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 It covers current issues, with original and unpublished articles, related to the various specialties of the biomedical and Public Health area.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> 2020: A year of great challenges and opportunities <p>Starting the year 2020 with the publication of the first issue of the Journal of the Faculty of Human Medicine, is refreshing and inspiring. The year 2019 was behind, it meant a year of great achievements and indexes for our Magazine. This new year opens up the possibility of deepening and advancing the quality of publications, as well as diversifying and internationalizing collaborations.</p> <p>Our main thanks to the Rector of the Ricardo Palma University, Dr. Elio Iván Rodríguez Chávez, for all his support and vision to guide the Magazine.</p> Jhony A. De La Cruz-Vargas ##submission.copyrightStatement## 2020-01-13 2020-01-13 20 1 1 1 10.25176/RFMH.v20i1.2706 Liquid Biopsy in Oncology: Myth or Reality? <p>One of the most relevant challenge in oncology would be the ability to deeply know tumoral genetic aspects through technological innovation and translational research to be finally able to personalize oncological treatment based not only on classical patient’s clinical characteristics but also on its tumoral genetic portrait. In the last few years, many studies showed that to select cancer patients for a specific drug on the basis of specific genetic alterations could determine the greatest potential clinical benefit for a longer time, compared to treatment with the classic cytotoxic chemotherapy. Thus, oncology moves from the classic "one size fits all" approach, which provided classic chemotherapy agents on the basis of the cancer primary site and its histological type, to a new classification based on the tumor molecular profile. The characterization of the genetic alterations of the tumors, and the understanding of the complex interaction between the molecules of the same network represents, therefore, the rationale on which precision medicine is based. These advances have been made possible by the recent development of new technologies, such as next generation sequencing (NGS) or massive parallel sequencing (MPS), which allow the sequencing of larger gene portions compared to previous technologies, with reduced times and an increase in analytical sensitivity.</p> Antonio Russo Antonio Galvano ##submission.copyrightStatement## 2020-01-08 2020-01-08 20 1 1 1 10.25176/RFMH.v20i1.2643 Presentation of the technical document: Analysis of the situation of Cancer in Peru 2018 <p>The design and planning of prevention and control interventions as well as the evaluation of interventions already implemented require a situational analysis based on various systems and sources of information that allow directing and prioritizing resources to the most vulnerable and / or disadvantaged populations. Health situation analyzes constitute a powerful tool for the identification of needs and priorities, being essential for the construction of health policies. On December 27, 2019, the National Center for Epidemiology, Disease Prevention and Control presented in the Paraninfo of the Ministry of Health the "Analysis of the situation of cancer in Peru, 2018". This technical document seeks to contribute based on the analysis of data from various sources of information to the design of cancer prevention and control interventions in the country, particularly in the formulation of the National Plan for Comprehensive Cancer Care 2020-2024 which represents the continuation of the Hope Plan.</p> Willy Ramos Jhony A. De La Cruz-Vargas ##submission.copyrightStatement## 2020-01-13 2020-01-13 20 1 1 1 10.25176/RFMH.v20i1.2704 Perspectives for health technology assessment <p>An unplanned health care system is like a paper boat carried by a slowly sinking current. In times of disinformation and excessive distraction, investing in better facts on health technology assessment (HTA) will enable more active actions rather than reactive to the market dynamics. This paper aims to raise some reflections on HTA in terms of political context, health technologies and epidemiological priorities. The perspective of HTA is context dependent, intrinsic to its political and institutional articulation. At the moment, the paradox is to maintain a specialized structure in the face of economic austerity policies that reduce health resources, and a scenario of greater interest in raising public funds by the private sector. Particularly in Brazil, HTA will also have to deal with the gradual shift from a universal health system to a minimum portfolio of services offered by the private sector. The public sector will be requested for very expensive technologies, usually by judicial measures. The precariousness of work relationships will influence HTA workers because they will not have a link and identity with the health system. Thus, there will be more productive and less reflective HTA processes. The context of greater dependence on the private market will allow new problems with medical technologies to emerge, such as the opioid crisis in the United States.</p> Marcus Tolentino Silva ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2562 Severity prognostic factors in patients with acute pancreatitis in Hospital Nacional Sergio E. Bernales <p>Objective:&nbsp;To determine the prognostic factors of severity in patients with acute pancreatitis (AP) at the Hospital Nacional Sergio E. Bernales during the period June 2016 to June 2018. Methods: Study of cases and controls, being the cases patients with AP moderately severe or severe and controls those of mild AP. The medical records were reviewed to apply the APACHE-II score. Chi- square was used and the ORs were obtained with their respective 95% CI. SPSS 25 program was used. Results: 162 medical records were reviewed. 