and 85% of all Hodgkin Lymphomas. According to the current World Health Organization classification, CHL is divided into 4 types: Nodular Sclerosing (NS), Mixed Cellularity (MC), Lymphocyte-Rich (LR), and Lymphocyte-Depleted (LD).&nbsp;<strong>Objetive:</strong> We reviewed all cases of Classical Hodgkin Lymphoma in the Pathological Anatomy Department at Edgardo Rebagliati Martins National Hospital during 2015 to 2019, in order to determine the most frequent type, the incidence according to age and gender, phenotypical characteristics and relation to Epstein Barr Virus (EBV).&nbsp;<strong>Materials and Methods:</strong> &nbsp;We performed a retrospective descriptive case study of Classical Hodgkin Lymphoma and its 4 clinical-pathological types in the Pathological Anatomy Department at Edgardo Rebagliati Martins National Hospital during 2015 to 2019. 72 patients were identified with Classical Hodgkin Lymphoma diagnosis, of which only 64 were selected for the study. The exclusion criteria were the absence of confirmatory immunohistochemical tests and relapse cases.&nbsp;<strong>Results:</strong> The most frequent type observed was Nodular Sclerosing with 34 cases (53.12%) and the least frequent type was Lymphocyte-Rich with 2 cases (3.12%). Likewise, a predominance in the male gender was observed, with 42 cases, 20 of which were Nodular Sclerosing and 14 not classified, as the most frequent types, and a greater incidence among those 41 to 50 years of age, without detection of the bimodal peak referenced in international literature. The most frequent immunohistochemical profile of Hodgkin/ Reed- Sternberg was CD15 and CD30 positive, with CD45 negative. EBV was present in 36% of cases and is more frequent in the Mixed Cellularity and Lymphocyte-Depleted types.&nbsp;<strong>Conclusions:</strong> Classical Hodgkin Lymphoma is a group of lymphoid neoplasms with clinical, histological, and phenotypically defined characteristics. It is more frequent in men between 41 and 50 years of age. A complete clinical information and a good biopsy, preferably excisional, is required for an adequate diagnosis. The Nodular Sclerosing type is the most frequent and the Lymphocyte-Rich is the least frequent type. Hodgkin/ Reed- Sternberg cells are usually CD-15 and CD-30 positive and CD-45 negative. The Pax-5 mild positivity allows it to be differentiated from B-cell Non-Hodgkin Lymphomas. EBV is most frequent in Mixed Cellularity and Lymphocyte-Depleted types.</p> María del Pilar Quiñones Ávila Eugenio Américo Palomino Portilla Herbert Alejandro Yábar Berrocal ##submission.copyrightStatement## 2021-06-02 2021-06-02 21 3 10.25176/RFMH.v21i3.3949 Toxoplasma gondii infection and associated factors in blood donors from hospital II-2 Tarapoto, Peru, July to December 2019 <p><strong>Introduction:</strong>&nbsp;Toxoplasmosis is a worldwide parasitic infection caused by&nbsp;<em>Toxoplasma gondii</em>&nbsp;that can be transmitted through blood transfusions.&nbsp;<strong>Objectives:</strong>&nbsp;To determine the frequency and associated factors of&nbsp;<em>T. gondii</em>&nbsp;infection in blood donors from Hospital II-2 Tarapoto, Peru, July to December 2019.&nbsp;<strong>Methods:</strong>&nbsp;Analytical cross-sectional study carried out in a sample of 92 donors. Infection was determined by detecting serum IgM and IgG anti&nbsp;<em>T. gondii</em>&nbsp;antibodies by the Elisa technique. Sociodemographic, environmental and habit factors were collected by applying an interview to each volunteer participant.&nbsp;<strong>Results:</strong>&nbsp;The donor sample was characterized by a median age of 30 years, male gender (76.1%), urban home area (81.5%) and student occupation (34.8%); likewise, 29.4% stated that they ingested non-potable water and 61.9% had contact with earth or sand. 77.2% (95% CI: 68.6 - 85.8) of donors had past infection. No cases of active infection were observed. Contact with cats and domestic animals was associated with infection by&nbsp;<em>T. gondii</em>&nbsp;(p = 0.037; PR = 1.28 and 95% CI = 1.02 - 1.61).&nbsp;<strong>Conclusions:</strong>&nbsp;Blood donors from Hospital II-2 Tarapoto presented a high frequency of chronic infection by&nbsp;<em>T. gondii</em>. The possible transmission of the parasite through blood transfusion is suggested, for which reason it is recommended to assess the inclusion of toxoplasmosis as a screening test.</p> Adolfo Díaz-Ginéz Heber Silva-Díaz ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3774 Teacher-student perspective on teaching strategies and constructivist pedagogical skills in master's programs of a Peruvian public university. <p><strong>Introduction:</strong>&nbsp;This research addresses the evaluation of teacher performance through the student-centered paradigm.