Revista de la Facultad de Medicina Humana

Systemic immunomodulatory therapy in the management of atopic dermatitis: the value of Tralokinumab

Sara Muñoz Ordóñez — 2023-09-21

N/A

First course of palliative care in undergraduate medicine at a Peruvian university

José Portugal-Sánchez — 2023-09-14

The inclusion of a palliative care course for students in the ninth semester of the professional medical career is an important step in teaching in a Latin American country, seeking to bridge the gap between curative medicine that neglects symptom control and quality of life. Allowing students to better understand the disease process and the epidemiological transition that is taking place worldwide and affects all health systems. The students' appreciations are presented regarding little-reviewed aspects such as coping with death, end of life and the patient-family relationship.

Can vitamin D be the ray of sunshine that lights up the treatment of gastric cancer?

José Manuel Vela-Ruiz — 2023-09-14

Mr. Editor

Gastric cancer, a malignant neoplasm that originates in the cells of the stomach lining, represents a significant burden in terms of mortality worldwide. According to data from the American Cancer Society, the estimated mortality rate is 4.9 per 100,000 people in 2021. In South America, mortality rates from gastric cancer continue to be of concern, with countries such as Chile and Peru reporting mortality rates of 18.7 and 13.6 per 100,000 persons respectively in 2021(1).

Gastric cancer being a major pathology mentioned in other previously published studies(2).

Vitamin D is a fat-soluble hormone that occurs in two main forms, D2 (ergocalciferol) and D3 (cholecalciferol). It is produced in the skin under exposure to ultraviolet light or derived from plant sterol. It is metabolized in the liver and kidney to active forms. In addition to its role in calcium homeostasis, studies suggest that vitamin D has anticancer effects by inhibiting cell proliferation and promoting apoptosis. Thus, there is increasing interest as a potential anticancer agent(3).

Studies have demonstrated the therapeutic potential of vitamin D3 in gastric cancer. An in vitro and in vivo study found that vitamin D3 suppresses the growth of gastric cancer cells by down-regulating the expression of CD44(4). In addition, another study showed that vitamin D3 affects gastric cancer progression by repressing BMP3 promoter methylation(5).

Raising vitamin D levels to 42 ng/mL is estimated to reduce disease rates and mortality in various cancers by 18% per year(6). Inactivation of Wnt/beta-catenin signaling, induction of cell apoptosis, and inhibition of cell invasion and cancer metastasis are some of the mechanisms described(6). Some studies are described in Table 1.

Although the antitumor effects of vitamin D3 have been demonstrated in preclinical studies, there is still a lack of adequately designed clinical studies evaluating the safety and efficacy of vitamin D3 in gastric cancer. In addition, further studies on the antitumor effects of vitamin D3 in gastric cancer are needed to develop more effective therapeutic strategies(4-6).

Systemic sclerosis sine scleroderma in a woman with centromere antinuclear antibodies, pulmonary and digestive involvement: Case report

Freddy Liñán Ponce — 2023-09-14

Las entidades sinusoidales son raras en reumatología. En la esclerosis sistémica progresiva existe una variante de la forma cutánea limitada denominada esclerosis sistémica sine scleroderma, cuya característica central es la ausencia de afectación cutánea, pero sí afectación visceral. Los anticuerpos antitopoisomerasa o anticentrómero positivos confirman el diagnóstico. Presentamos el caso de una mujer de 63 años con enfermedad pulmonar intersticial, afectación del tránsito intestinal y fenómeno de Raynaud, con títulos elevados de ANA con patrón centromérico y positividad para anticuerpos anti-topoisomerasa. Ante un paciente con fenómeno de Raynaud, compromiso visceral y ANA elevado, se deben solicitar anticuerpos específicos para el diagnóstico de esclerosis sistémica en su variedad sinusal .

(Uveitis - glaucoma - hyphema syndrome: Clinical case)

Diego José Mamani Maquera — 2023-09-22

Introduction: Uveitis-glaucoma-hyphema syndrome (UGH) is a rare complication of cataract surgery, due to mechanical chafing exerted by an intraocular lens (IOL) on the iris. Clinical case: We present the case of a 64-year-old man with a history of cataract surgery, who presented decreased visual acuity and pain in the right eye. The ophthalmological examination revealed signs of anterior uveitis, elevated intraocular pressure (IOP), microhyphema, and a single-piece foldable IOL in the sulcus that caused a mechanical chafing with the posterior face of the iris. The medical treatment was insufficient, for this reason a folding simple-piece IOL explant surgery was performed and replaced by a three-piece IOL. Postoperative evolution was favorable. Conclusion: We should suspect this complication in patients with a history of cataract surgery, especially in cases in which the IOL is in single-piece and has been implanted outside the capsular bag.