54 (33.3%) patients developed AP moderately severe or severe and 108 (66.7%) had mild AP. Of the patients with AP moderately severe or severe, 55.6% were men; while in mild AP the female sex was predominant with 91.7%. The majority were of biliary origin (83.3%). There was a predominance of mild AP. AP moderately severe or severe was associated with being over 60 years old (OR: 3.10; 95% CI: 1.26-7.65; p= 0.011), presenting pleural effusion (OR: 7.78 95% CI: 5.745-54.418 ; p &amp;lt;0.001), hematocrit&amp;gt;40% (OR: 4.17; 95% CI: 2.07-8.39; p &amp;lt;0.001) and APACHE score ≥8 (OR: 7.88; 95% CI: 3.77-16.45; p&amp;lt;0.001). Conclusions: The factors associated with the severity of pancreatitis were age, presenting pleural effusion, hematocrit&amp;gt; 40% and APACHE score ≥8.</p> Hellen Jamanca-Milian Luis Cano-Cardenas ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2543 Characteristics of the non-urgent demand in the emergency service of a social Security hospital in Peru <p>Objective: To describe the characteristics of patients with non-urgent demand to the emergency room of an urban social security hospital. Methods: Observational study in a referral hospital. Stratified random sampling, 120 patients older than 14 years of priority IV (patients without commitment to vital functions or risk of immediate complication, which can be attended in outpatient room or decentralized offices). A validated predesigned questionnaire was applied. Performing descriptive statistics with IBM SPSS 24. Results: 66% of patients were female, most frequent ages over 65 years and between 20-40 years. 47% were active workers, with high school level or higher 86%, they had 83% personal cell phone and 73% wire TV or internet at home. 63% arrived at the public transport emergency, the delay time to the hospital was 30-60 minutes in 50% of cases and &amp;lt;30 minutes in 28%. He did not know his primary care center 33%, he was never treated before in this 57% and did not go to another health facility prior to his 87% emergency arrival. Most frequent symptoms: malaise, odynophagia, diarrhea and low back pain; with presentation time between hours and days in 91% of cases. Conclusion: Non-urgent consultation patients in the emergency room are predominantly female, young and old people, who are active in work, with a high level of education and access to communications technology, reside near the hospital and do not know their primary care center.</p> Waldo Taype-Huamaní Lucila De la Cruz-Rojas Delcio Miranda-Soler José Amado-Tineo ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2544 Index waist size a visceral obesity marker related to non-complicated cystitis <p>Objective: The aim of this study was to determine the association between<br>waist to height ratio and uncomplicated cystitis in a primary health care center in Lima, during the year 2018. Methods: We conducted an observational, analytical, case-control study, in which a total of 131 cases and 131 controls were obtained by simple random sample, applying exclusion and inclusion criteria. Retrospective recollection of the data was performed using the medical record of each selected patient. Odds ratio was calculated to measure the strength of association. Results: the waist to height ratio mean for uncomplicated cystitis was 61,9 ± 6.39 and 58.12 ± 3.87 for the controls. We found an statistical significant association between uncomplicated cystitis and waist to height ratio (OR 5,27; 95%CI 3,10 – 8,95; p &amp;lt;0,001). Waist circumference (OR 2,11 95%CI;1,26 – 3,55; p=0,005) and body mass index (OR 2,02; 95%CI 1,20 – 3,37; p=0,007) were also associated. Conclusion: we found a strong association between waist to height ratio and uncomplicated cystitis, prospective studies are suggested to confirm the association between visceral obesity and the appearance of urinary tract infections</p> Ezequiel Roque Quezada Cluadia Saldaña Joseph Alburqueque- Melgarejo ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2545 Preparation and validation of a systemic loxoscelism prediction protocol <p>Introduction: Systemic loxoscelism is the most severe complication of loxoscelism. The management of the cadre by health personnel presents a high variability due to factors that are currently unknown. There is no standard of reference or a clinical prediction model that can guide our decisions when approaching a spider bite patient. Objective: Develop and validate a clinical prediction rule for systemic loxoscelism. Methods: An observational study of derivation and validation of a clinical prediction model was carried out with diagnostic test validation based on a historical single-arm cohort in patients treated at Vitarte Hospital between 2007 and 2016 and international clinical reports published. Results: Systemic loxoscelism occurred only in 32.9% (n = 24) of cases. For the bivariate analysis, the variables that showed a statistically significant association (P &amp;lt;0.05) were sex, bite in an independent abdomen in relation to other parts of the body, bite in other parts of the body than the abdomen, vomiting , fever and hemoglobinuria. The regression analysis included in the analysis the variables: sex, vomit, fever and hemoglobinuria. Bootstrapping determined the internal validity of the model. The area under the curve was 0.91 (P &amp;lt;0.05) and the sensitivity, specificity, LR + and LR- were 79.1%, 93.8%, 12.9 and 0.22 respectively. Conclusions: The protocol of prediction of systemic derived loxoscelism is valid, for the moment.