&nbsp;<strong>Objective:</strong>&nbsp;To determine the teaching strategies and pedagogical skills with a constructivist approach used, from the teacher and student perspective, in the health master's programs of a Peruvian public university.&nbsp;<strong>Methodology:</strong>&nbsp;Quantitative, descriptive and cross-cutting study. Based on the Evaluation Questionnaire of the Teaching and Evaluative Methodology of University Professors (CEMEDEPU), an instrument was developed, which was validated by expert judgment with an Alpha cronbach reliability of 0.961, which was applied to teachers and students. The sample obtained was from 42 teachers and 130 students from eight master's degrees. The descriptive analysis was performed by categorizing the results in each group and the inferential analysis using the T-student test.&nbsp;<strong>Results:</strong>&nbsp;Predominated teachers over the age of 56 (55%), with the degree of master (61.9%); students under the age of 40 (79.2), who referred to the research subject when answering the questionnaire. (52.2%). Constructivist teaching strategies, according to the teacher, were regularly used (42.9%) and of low student use (52.6%) while constructivist pedagogical skills were acceptable (66.7%) according to the teacher in contrast to students who were not acceptable (42.3%).&nbsp;<strong>Conclusion:</strong>&nbsp;Significant difference was found in teaching strategies and pedagogical skills of constructivist approach between teachers and students.</p> Janet Pilar Campos Gutierrez Maritza Placencia-Medina Javier Silva-Valencia María Elena Muñoz-Zambrano ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3775 Factors associated with pregnancy-induced hypertension in women living at high altitudes <p><strong>Objective:</strong>&nbsp;To determine the factors associated with pregnancy-induced arterial hypertension (HIE) in people living at high altitude.&nbsp;<strong>Methods:</strong>&nbsp;The research was observational, cross-sectional, analytical study of cases and controls. It was held at the El Carmen de Huancayo Regional Teaching Maternal and Child Hospital, Peru located at 3,259 m.a.s.l. The calculation of the sample was Epidat 3.0. 80% power level, with frequency of 27% for cases, 17% for controls, precision of 5% and odds ratio (OR) = 2. X2 squared, binomial and multivariate logistic regression were used for statistical analysis.&nbsp;<strong>Results:</strong>&nbsp;960 (100%) pregnant women were included, with a mean age of 36,7 years ± 5.8 years (range: 15 to 44 years). The most frequent clinical manifestations of pregnant women with HIE were: edema (63.1%), headache (61.9%), epigastralgia (51.4%), ringing in the ears (41.9%), hyperreflexia (26.4, 2%), and scotomas (19.8%). The risk factors associated with a higher probability of HIE compared to normotensive pregnant women were: obesity (78,1% vs 39,2%); OR= 3,54; IC95: 2,31-5,42; p=0.000); scotomas (19.8% vs 4.4%; OR = 3.30; 95% CI: 1.85 - 5.91; p = 0.000), hyperreflexia (26.4% vs 2.9%; OR= 8.39; IC95%: 4.47 – 15.76; p=0.000) and extreme age (27.1% vs 17.3%; OR = 1.56; 95% CI: 1.05 - 2.319; p = 0.000).&nbsp;<strong>Conclusions:</strong>&nbsp;The most frequent symptoms in HIE are edema, headache and epigastric pain. The factors associated with a higher risk of HIE were obesity, scotomas, hyperreflexia and extreme age.</p> Jenny Mendoza-Vilcahuaman Rossibel Juana Muñoz- De La Torre Anibal Valentin Diaz-Lazo ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3425 Access routes for infiltration of viscosuplementation in the knees of patients with grade II-III gonartrosis <p><strong>Introduction:&nbsp;</strong>Knee joint injection is a daily procedure in orthopedic outpatient visit. In order to obtain the maximum therapeutic benefit, it is necessary to perform the injection directly into the articular space and not into the adjacent structures.&nbsp;<strong>Objective:</strong>&nbsp;To establish the accuracy of the injection site into the knee joint in patients with grade II-III gonarthrosis. The portal approaches taken into consideration in this study were: Anterolateral (AL), Anteromedial (AM), Lateral Suprapatellar (LSP), Lateral mid-patellar (LMP), Medial mid-patellar (MMP) and Transtendinous (TT).&nbsp;<strong>Material and methods:</strong>&nbsp;A cross-sectional and descriptive study was conducted. A total of 123 knee joints were injected under fluoroscopy through the different approach portals. Variables: gender, positive arthrography at the first attempt, level of pain in patients during the procedure, as well as complications and side effects.&nbsp;<strong>Results:</strong>&nbsp;Lateral mid-patellar (LMP) approach was used on 20 knee joints with a 40% positive arthrography, 17 through LSP with 70.5%, 20 MMP with 90%, 21 AL with 61.3%, 26 M with 69.9%, 19 TT with 78.9%.