Spontaneous pneumothorax and bullous emphysema in a young patient? About a case

María Manuela Rodriguez-Gutierrez — 2023-09-20

Introduction

Pneumothorax is a pathology prevalent in traumatic accidents in the thorax, but it can also be found spontaneously due to causes attributable to bullous disease, pneumonia, airway obstruction, malignancy, among others.

Case report

Young male patient who debuted with spontaneous pneumothorax who required management in the intensive care unit with subsequent appearance of bullae in diagnostic images and pathology.

Discussion

Primary spontaneous pneumothorax (PSP) in the young population is influenced by psychosocial factors such as age, gender, habits, environment, and genetic factors. In 80% of patients with PSP, the presence of bullae or apical blebs has been demonstrated, in addition from the porosity of the pleura that usually occurs in tall adolescents with athletic bodies; but it is also observed that tobacco use can increase the risk.

Conclusions

Spontaneous pneumothorax due to bullous emphysema has increased in young people due to the use of psychoactive substances, vapers, and cigarettes.

Lifestyles and diet related to nutritional status and the risk of DM2 in young women from two Colombian universities

Mylene Rodríguez Leyton — 2023-09-22

Objective: To analyze the lifestyles and diet related to nutritional status and the risk of DM2 and in female students of two Colombian universities.Methods: a descriptive, cross-sectional, multidimensional and exploratory study, carried out in a sample of 220 women, NyD students selected by random medsampling of proportions^[1]. A questionnaire was applied to identify sociodemographic variables, lifestyles related to food and DM2 risk according to the FINDRISC test; BMI, waist circumference, fat percentage, and active body substance index (IAKS) were determined. Bivariate analysis was performed using Statgraphics v.16, the chi2 test was applied with 95% confidence and statistical significance (p <0.05).Results: Overweight and obesity according to BMI (21.4%) showed statistical significance with the frequency of consumption of sugary drinks, packaged products, sugars and sweets, fast foods and alcoholic beverages; These two eating practices were related to very high cardiovascular risk by waist circumference and excessive fat percentage, which also presented significance with excessive screen time; the IAKS was related to the classification of physical activity. According to the FINDRISC test, 91% had DM2 risk factors; 20.5% presented medium risk and 2.3% high.Conclusions: Lifestyle and diet were related to anthropometric indicators: body weight, fat distribution, and body composition; are risk factors for the development of DM2 in young women. It is necessary to promote protective factors to maintain a healthy weight.

Use of inhaled corticoids as a risk factor for community-acquired pneumonia in patients with chronic obstructive pulmonary disease

María Alejandra Castillo Vega — 2023-09-22

Objective: To determine if the use of inhaled corticosteroids is a risk factor for community-acquired pneumonia in patients with Chronic Obstructive Pulmonary Disease at the Víctor Lazarte Echegaray Hospital during the period 2017-2020. Methods: The study was analytical, observational, retrospective of cases and unmatched controls in a ratio of 4:1 with a population of 405 subjects from whom 81 cases and 324 controls were selected, who met the selection criteria. A non-probabilistic sampling was carried out. The variables, use of inhaled corticosteroids, patients with community-acquired pneumonia, age, sex, malnutrition and smoking were included. The association measure was made using Pearson's non-parametric Chi Square test. The bivariate and multivariate analysis was performed using multiple logistic regression with statistical significance (p value <0.05). The study statistician was the Odds ratio (OR). Results: Through the multivariate analysis of the variables under study, no relationship was found between the use of inhaled corticosteroids and patients with community-acquired pneumonia (OR= 1.17; 95%CI: 0.48-2.99 and p value=0.737). It was observed that only age can be considered as a risk factor in view of its significance (OR=1.09; 95%CI: 1.06-1.12 and p value<0.001), while the variables sex, malnutrition, and smoking proved not to be significant ( p> 0.05). Conclusions: The use of inhaled corticosteroids is not a risk factor for community-acquired pneumonia in patients with Chronic Obstructive Pulmonary Disease.