</p> Rafael Pichardo-Rodriguez Marcos Saavedra-Velasco Jhonatan Ascarza-Saldaña Cesar Naquira-Velarde ##submission.copyrightStatement## 2020-01-08 2020-01-08 20 1 1 1 10.25176/RFMH.v20i1.2642 Learning and academic performance styles in nursing internships of a peruvian public university <p>Objective: To evaluate the learning style (EEAA) and its relation with the academic performance (RA), in Nursing Interns of a national university of Peru. Methods: Cross-sectional, quantitative, correlational study; conducted in 70 nursing interns during 2018, the Honey-Alonso validated questionnaire (CHAEA) was applied for learning styles and record of grades for academic performance, the data were submitted to descriptive and inferential statistics, using SPSS 26.0. Results: The population characteristics, according to age, 84.5% were between 20 and 25 years old, usually single, do not work, although a significant group does, and 82.9% women. In EEAA reflexive learning (0.80) predominates, followed by theoretical (0.75), pragmatic (0.66) and active (0.57). The weight average of R.A. It was 15.84, with a good and excellent qualification, 62.86% presented a good performance, followed by 32.86% with excellent performance. The results of association between EEAA and RA were not significant (P&gt; 0.05). Conclusion: The academic performance of nursing interns was mainly good and excellent. The EEAA evaluation showed the reflexive style as predominant. We found no significant association between learning styles and their contribution to academic performance.</p> Ana Maria Chambi-Choque Jorge Manrique-Cienfuegos Tula Margarita Espinoza-Moreno ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2546 Genetic Biomonitoring in Workers of the Radiology Service of National Police Hospital Luis N. Sáenz <p><strong>Objective:</strong> To evaluate the genotoxic effect on workers exposed to X-rays in the Radiology Service of the Luis N. Sáenz National Hospital PNP. <strong>Materials and methods</strong>. The type of study was observational, prospective, cross-sectional, analytical, using the comet assay as an analysis technique. The study population was 20 workers exposed to X-rays and 20 people without exposure. <strong>Results</strong> The mean length of migration of damaged DNA in the control group was 1.28 ± 0.38 µm and 10.39 ± 9.44 µm for the exposed group, the means of the groups were compared, obtaining p = 0.001 significant. The correlation analysis for DNA damage, years of exposure and dose received, a significant correlation was found (p &lt;0.05). For the correlation of DNA damage with age, no statistical significance was found (p&gt; 0.05). <strong>Conclusions</strong> X-rays at low permissible doses can cause damage to DNA integrity, correlating with the first years of exposure of personnel working in the radiology service. Keywords: Genotoxic, exposure, X-ray, comet test.</p> Walter Ivan Infantes-Vizcarra ##submission.copyrightStatement## 2019-12-19 2019-12-19 20 1 1 1 10.25176/RFMH.v20i1.2256 Microscopic findings of lung tissue and respiratory muscles in Chronic Obstructive Pulmonary Disease (COPD) <p><strong>Introduction: </strong>In chronic obstructive pulmonary disease (COPD), the diaphragm and sternocleidomastoid respiratory muscles (ECOM) work against increased mechanical loads due to limited air flow and changes in chest conformation due to the condition of pulmonary hyperinflation. <strong>Objective:</strong> To evaluate the histopathological changes present in the lungs and respiratory muscles (diaphragm and ECOM) of the corpses affected by COPD. <strong>Materials and methods:</strong> This is a blind and descriptive study with analysis of histological images of biopsy. The history of smoking associated with the presence of pulmonary anthracosis, septal thickening and emphysematous bullae included the inclusion criteria of the study. The study was conducted by optical microscopic analysis of histological sheets obtained from 36 corpses with COPD. The histopathological diagnosis was made by a pathologist who did not know the objectives of the study. <strong>Results:</strong> In the diaphragm, there was the presence of interposed adipose tissue, muscle atrophy, removal of muscle fibers and fibrosis. In ECOM, the elimination of muscle fibers, muscular atrophy, interposed adipose tissue, muscle hypertrophy and thickening of the tendons were also evident. <strong>Conclusions: </strong>The changes found in the diaphragm and ECOM muscle biopsies of the bodies with COPD were evidenced as a mechanism of compensation and / or dysfunction of the respiratory system due to biomechanical alterations promoted by the disease.