&nbsp;<strong>Conclusion:</strong>&nbsp;The medial mid-patellar approach portal provides the greatest effectiveness in comparison to the other portals used on this study. Additionally, a greater percentage of positive arthrography was achieved at the first attempt.</p> Miguel Ángel Sánchez-Durán Oswaldo Fernández-Miranda Blanca Paola Rivera-Zúñiga Rodolfo Barragán-Hervella Jorge Quiroz-Williams ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3802 Prior use of antibiotics and clinical characteristics of women who developed urinary tract infection due to beta-lactamase bacteria in a peruvian hospital <p><strong>Introduction:</strong> The overused of antibiotics has existed as a threat to public health for several years. The World Health Organization (WHO) warns that in the year 2050 the "post-antibiotic era" will begin, where approximately 10 million deaths per year will be attributed to resistant infections. The infection where this type of bacteria is most relevant is in urinary tract pathology.&nbsp;<strong>Objective:</strong>&nbsp;Determine the factors associated with the development of urinary tract infections by beta-lactamase-producing bacteria in older adults in the internal medicine service of the Dos de Mayo National Hospital.&nbsp;<strong>Methods:</strong>&nbsp;An analytical, cross-sectional, retrospective, case-control type study was carried out. Data were obtained through the review of medical records, with the completion of a data collection form related to sociodemographic aspects such as clinical data. With a total sample of 139 patients, 56 cases and 86 controls were obtained. To measure the association, we used the Odds Ratio, the statistical software SPSS was used.&nbsp;<strong>Results:</strong>&nbsp;A statistically significant association was observed between E. Coli ESBL infection with antecedents such as previous use of antibiotics and a history of recurrent urinary infection. The ORs and the confidence intervals of the variables that were shown to be significant were: recurrent urinary tract infection (95% CI, OR = 1,722), Anemia (95% CI OR = 1.96), Hypothyroidism (95% CI, OR = 1.13), Hypertension (95% CI, OR = 1,050), multi-pregnancy (95% CI, OR = 1,062) and History of previous antibiotic use (95% CI, OR = 22,106).&nbsp;<strong>Conclusion:</strong>&nbsp;The study identified the average age of presentation of urinary infection by E. Coli ESBL is between 65 to 75 years. Recurrent urinary tract infections and previous use of antibiotic treatment are significant risk factors for developing ESBL bacterial infections.</p> Ítalo Renato Valero Román Félix Llanos-Tejada ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3151 Risk of infections, chronic diseases and mental health disorders after Floods by the Coastal Child Phenomenon in displaced populations, Piura, 2017 <p><strong>Introduction:</strong>&nbsp;In Peru, the presence of the Coastal Child Phenomenon produces floods and the appearance of diseases cyclically.&nbsp;<strong>Objective:</strong>&nbsp;To determine the risk factors for the presence of diseases in displaced populations in Piura due to the Nino Costero.&nbsp;<strong>Methods:</strong>&nbsp;Quantitative, longitudinal, analytical investigation of cases and controls with 544 families that were selected through a two-stage random sampling considering the proportion of families per block, area and cluster. For data collection, various diagnostic and monitoring instruments were used, such as that of the International Organization for Migration (IOM), the health care base and the application of an instrument for mental health.&nbsp;<strong>Results:</strong>&nbsp;The analysis of the variation of care in two time periods at 3 and 9 months shows that there are statistically significant changes in these periods that include skin infections, urinary tract infection, joint pain, diabetes mellitus and family violence. 26.46% presented some psychological disorder associated with coexistence in shelters. The bivariate analysis showed that families with less than 80% of safe water management and safe water storage were at risk of presenting acute diarrheal diseases with OR = 6.15 (95% CI 5.97-6.95) and OR = 2.08 (95% CI 1.06- 2.97) respectively.&nbsp;<strong>Conclusions:</strong>&nbsp;The epidemiological profiles show the presence of psychological effects and the transition of communicable diseases at the beginning of the disaster and that over time, non-communicable diseases and violence appear in the shelters associated with the previous health profiles of the displaced population.</p> Manuel J. Loayza-Alarico Jhony A. De La Cruz-Vargas ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3826 Resilience, anxiety and eating habits of the south-east amazon population before and during the pandemic <p><strong>Objective:</strong>&nbsp;To determine the relationship between resilience, anxiety and eating habits of the south-eastern Amazonian population before and during the pandemic in 2020.