Keywords: Chronic Obstructive Pulmonary Disease (COPD), corticosteroids, pneumonia. (source: MeSH NLM)

Antiseptics solutions for Prevention of surgical wound infection in appendectomized patients by complicated acute appendicitis

Arturo García Galicia — 2023-09-22

Surgical wound infection secondary to complicated acute appendicitis is frequent. The objective was to compare the Dakin and the Superoxidative solutions to prevent surgical wound infections in complicated acute appendicitis. It was a comparative, cross-sectional study, in 104 patients with complicated acute appendicitis (medium age 36.29 years, 69(66.43%) men). Group 1: 52 patients with surgical wound lavage with Dakin modified solution. Group 2: 52 patients with superoxidative solution (Microdacyn®). All patients received ceftriaxone 1 g before surgery; conventional appendectomy was performed and the wall closure with Vicryl 1 and Nylon 2/0. Surgical wound was evaluated 7 days after surgery, looking for pus, edema, erythema, local heat. X² and Student's t were used. Surgical wound infection was present in 11 (10.6%) patients, 3(5.8%) patients from group 1 and 8(15.4%) from group 2 (p=0.1). Both solutions are useful to prevent surgical wound infections in patients operated by complicated acute appendicitis.

First report of a Dengue outbreak in Balsas, Amazonas, Peru, during 2021 and 2022.

Lourdes Ramírez Orrego — 2023-09-20

Introduction: The increase in dengue cases in Amazonas is a risk to public health. In 2021, Balsas reported a dengue outbreak for the first time. Methodology: The population included patients who met the case definition between December 2021 and February 2022. Identification of serotypes will be reduced by multiplex qRT-PCR. Results: 72 patients were identified, of which 53 (74%) were confirmed by serology (Ag NS1). The predominant serotype was DENV-2 (94%), and 6% was DENV-1. Patients between 19 and 45 years old presented the highest percentage of cases (59%). The most frequent symptoms were fever, headache, myalgia and arthralgia; 23% presented severe abdominal pain. Conclusion: This was the first confirmed dengue outbreak in the Balsas district, with DENV-2 being the main cause of the outbreak, highlighting the need to improve surveillance in areas without autochthonous transmission of the disease.

Vulnerability of the sanitary infrastructure in relation to COVID-19 in the district of Castilla-Piura 2021-2022

Luis Fernando Chero Córdova — 2023-09-19

Objective: The relationship between the sanitary infrastructure, considering three aspects such as: equipment and supplies; built environments; humanization of care against COVID-19 in the district of Castilla - Piura in the year 2022. Methods: It adopts the Hermeneutic paradigm, with a cross-sectional, qualitative design, based on surveys applied to a statistical sample from the Castilla sector, unstructured interviews were conducted, aimed at health professional experts. Results: It is observed that 100% of the II and III level hospitals and health centers in Piura are in inadequate conditions to achieve efficiency and effectiveness in care, both in infrastructure-equipment, in built environment and humanized. Conclusion: The deficient state of health establishments has determined the increase in cases of COVID 19, during the pandemic, because they do not have adequate environments to treat different pathologies, as well as due to inadequate zoning of respiratory and vector isolation areas. , those that must respond to the reality of this Region; This situation raises the need to formulate a regional contingency plan, the same one that guarantees priority and quality care in emergency situations, as well as life during the pandemic.

Emotional intelligence and stress coping strategies in health personnel.

Roxana Traverso Zumaeta — 2023-09-14

Objective: To determine the relationship between emotional intelligence and stress coping strategies in health care workers of a Third Level of Care Hospital during 2021.

Methods: An analytical cross-sectional study was carried out. Two surveys were used: the COPE test which measures how to cope with stress and the Bar-On Emotional Coefficient Inventory which measures the level of emotional intelligence. The main variable was coping with stress. The independent variable was emotional intelligence.

Results: A total of 290 health care workers were worked. Emotional intelligence was significantly positively correlated (Pearson = 0.6003) with stress coping. The stress coping strategies with the highest mean were planning, positive reinterpretation and growth, and religious coping. These strategies had a positive correlation with emotional intelligence, these correlations were 0.5271, 0.5200 and 0.2051 respectively. For the multiple regression analysis, it was observed that the average BARON test score increased by 0.261 points for each point increase in the COPE TEST (coefficient = 0.261; 95%CI: 0.215 - 0.307); adjusted for all covariates of interest.