</p> Tales Lyra de Oliveira Tacio Nertan Cartaxo de Souza Byron Martins Lucena Fernanda Mayara Santos Santana Lysien Ivania Zambrano Ana Rose de Carvalho Araujo Ana Lúcia de Gusmão Freire ##submission.copyrightStatement## 2019-12-19 2019-12-19 20 1 1 1 10.25176/RFMH.v20i1.2447 Factors associated with gestational trophoblastic disease at the Hipólito Unánue Hospital during the period from January 2014 to December 2018 <p>Objective: To determine the risk factors associated with gestational trophoblastic disease in patients treated in an outpatient office of the Gynecobstetrics service of the National Hospital Hipólito Unanue between January 2014 and December 2018. Methods: An observational, retrospective, analytical study of cases and controls was conducted. A total of 60 cases were taken as a sample and 120 stories were reviewed as a control group. The information obtained from the review of medical records was recorded in the data collection form. The odds ratio was determined with their respective confidence intervals (CI = 95%). For the multivariate analysis, a binary logistic regression model was used. Results: In the bivariate analysis, the factors associated with gestational trophoblastic disease were the history of abortion (OR 6.54; 95% CI 3.12 - 13.74; p &lt;0.001) and multiparity (OR 3.35; 95% CI: 1.47 - 7.65; p &lt;0.001). Age under 20 years was associated with a lower frequency (OR: 0.13; CI: 0.03-0.48 p &lt;0.001). In the multivariate analysis, the only variables that showed significance were the history of abortion (OR 4.85; 95% CI 1.82-12.91; p = 0.002) as a risk factor and age under 20 years as a protective factor (OR 0.08; 95% CI 0.02 -0.32; p &lt;0.001). Conclusion: The history of abortion and multiparity were associated with the presence of gestational trophoblastic disease, while the age under 20 years behaved as a protective factor.</p> Johana Huanca-Llamo German Aranzabal-Alegria Willer Chanduví ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2547 Association between characteristics of mammographic calcifications and malignie Neoplasia in a national hospital – 2017 <p>Introduction: The presence of calcifications may be useful for the diagnosis of breast neoplasia. Objective: To determine the association between the characteristics of mammographic calcifications and malignant neoplasia. Methods: Observational, analytical, retrospective of cases and controls. Developed in the Gynecology Breast Pathology Unit. Female patients with mammogram suggestive of malignant neoplasm with a positive malignancy biopsy were included as cases, and 67 patients without histological evidence of malignancy as controls. Results: The average age of the cases was 54.12 years, in the controls 50.34. 50,.9% (59) are older than or equal to 50 years, OR 2,399 95% CI (1,125-5,114) p = 0.022, of these 52.5% (31) had breast cancer. 9.5% (11) had calcifications suspicious of malignancy, the most frequent, the amorphous and the pleomorphic fine. 37.1% (43) of the total cases have the BI-RADS 0 category, 6.9% (8) BI-RADS 1, 8.6% (10) BI-RADS 2, 7.8 % (9) BI-RADS 3, 28.4% (33) BI-RADS 4, 8.6% (10) BI-RADS 5 and 2.6% (3) BI-RADS 6. 72, 7% (8) of patients with calcifications suspected of malignancy presented breast cancer. In the bivariate analysis, an OR of 4,163 was obtained. 95% CI (1,043-16,606) p = 0,031. In the multivariate analysis the association remained unchanged regardless of age and BI-RADS. Conclusion: Age 50 years or older and mammographic calcifications suspected of malignancy are associated factors for breast cancer.</p> Víctor Arteaga-Huanca María Loo Haylin Loo Lucy Cedillo-Ramirez ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2548 Maternal characteristics associated with the fetal macrosomy diagnosis in a hospital III-1 of the capital of Peru <p>Objective: To identify the maternal characteristics associated with the diagnosis of fetal macrosomia at Sergio E. Bernales Hospital from January to December 2018. Methods: An observational, analytical, retrospective, case-control study was carried out. The population studied was pregnant women with a diagnosis of fetal macrosomia treated in the gynecoobstetrics service of Sergio E. Bernales Hospital from January to December 2018. Through a data collection sheet, the information from the medical records was extracted; the data was then processed according to the IBM SPSS Statistics v25 program. Results: Of 532 patients studied, 133 cases and 399 controls were obtained. Maternal age varies between 14 and 45 years (average age of 27.01). A statistically significant association was found between fetal macrosomia and the following variables: post-term pregnancy (OR = 13,613 95% CI 2,901-63,891), gestational diabetes (OR 5.7 IC95% 2.5 -12.7), excessive weight gain (OR 1,833 95% CI 1,154-2,911), sex of the newborn (OR 1.83 95% CI 1.2-2.7) and age of the mother (OR 1.7 95% CI 1.0-2.9). When performing the multivariate analysis, no association was found with the variables age of the mother (P = 0.228, OR 1.510 95% CI 0.773-2.950) and BMI (P = 0.331, OR 0.740 95% CI 0.403-1.358), so they were considered confusing variables. Conclusion: The maternal characteristics associated with the diagnosis of fetal macrosomia are post-term delivery, gestational diabetes, excessive weight gain and sex of the newborn.</p> Kelly Huacachi-Trejo Lucy E. Correa-López ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2549 Risk factors associated with low back pain in marines treated by the outpatient clinic of the Centro Medico Naval <p>Objective: To determine the risk factors associated with low back pain in marines attended by an outpatient of the Centro Médico Naval in Lima in 2017. Methods: Cases and controls study that included 66 cases and 132 controls, obtaining the information from medical records of the personnel of the Peruvian Navy in activity attended by an outpatient of physical medicine and rehabilitation through a validated data collection form. For the calculation of the chi-square and the p-value; logistic regression was used to estimate the Odds Ratio (OR) and CI 95%. Results: Of the total population, the male sex was 90.4%, the median age was 26 years (IR: 36-77). The presence of low back pain was associated in the multivariate analysis with age (OR = 1.05; 95% CI (0.94 - 1.16)), service time (OR = 0.91; 95% CI (0, 81-1)), overweight or obesity (OR = 2.24; 95% CI (1.16-4.28)) and dyslipidemia, (OR = 2.00; 95% CI (1.47-5, 66)). Conclusion: The presence of low back pain in naval personnel associated with age, gender, nutritional status and dyslipidemia.