&nbsp;<strong>Methods:</strong>&nbsp;Relational, quantitative and qualitative descriptive, the sample consisted of 150 inhabitants aged 30 to 45 years. The instrument used was the STAI: state-trait anxiety inventory, the data were processed with SPSS-25, analysis of significance and difference of means was performed, non-parametric test and post-test significant differences (Wilcoxon test for related samples ).&nbsp;<strong>Results:</strong>&nbsp;In adults, State-Trait Anxiety was greater than 65%, a bilateral significance of p = 0.01 was obtained, indicating that anxiety was related to resilience. Food consumption before the pandemic was classified: natural 60%, processed 40% and ultra-processed 0%; During confinement, the consumption of processed foods was 53.33% and ultra-processed 20%. The level of food consumption before and during the pandemic shows a difference, being significant of p &lt;5%. The level of anxiety before and during the pandemic, obtaining a significant of p &lt;5%. <strong>Conclusions:</strong> State-Trait Anxiety was greater than 65% in adults. Anxiety was related to resilience. There is a significant difference in the type of food consumed, in anxiety levels, before and during the Covid-19 pandemic, in the inhabitants of the South-Eastern Amazon. The consumption of processed and ultra-processed foods, before the pandemic, was 40% and during the pandemic this consumption has increased to 73%, therefore the consumption of food was high in fat and sugar content.</p> Ana María Montero Doig Guisela Yábar Torres Lucy E. Correa-Lopez ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3732 Validity of the American Diabetes association Diabetes risk test as screening for Prediabetes in a sample of peruvian workers. <p><strong>Objective:</strong>&nbsp;To evaluate the validity of the risk test of the American Diabetes Association (ADA Test) as a screening for hyperglycemia in a sample of workers in Lima, Peru.&nbsp;<strong>Methods:</strong>&nbsp;Cross-sectional study of diagnostic tests. Secondary analysis of the data generated by the electronic health record of an occupational polyclinic, carried out in January and February 2020. The sample was made up of workers from different areas who attended for their occupational medical evaluation. Prediabetes was considered with a fasting glucose ≥ 100 mg / dl but less than 126 mg / dl.&nbsp;<strong>Results:</strong>&nbsp;397 subjects were evaluated. The prevalence of hyperglycemia was 29% (115/397). With a cutoff ≥ 3 points, the ADA Test presented an area under the curve of 0.868, a sensitivity of 94.8%, and a specificity of 51.8%. The PPV was 44.5% and the NPV was 96.1%. Finally, the positive likelihood coefficient calculated was 1.96, and the negative was 0.101.&nbsp;<strong>Conclusion:</strong>&nbsp;The ADA test, with a 3-point cutoff, proves to be a simple pragmatic screening tool for undiagnosed cases of prediabetes. If current results are confirmed in future research, due to its simplicity, it can facilitate various initiatives aimed at introducing and expanding early prevention and management strategies based on this trial.</p> Víctor Juan Vera-Ponce Jorge Enrique Osada Liy Mario J. Valladares-Garrido ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3614 Factors associated with the level of knowledge about palliative care among medical students at a University in lima, Peru <p><strong>Introduction:</strong> In Peru, medical schools do not have any formal course on palliative care. <strong>Objective:</strong> To determine the factors associated with the level of knowledge about palliative care in medical students of the sixth and seventh year of Ricardo Palma University, during the second half of 2020. <strong>Methodology:</strong> Observational, cross-sectional and analytical study. The sample consisted of 139 sixth and seventh year students, who were surveyed with the Palliative Care Knowledge Test (PCKT) modified by Ordoñez et al<sup>1</sup> for medical students in Peru. Sampling was probabilistic, stratified. <strong>Results:</strong> 48.9% were sixth year students and 51.1% were seventh year students. 87.8% reported not having taken an elective/rotation course in Palliative Care. The prevailing level of knowledge was "regular" (61.9%) followed by "bad" (23.7%). In addition, the variables sex (p = 0.020), age (p = 0.017) and year of study (p = 0.031) had statistically significant associations with the level of knowledge, the variable elective course / previous rotation on Palliative Care did not show a significant association. According to the opinion / perception of medical students about the need for education and training in Palliative Care, undergraduate: about half of the population considers this inclusion as “very necessary”, followed by “necessary”. <strong>Conclusion:</strong> The Level of Knowledge about Palliative Care that predominates in sixth and seventh year students is the “regular” level followed by “bad”. The variables sex, age and year of study showed a significant association.</p> Daniela Eusebia Tarazona Pedreros Rubén Espinoza Rojas ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3768 Cost of Pulmonary Arterial Hypertension in Peru <p><strong>Introduction:</strong>&nbsp;Pulmonary arterial hypertension (PAH) is a low prevalence condition for which there is very little information in Peru. Several studies indicate that it is associated with elevated costs for health systems in the world.&nbsp;<strong>Objective:</strong>&nbsp;To establish the economic burden of PAH in the Peruvian context.&nbsp;<strong>Methods:</strong>&nbsp;Information on the use of health resources was collected through consultations with clinical experts and key opinion leaders. Cost data was obtained from two tariff manuals and from the Observatory of Pharmaceutical Products (DIGEMID).&nbsp;<strong>Results:</strong>&nbsp;Expert consultations indicated that about 68% of the patients were in an intermediate stage of the disease and that the use of sequential combination therapy is predominant in FC III and FC IV stages, compared to earlier stages. The annual cost of PAH treatment in Peru was $ 14,842 USD, where the main cost driver was drugs (81.72%), followed by diagnosis (8.96%) and outpatient follow-up (5.75%).&nbsp;<strong>Conclusions:</strong>&nbsp;Information on pulmonary arterial hypertension in Peru is critical for decision makers, due to the high economic impact that the disease entails. Moreover, studies in this therapeutic area are relevant for the dissemination of knowledge of the disease to different health professionals.</p> Fabian Hernández Julieta Larrosa Jéssica Nacazume Óscar Aguirre Nelson Larrea Sarah Franco-Watanabe Jorge Álvarez André Morais ##submission.copyrightStatement## 2021-06-16 2021-06-16 21 3 10.25176/RFMH.v21i3.3905 Family cohesion and time of hospitalization in patients with mental disorders in a hospital in Lambayeque, Peru <p>Mental disorders represent about 22% of the total burden of disease, and family support plays an important role in the length of hospitalization time in these patients. We described the family cohesion and the time of hospitalization in patients of the psychiatric service of the Almanzor Aguinaga Asenjo National Hospital (H.N.A.A.A) during 2019. This is a cross-sectional descriptive census-type study, in which a questionnaire of 11 questions on family cohesion was applied. Sociodemographic and clinical data were collected through a data collection form. 60 patients were surveyed, the median age was 50 years, the most frequent diagnosis was schizophrenia; most are female, not working and are single. The median length of detention was 12.5 days. Those who respond positively to questions tend to stay longer</p> Alain Eduard Monsalve Mera Kimberly Requelme Portocarrero Melissa Delgado Arriola Víctor Hugo Díaz Silva Henry Ricardo Villareal Trujillo ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i1.3408 Rehabilitation Recommendations for Adult Patients with COVID-19 <p><strong>Introduction:</strong> The SARS-CoV-2 coronavirus is a new pathogen causing COVID-19 disease, ranging from an asymptomatic infection to a critical condition dependent on mechanical ventilation. Rehabilitation interventions contribute for the prevention and treatment of related complications and associated disability.&nbsp;<strong>Objective:</strong> Evaluate the rehabilitation interventions for the care of patients with COVID-19 according to the available evidence.&nbsp;<strong>Methods:</strong> A systematic review was conducted through electronic and library searches of national and foreign medical journals over a 10-year horizon in Spanish, English, Chinese and Italian, as well as in textbooks with information related to COVID-19 and Physical Medicine and Rehabilitation.&nbsp;<strong>Conclusions:</strong> Rehabilitation interventions are essential and indispensable resources for the transdisciplinary treatment of patients with COVID-19, despite of the low quality of the available evidence.</p> Roger De la Cerna Luna Analía Vélez de Villa Velarde Diana Luzquiños Castillo Mariela Montesinos Daza Luisa Valdivia Estrada Romina Tang Candiotti ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.2957 Frequency of coinfection by respiratory pathogens and its impact on the prognosis of patients with COVID-19. <div><strong>Introduction:&nbsp;</strong>Co-infection between other microorganisms and SARS-CoV-2, such as viruses, bacteria&nbsp;and fungi, is an important factor in the management of COVID-19, which could increase the difficulties&nbsp;in diagnosis, management, prognosis, and even increase the mortality.