</p> Roxana Arellano-Hidalgo Sandra Mendoza-Cernaqué Consuelo Luna-Muñoz ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2550 Treatment of Nevus de Ota with 755 nm Alexandrite Q-Switched Laser <p>Introduction: Ota nevus is a benign dermal melanocytic hamartoma with a macular appearance, poorly defined and in a gray-black patch that generally affects the first and second branches of the trigeminal unilaterally. Objective: To evaluate the efficacy, safety and adverse events caused by the application of 755 nm Alexandrite laser for the treatment of Ota nevus. Methods: Case series of 10 phototype IV patients with unilateral Ota Nevus treated between January 2017 and December 2018, which were treated with this light energy and with defined parameters. Results: The mean age was 29 years. The patients who completed the treatment did not show repigmentation in the treated lesion and the satisfaction index was acceptable. It was observed that the average of sessions to obtain favorable results varied between 8 and 10 applications. Among the most important adverse effects, post-inflammatory hyperpigmentation and the removal of the superficial layer of the post laser skin stand out. All were controlled without leaving permanent residual lesions. Conclusion: The 755 nm Alexandrite Q-switched laser is an effective technology to achieve a high degree of depigmentation in the treatment of Ota nevus and can be considered as a first-line treatment for the management of this pathology.</p> Julio Cesar Negron Beuzeville Edmundo Saco M. Iván Hernández P. ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2551 Anti-inflammatory activity of the ethnolic extract of the leaves of manihot esculenta Crantz (yuca) in an experimental model of acute inflammation <p>Introduction: Manihot esculenta Crantz (yucca) leaves have been used around the world and over time in order to decrease the anti-inflammatory response. Objective: To evaluate the anti-inflammatory activity of the ethanolic extract of the Manihot esculenta Crantz leaf in rats. Methods: An experimental study was conducted. The study population included 60 albino rats sp. Rattus novergicus, distributed in 4 groups of 15 rats each. A homogeneous solution of ethanolic extract of Manihot esculenta Crantz leaves was used for intraperitoneal administration. Carrageenan was used as an inflammatory inducer that was administered intradermally; for the measurement of plantar edema, the Digital Water Plethysmometer (LE7500) was used. Tween 80 / water solution (1:10) was administered to the negative control group at a dose of 1mL./100g., To the betamethasone positive control group 4mg / Kg and to treatment groups 1 and 2 Manihot esculenta Crantz, 2 mg / kg and 4 mg / kg, respectively. The 1-tail ANOVA test and the Tukey post hoc test were used for comparisons between the groups. Results: In 37.67% of treatment group 2 a reduction in edema was observed 3 hours after administering Manihot esculenta Crantz (p &lt;0.05). In both administration groups of Manihot esculenta Crantz there was a nonsignificant trend to reduce plantar edema with values close to significance. Conclusion: The Manihot esculenta Crantz ethanolic extract at a 4 mg / kg dose probably have anti-inflammatory activity in this animal model of acute inflamation.</p> Nathalie D. Amado-Cornejo Geraldine Atusparia-Flores Maricielo V. Huamán-Cabrera Ángela Méndez-Pajares Etty Prado-Asencios Hilda Jurupe-Chico Vilma Herencia-Reyes ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2552 The measurement of inequality in the reduction of child mortality in Peru <p>Objective: To define the feasibility of determining inequality in infant mortality according to the mother's educational level and according to the wealth quintile of the 1991-2013 period, considering the level of precision of said rates. Methods: The type of study was quantitative and observational, with a crosssectional design based on repeated surveys. The data from the ENDES surveys corresponding to those of 1991, 1992, 1996, 2000, 2008 and 2013 were used. Infant mortality was determined using the direct method of synthetic cohort life tables. The level of precision of the estimates was determined by the relative error. Results: It´s observed that the level of precision of the estimates of these general rates has fluctuated between good and very good in the 1991-1992, 1996 and 2000 surveys; however, in 2008 and 2013 they only reach an acceptable level. Infant mortality rates tend to be lower as the mother's educational level improves, as well as the wealth quintile and elsewhere exists among successive surveys a tendency to reduce infant mortality in different categories. Conclusion: It is not feasible to determine the inequality of the measurement of Infant Mortality according to the mother's educational level and according to the wealth quintile in the period 1991-2013, because the sample size has not been increased, depending on the decreased mortality.