&nbsp;<strong>Objectives:&nbsp;</strong>The objective of this&nbsp;review is to describe the published scientific evidence regarding coinfection in patients with COVID-19.&nbsp;<strong>Methods:&nbsp;</strong>A bibliographic search of studies published in Spanish or English was carried out using the&nbsp;PubMed, The Cochrane Library and Google Scholar search engines. Studies published between January</div> <div>2020 and January 24, 2021 were assessed.&nbsp;<strong>Results:&nbsp;</strong>25 articles from various continents (America, Asia and&nbsp;Europe) were included. All the studies had patients with a confirmed diagnosis of COVID-19 added to some&nbsp;other test that identified some co-infection. We identified 18 studies that showed bacterial coinfection,&nbsp;17 studies of viral coinfection and 5 studies of fungal coinfection. The prevalence of coinfection showed&nbsp;extremely dissimilar figures according to the population studied and diagnostic criteria.&nbsp;<strong>Conclusions:&nbsp;</strong>The</div> <div>presence of coinfection seems to be linked to a higher frequency of unfavorable outcomes. However, it&nbsp;is important to develop Latin American studies, given the heterogeneity in the studies seen in different&nbsp;countries. Standardized definitions should be developed in order to be able to assess the impact of co-infections in patients with a diagnosis of COVID-19</div> Dante Manuel Quiñones-Laveriano Alonso Soto Lucero Quilca-Barrera ##submission.copyrightStatement## 2021-05-19 2021-05-19 21 3 10.25176/RFMH.v21i3.3520 Critical reading of clinical studies. Practical bases for the resident physician in medical specialties <p>Critical reading from the point of view of evidence-based medicine is a structured reading that allows us to evaluate the validity and relevance of the results and the applicability of a clinical study in our patient. However, the level of critical reading in resident physicians is low, as various studies have described. In a study of oncology resident physicians, a poor level of critical reading of clinical research articles was found. And in the same way, deficient levels were found in cardiology and family medicine residents. In our country, this situation is unknown and it is most likely deficient. Reason why we prepared a small review to be able to share practical bases that help the resident of specialties apply in a simpler way the critical reading of clinical studies.</p> Rafael Pichardo-Rodríguez Liz B. Cordova-Cueva Marcos Saavedra-Velasco ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i1.3166 Damage control approach and reduced resuscitation of the polytraumatized pediatric patient in the emergency room <p>Polytrauma in pediatric patients is a frequent event, so its timely approach and management define its prognosis. Polytrauma is defined as the presence of two or more traumatic injuries or a single one that endangers life or there is a risk of serious sequelae; resuscitation is understood as the restoration of vital functions of the patient in the pre-hospital area to the hospital area aimed at avoiding the damage caused by the fatal pentad of trauma (coagulopathy, acidosis, hypothermia, hyperglycemia and hypoxia) for which the Damage control protocol which is referred to all the maneuvers that have the purpose of preserving life, but without carrying out definitive repairs in order to mitigate complications derived from the prolonged state of shock, secondary to a prolonged surgical time that postponed adequate resuscitation, this reduced resuscitation consists of 6 precise indications for its performance, being approached from the TEP (Pediatric Evaluation Triangle) and the MARCHDEF protocol (Massive Bleeding, Airway, Breathing, Circulation, Hypothermia, Neurological Deficit, Glycemia, Pain, Exposure, FAST).</p> Augusto Flavio Figueroa-Uribe Julia Hernández-Ramírez Gabriela Mendoza-Besares Inti Ernesto Bocanegra-Cedillo Michelle Fabienne Vela-Díaz Jorge Omar Flores- del Razo ##submission.copyrightStatement## 2021-06-16 2021-06-16 21 3 10.25176/RFMH.v21i3.4016 Indigenous communities from Oaxaca, Mexico. Health problems, opportunities and challenges in public health with special attention in mental health <p><strong>Objectives: </strong>To present an instrument in Mixtec, Zapotec, and Spanish to assess the mental health of indigenous Oaxacan communities from Mexico. To provide suggestions on how this instrument could be useful for indigenous communities in other Latin American regions. <strong>Methods: &nbsp;</strong>&nbsp;This manuscript includes a literature review of articles published in mental health among communities originating from Oaxaca, Mexico and presents the process followed in the development of a culturally appropriate mental health instrument. The instrument was created by a Spanish speaking Advanced Practice Nurse and translated by a university student public health worker and a professional nurse from Oaxaca, Mexico whose native languages are Mixtec and Zapotec. <strong>Results: </strong>A culturally appropriate instrument was developed to assess the mental health of people with Oaxacan origin. This instrument includes some questions related with Covid-19. &nbsp;It was translated into Spanish, Mixtec, and Zapotec. The Spanish version is available in the written form but the Mixtec and Zapotec versions are available only in the audio form since they are languages of oral tradition. <strong>Conclusions: </strong>The mental health needs of Oaxacan communities living in the United States and other parts of Latin America are pressing and even more in the domain of mental health. The mental health instrument here discussed is a contribution to the understanding and solution of the identified relevant problems.</p> Helda Pinzon-Perez Leoncio Vásquez Santos ##submission.copyrightStatement## 2021-07-15 2021-07-15 21 3 10.25176/RFMH.v21i3.3929 Bilateral breast carcinoma in visceral crisis <p>Bilateral breast carcinoma is rare and infrequent , it is good to define if it occurs synchronously or metachronously, to define if the lesion in the second breast &nbsp;is metastasis or a primary tumor using pathological criteria, the state and clinical condition . For the prognosis and specialized treatment to follow. We present the case of a patient with ECIV breast cancer due to contralateral breast metastasis in a state of visceral crisis at debut, with pathological anatomy of grade 2 infiltrating ductal carcinoma of the breast, absent in situ component in both breast , RE (70%) , RP (80%), Cerb2 negative, Ki67 30% in the right breast and RE (100%) RP (80%) Cerb2-Ki67 20% left breast. A chest-abdomen-pelvis tomography was performed, showing pleural effusion. bilateral and large volume ascites. It was decided to start treatment with systemic chemotherapy, reaching a complete radiological and clinical response. After achieving good control of the disease, the first hormonal line will be sought.</p> José Manuel Vela Ruiz Diana I. Ferrer-Ponce Miguel J. Sotelo Reina Bustamante –Coronado Nury León-Nué ##submission.copyrightStatement## 2021-05-22 2021-05-22 21 3 10.25176/RFMH.v21i3.3921 Autologous serum in vascular ulcer of long evolution <p>The treatment of chronic wounds continues to be a topic of great interest due to the slow evolution and difficult healing they present, despite the development of new therapies on wound care and treatment.&nbsp;We present the case of a 76 year old male patient with a chronic vascular ulcer, 3 years of evolution, located in the distal portion of the left leg, with severe incompetence of saphenous vein minor to predominance of left lower limb. Who receives as treatment the application of autologous serum, achieving epithelialization and subsequent healing of the lesion.</p> Germán Víctor Martin Rossani Alatrista Rafael I. Hernández-Patiño ##submission.copyrightStatement## 2021-06-16 2021-06-16 21 3 10.25176/RFMH.v21i3.3942 Seizure or child abuse? <p>More child abuse cases are reported in Peru every year; however, there is no official report that describes the actual incidence, especially of the most vulnerable population such as infants. Signs of physical abuse generally involve brain injury and constitute shaken baby syndrome or pediatric abusive head trauma, which is a challenging diagnostic challenge.&nbsp;A 3-month-old infant is admitted to the emergency room for 30-minute generalized tonic-clonic seizures. On physical examination, the presence of a bony callus on the right clavicle was striking. A brain tomography and magnetic resonance imaging were performed, showing hyperintense lesions in the white matter, non-contrast enhancers, limited diffusion, and a bilateral subdural collection. Together, a bone survey was taken, which revealed multiple fractures in different areas of the body and suspecting the case of child abuse, so the relevant authorities (medical and judicial) were notified. Currently, the infant is in the custody of the Child Protection Unit, pending the definition of her final custody.