</p> Ramón Figueroa Mujica Guisela Yábar Torres Krupuskaya Figueroa Yabar ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2553 Advancing sustainable development goals through public health service learning <p>Objective: To discuss the development and implementation of a service learning experience designed to improve the health status of vulnerable populations in a middle-income country through the implementation of science-based programs designed to address the World Health Organization’s “Ten Threats to Global Health.” Methods: Describes the pragmatic development of a service learning experience designed to provide hands-on experiences to public health and medical students as they develop into professionals in high-middle-and low-income countries. Results: “Exploring Global Social Determinants of Health in the Dominican Republic,” originally designed as an observational experience of social determinants of health, has evolved into an experiential learning experience designed to assist students in the application of their public health knowledge and experience. Conclusion: Public health professionals, including those in training, have a responsibility to implement actions designed to improve the health status of populations around the world. Service learning programs such as “Exploring Global Social Determinants of Health in the Dominican Republic,” provide those hands-on opportunities.</p> Miguel A. Perez Jenette L. Smith ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2561 Feasibility Study to Evaluate the Proportion of Cancer Attributable to Modifiable Factors of Risk in Peru and Latin America <p>Objective: To evaluate the feasibility of the methodological proposal to estimate the incidence and mortality due to cancer attributable to modifiable risk factors for Peru and Latin America. Methods: Pilot study, ecological from secondary sources. Modifiable risk factors, exposure prevalence, relative risks of these factors (RR) or an approximation by means of possibilities ratio (OR) were searched and selected. The information was recorded in a data collection form which was validated by expert judgment. For the calculation of the Population Attributable Fraction (FAP), the formula proposed by Parkin was tested and a statistical simulation model was developed with R. Studio V. 3.6.1 software. Results: In Peru there are prevalence studies for the majority of modifiable risk factors; Likewise, studies with OR estimates for several of the factors are available in Latin America; however, studies from the United States had to be used for the remaining factors. No national studies of ionizing or ultraviolet radiation were found. The syntax of the statistical simulation model was tested, which proved to be valid and consistent with the results of international FAP studies within the ranges of published studies. Conclusion: It is feasible and viable to carry out PAF studies of modifiable risk factors for cancer in Latin American countries, particularly in Peru, where the information required for its estimation is available.</p> Jhony A. De La Cruz Vargas Willy Cesar Ramos Willer Chanduví Ruben Espinoza Nadia Guerrero Joan Loayza-Castro Alfonso Gutiérrez Aguado Ronald Carpio Manuel Loayza Alarico ##submission.copyrightStatement## 2020-01-28 2020-01-28 20 1 1 1 10.25176/RFMH.v20i1.2657 Prevalence and factors associated with the low consumption of fruits and vegetables in students of the professional career of human medicine of a peruvian university <p><strong>Objective</strong>: To determine the prevalence and factors associated with the low consumption of fruits and vegetables in students of the professional career of human medicine of the National University Hermilio Valdizán (UNHEVAL). <strong>Methods</strong>: Cross-sectional study. The population was constituted by 371 students of the professional career of Human Medicine who were enrolled and taking courses in July 2018. It was applied a self-administered questionnaire which allowed to obtain information about the consumption of fruits and vegetables. From the collected data it was obtained the prevalence and factors associated with low consumption of fruits and vegetables. <strong>Results</strong>: The prevalence of low consumption of fruits and vegetables was 60,1% (IC95%: 55,0% -65,2%). The main reasons for not consuming fruits and vegetables were that it is rare to get them in the cafeterias of the university (78,7%), insufficient time for their selection, purchase and preparation (73,6%) and living with one of the parents who were in charge for their feeding. (55,3%). The multivariate analysis found that the only factor associated with low consumption of fruits and vegetables was the insufficient time for selection, purchase and preparation; whereas, living with one of the parents constituted a factor protector. <strong>Conclusion</strong>: There is a high prevalence of low consumption of fruits and vegetables in students of the professional career of human medicine of the UNHEVAL. The insufficient time for the selection, purchase and preparation of fruits and vegetables is an associated factor and living with one of the parents constitutes a protector factor.