</p> Consuelo del Rocio Luna Muñoz Martín Seminario-Aliaga Sandra Mendoza-Cernaqué Giuliana Reyes-Florian ##submission.copyrightStatement## 2021-05-22 2021-05-22 21 3 10.25176/RFMH.v21i3.3922 Spinal cord infarction after chemoembolization of bilateral breast tumor: a case report. <p>Spinal cord infarction is a rare entity that can be caused by interventional procedures such as chemoembolization, despite its high level of safety. We present a case of a 51-year-old female with chest pain and hemorrhage from a friable neoplastic lesion of the bilateral breast without improvement after conservative measures. After embolization of the tumor arteries, the patient developed crural paraparesis and global lower extremity hyporeflexia. MRI showed hypersignal in the anterior spinal cord, suggesting ischemia/infarction of the spinal cord in the territory of the anterior spinal artery. Despite the interventional procedures being safe, the inherent risks are always present, and unfortunately some serious ones, such as the one reported in this case. That is why the importance of case-by-case evaluation in order to offer the best treatment and maintain informed consent.</p> Wilton Luis Cervera Ocana Martha Sofia Cervera Ocaña Rut Irene Cervera Ocaña Karol Jasmin Huanca Bernal ##submission.copyrightStatement## 2021-06-02 2021-06-02 21 3 10.25176/RFMH.v21i3.3710 Pheochromocytoma: Multidisciplinary Approach Perioperative Considerations <p>Patient scheduled for an adrenalectomy with laparoscopic technique, due to a tumor of the left adrenal gland. The diagnosis of chronic arterial hypertension was difficult to control, so a test was requested to rule out pheochromocytoma, resulting in a tumor of the left adrenal gland. The teamwork of the specialties involved in the care of the patient, effective communication, pre-surgical preparation and perioperative management, resulted in minimal perioperative complications in the patient, remaining in the intensive care unit for one day and reducing the hospital stay.</p> Miryam Elizabeth Céspedes Morón Roxana Camargo-Román Nicanor Rodriguez-Gutarra Alicia Mispireta-Castañeda ##submission.copyrightStatement## 2021-07-21 2021-07-21 21 3 10.25176/RFMH.v21i3.3923 Reorganization of the offer of health services for the care of newborns in Metropolitan Lima in the IPRESS of the Ministry of Health, 2015-2019 <p>Neonatal maternal morbidity and mortality is a public health problem in Peru.&nbsp;The Ministry of Health (MINSA) has designed various interventions to address this problem, such as family planning, delivery care by a health professional, and refocused prenatal care; which are part of the Budgetary Program (PP) Maternal Neonatal Health that is executed in the health establishments of the country of the MINSA and the Regional Governments.</p> <p>&nbsp;</p> Alfonso Gutierrez-Aguado Seimer Escobedo Palza José Manuel Luicho Sobrado Miguel Angel Huamaní Contreras ##submission.copyrightStatement## 2021-06-16 2021-06-16 21 3 10.25176/RFMH.v21i3.3746 Evaluation of three brands of rapid tests against blood samples for the detection of antibodies against HIV <p>One of the important factors to reduce the spread of the human immunodeficiency virus (HIV) in Peru is the accessibility of diagnosis through rapid tests (RP), which are applied even in the most remote communities. However, during the five years 2011 - 2015, health establishments acquired and used more than 10 different brands, generating confusion in applying the methodology described in the inserts and consequently erroneous results (false positives and false negatives).</p> Eduardo Fernando Miranda Ulloa Ronal Briceño Espinoza Soledad Romero Ruiz Fany Cárdenas Bustmante ##submission.copyrightStatement## 2021-06-16 2021-06-16 21 3 10.25176/RFMH.v21i3.3941 Comparison of scales apache II and bisap in the prognosis of Acute Pancreatitis in a hospital in Peru <p>I have read the article “Comparison of APACHE II scales and BISAP in the prognosis of acute pancreatitis in a hospital in Peru” by García-Revilla et al, where they make a comparison of both scales in the prognosis of organ failure in hospitalized patients with acute pancreatitis in a public hospital in Peru. In this context, I would like to comment on the methodology used in this article.</p> Annie Thalia Velasquez Manrique ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3733 The COVID-19 pandemic from Anatomic Pathology laboratories in Peru <p>The anatomic pathology specialty plays a fundamental role within the multidisciplinary health systems team, since the majority of diseases are diagnosed by studying changes in cells, tissues and organs at both the macro and microscopic levels. Thus, this specialty is generally circumscribed in: surgical pathology, cytology and necropsy. Today, with the advent of new technologies in Peru, the practice of the specialty has considerably expanded its activity (immunohistochemistry, immunofluorescence, electron microscopy, molecular pathology, among others).</p> Karina Patiño-Calla Alejandro Yabar Berrocal ##submission.copyrightStatement## 2021-05-10 2021-05-10 21 3 10.25176/RFMH.v21i3.3787