</p> Alan Huamancayo-Espíritu Luis Pérez-Cárdenas ##submission.copyrightStatement## 2020-01-09 2020-01-09 20 1 1 1 10.25176/RFMH.v20i1.2660 Radiological semiology in emergency brain pathology <p>Radiology is a great tool in the diagnosis of encephalic pathologies, especially in situations of neurological urgency and emergency, to rule out the presence of a specific pathology, and to definite the location and size of the lesion, or clarify an initial uncertain diagnosis. In this way, the knowledge of its main signs, findings and characteristics is important to perform an adequate examination, because it facilitates the description of the images obtained with greater speed and precision allowing an optimal and immediate labor of the treating doctor in favor of the patient. Therefore, this article presents a brief review of the representative radiological semiology obtained in the medical literature, where the references were bibliographies and researches, which is convenient to localize the signs that could exist as soon as the examination was obtained, for the future therapeutic of the patient, such as the possibility of extension in the radiology exam or suggestion by the medical technologist of radiology in coordination with the requesting physician to guarantee the patient's care effective.</p> Alexander Humberto Román Meza Celso Huamán-Correa ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2280 Case-Control Studies <p>Case-control studies are analytical observational epidemiological studies generally devoted to evaluate factors associated with infrequent diseases. Its hierarchy within the pyramid of evidence lies in an intermediate place between cross sectional and cohort studies. The measure of association used for these studies is the Odds Ratio. Some variants of this design, such as incident and nested case studies and nested case-control studies (within a cohort) can reduce the risk of selection bias. The basic concepts related to this type of studies are reviewed.</p> Alonso Soto Aleksandar Cvetkovic-Vega ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2555 Association between pre-hospital care time and hospital mortality in victims of traffic accidents <p>Introduction: Traffic accidents (AT) are the first priority in health research in Peru, According to the World Health Organization (WHO) it is estimated that the economic costs of vehicle impact and injuries due to AT are 1 % and 1.5% of the Gross National Product (GNP) in low and middle income countries; In Peru it is approximately 1.5 - 2% of the Gross Domestic Product (GDP). Objective: To determine if there is an association between the time of prehospital care and hospital mortality in victims of traffic accidents. Methods: A systematic review was carried out through the literature search of related articles in indexing sources such as PubMed and BIREME. Results: Delays in the transfer of patients to the hospital and the lack of pre-hospital Emergency Medical System (SME) were significantly associated with an increase in mortality (P: 0.000) and the need for an SME as a prehospital care provider was significant predictor of emergency mortality with an adjusted odds ratio [OR] 2.19; 95% CI [1.88–2.55], and in the first 24 hours of admission with an adjusted OR 2.31; 95% CI [1.95–2.73]. Conclusion: The time of pre-hospital care in traffic accidents is significantly associated with hospital mortality, therefore, it is proposed to study factors associated with the longtime of pre-hospital care.</p> María Jesús G. Fernandez-Sandoval Bryam J. Vasquez-Zavala ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2558 Xp11.2 translocation renal carcinoma in a child <p>Translocation renal cell carcinoma (t-RCC) is a subtype of renal cell carcinoma (RCC). This case is about an 11-year-old with pain in right iliac fossa for two weeks. Tumor of 2.2 x 1.9 x 2.8 cm was evidenced in the upper pole of the right kidney, by ultrasound. Then, she underwent to a right radical nephrectomy and regional lymph node dissection, after which CRT subtype Xp 11.2 was diagnosed. Subsequently, first-line treatment with pazopanib and concomitant chemotherapy was initiated. This disease is more frequent between 10 and 15 years. Their prognosis is usually better compared to adults. The multidisciplinary management associated with the availability of first-line medications improves progression-free survival.</p> Gloria Paredes-Guerra Javier Larios-León Carol Gonzales-Gonzales ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2556 Severe acute hepatitis by coinfection by epstein-barr viruses and citomegalovirus - case report and review of literature <p>We report the case of a 6-year-old patient with a history of atopic dermatitis. Some days before her hospitalization she presented rhinorrhea and cough. Subsequently she presented maculopapular lesions, increase of body temperature and yellowing of the skin. After being hospitalized, in addition to the symptoms described, she presented 2 episodes of spontaneous epistaxis, hematemesis and melena; while in the physical examination, mucocutaneous jaundice, fever, generalized maculopapular rash, lymphadenopathy, and hepatosplenomegaly were evident. In the images studies, signs that indirectly indicated acute hepatitis and pleural effusion, were found. On the other hand, among the serological results, it was found that the markers of acute infection by EBV and CMV, as well as the marker of chronic EBV infection, were positive.</p> <p>As far as we know, this is the first report of CMV-EBV coinfection in our, due to an acute CMV infection. We report the case and we carry out a review of the literature.</p> Ítalo Renato Valero Román Grecia Claussen-Portocarrero Alexander Paucar-Ancassi Jaime Silva-Diaz ##submission.copyrightStatement## 2019-12-19 2019-12-19 20 1 1 1 10.25176/RFMH.v20i1.2253 Glycosiled hemoglobin a factor allied in the prevention of post-surgical infection of the diabetic foot <p>In this work an exhaustive search has been made of studies that show the effect of glycosylated hemoglobin (HbA1c) in the development of post surgical infection in diabetic foot patients. In our country the prevalence of patients with diabetes mellitus reaches up to 8.4%, in this regard it is known that one of the biggest complications of this disease is the development of diabetic foot and that consequently to this pathology up to 20% of these patients end in An amputation, it is also known that patients with diabetes mellitus have a high risk of postoperative complications, including infections, inadequate wound healing, cardiovascular events, venous embolism thrombus, and mortality. Because it has been thought that hyperglycemia mediates this risk, different international studies are carried out that seek to verify and publicize this association, however, because no national studies have been found in this regard, no solid conclusions can be drawn for our population, for which this manuscript aims to motivate the realization of them that reflect the national problem</p> Angela Marcela Villanueva Del Busto Fiorella Rocío Arce Huaroto ##submission.copyrightStatement## 2019-12-19 2019-12-19 20 1 1 1 10.25176/RFMH.v20i1.2198 Bacteriophages <p>Viruses that parasitize bacteria, called bacteriophages or phages, are returning to scientific news, evidenced by the creation of the Howard Hughs Medical Institute in the United States (USA), or the CRU-MEDI Institute in the United Kingdom; This change of interest is due to the possibility of using them in antibacterial therapy, against multiresistant bacteria.</p> <p>The knowledge of these viruses begins with the studies of Frederick Twort in the year 1915, demonstrating that "there are viruses that infect bacteria and kill them." But it was Felix d'Herelle, who successfully developed therapeutic protocols for digestive infections in animals and humans. Bacteriophages have been the basic laboratory tool for the development of science in virology and molecular biology.</p> Nicanor Domínguez Navarrete ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2554 Comments on the article: “depression of the peruvian elderly adult and associated Sociodemographical variables, analysis of endes 2017” <p>In the article published by Baldeón-Martínez et al1 on depression in the elderly, the authors estimated a prevalence of depression of 14.2% in a probabilistic sample of 4917 people over 60 in our country. The factors associated with this diagnosis were female sex, lack of education, age over 75, live in rural areas and be poor. This study was carried out based on data from the Demographic and Family Health Survey (ENDES) 2017, using the Patient Health Questionnaire (PHQ-9) instrument for the diagnosis of depression. The study presents some strengths such as wide coverage, quality of sampling and detailed and updated information on respondents, especially in socio-demographic aspects.</p> Jaime Lama-Valdivia Rodrigo Rodríguez-Del Pozo ##submission.copyrightStatement## 2019-12-26 2019-12-26 20 1 1 1 10.25176/RFMH.v20i1.2560 Genomic medicine in the schools of Medicine of Peru <p>Nowadays genomic medicine plays an important role in the promotion of population health, this is defined as the use of genomic information and technologies to determine the risk, predisposition, diagnosis and prognosis of diseases, with a personalized approach to The therapeutic options It is definitely the use of a patient's genotypic information for the benefit of their clinical care.</p> <p>In Peru, there are few institutions that are adequately equipped and implemented to develop both genetics and genomics activities applied to medical practice, the efforts that are being carried out are on specific topics and in an unsustainable way. These topics include neurological diseases, hereditary cancer, pharmacogenetics and some pediatric issues. Likewise, Peruvian research in these areas emerges at a slow pace, with representative institutions that are outlined in this topic, among which we can mention: Center for Genetics and Molecular Biology Research of the San Martín de Porres University, the Research Laboratories and Development of Science and Technology of the Peruvian University Cayetano Heredia, the Institute of Research in Biomedical Sciences of the Ricardo Palma University, also as part of the health care sector highlights the work of the National Institute of Neoplastic Diseases, the National Institute of Child Health and the National Institute of Health. However, it is necessary to join efforts to be able to articulate and / or coordinate between institutions to carry out larger research.</p> César Ñique-Carbajal Josely Pérez-Loaiza Jeanette Mestanza-Quispe ##submission.copyrightStatement## 2020-01-13 2020-01-13 20 1 1 1 10.25176/RFMH.v20i1.2705 Intrahospital infections in the medical student <p>The diseases associated with care in the health sector is a problem that not only involves patients who enter the service, but also the staff and students who carry out their practices in the different institutions. In-hospital infections are defined as: "Localized or systemic diseases resulting from an adverse reaction resulting from exposure to an infectious agent or its toxins, with no evidence that the infection was present or in the incubation period at the time of care." The lack of knowledge on the part of the personnel and students of the health sciences that are in contact with the patients, in addition to the realization of sanitary practices without taking into account the pertinent biosecurity measures are the main reasons for contracting a nosocomial infection.</p> Joan A. Loayza-Castro Josué R. Sánchez-Cruz Athenas P. Ortiz-Melgar ##submission.copyrightStatement## 2020-01-13 2020-01-13 20 1 1 1 10.25176/RFMH.v20i1.2703