Conclusion: There is a relationship between emotional intelligence and stress coping. A relationship was also found with stress coping strategies.

Association between hematological parameters and metabolically unhealthy phenotypes in children and adolescents.

María del Socorro Romero Figueroa — 2023-09-22

Objective. Metabolic syndrome has been associated with changes in the composition of circulating blood cells. Hematologic indices can be used to identify the subjects at risk of metabolically unhealthy phenotype (MUP). This study investigated whether hematological indices can serve as biomarkers to distinguish metabolically healthy phenotype (MHP) from MUP in children and adolescents.

Methods. Two hundred ninety-two children and adolescents were enrolled in a cross-sectional study. The MUP was diagnosed using consensus-based criteria proposed by Damanhoury et al. Group comparisons were performed using one-way ANOVA. To examine if sex, age group, nutritional status, puberty, hematological parameters, and insulin resistance were associated with MUP, we used multiadjusted logistic regression analysis with metabolic status as the dependent variable.

Results. The subject's age mean was 11 years (SD: 2.61). RDW values were significantly lower in children with metabolically unhealthy normal weight (MUNW) compared to children with metabolically unhealthy obesity (MUO) (12.33 ± 0.90 vs. 13.67 ± 0.52; p = 0.01), and in metabolically healthy obesity (MHO) compared to MUO (13.15 ± 0.53 vs. 13.67 ± 0.52; p = 0.04). In adolescents, the PLR was higher for the MHNW group, with a mean value of 152.60 (SD 62.97) compared to 111.16 (SD 44.12) for the MHO group. After adjusting for age, nutritional status, and puberty, hematological indices were not associated with MUP.

Conclusions. The study demonstrates that hematological indices are not independently associated with the metabolically unhealthy phenotype. Hematologic indices are unlikely to represent reliable biomarkers of MU phenotype in the pediatric population.

Functionality before and after physiotherapy in post COVID-19 patients

Margarita López Siete — 2023-09-22

Background: COVID-19 is a disease that since its appearance in 2019 has represented a challenge for health services. The sequelae are a consequence of a deterioration in the quality of life, fatigue, dyspnea and joint pain. Objective: Compare physical, respiratory, cognitive and functional independence functional parameters in post-COVID-19 patients, with respiratory sequelae before and after a respiratory physical and occupational therapy program. Methods: A comparative, quasi-experimental, prospective study was conducted in outpatients discharged from hospitalization due to COVID-19 in a 3rd level hospital of the Instituto Mexicano del Seguro Social in Puebla, Mexico during 2020-2021. Scales were applied before and after the rehabilitation program. Descriptive statistics were used. Results: We included 116 patients, 57.7% men, mean age 47.32 years (min. 20, max. 79); 77 (66.3%) patients had moderate symptoms in hospitalization. A significant p value was obtained (p <0.000) Conclusions: Significant improvement is observed in post-COVID-19 patients after receiving respiratory physical and occupational therapy.

Effect of Tropaeolum Tuberosum "Mashua" (Tropaeolaceae) on gene expression related to spermatogenesis in mouse

José Gonzales-Daga — 2023-09-18

Introducción: Tropaeolum tuberosum, conocido como mashua, es un tubérculo andino que tiene un valor tanto económico como nutritivo para las poblaciones de pocos recursos. Se cree que afecta la fertilidad masculina, porque los hombres andinos lo relacionan con impotencia y disminución de la capacidad fecundante. Estudios hechos en ratas que se alimentaron con mashua demostraron que hubo un 45% de decrecimiento de la tasa testosterona/dihidrotestosterona. El efecto de esta planta en la reproducción está relacionada a su contenido de isotiocianatos, compuestos que se unen covalentemente a las proteínas, las cuales pueden estar directa o indirectamente involucradas en el proceso espermatogénico. El propósito de esta investigación fue evaluar el efecto del extracto acuoso de la mashua sobre la espermatogénesis y la fisiología reproductiva de ratones. Metodología: Se evaluaron los parámetros morfofuncionales in vivo de espermios de ratones (espermatograma) y se cuantificó la expresión de: Cytochrome P450 17α-hydroxylase/17,20-lyase, proteína reguladora de esteroidogenesis aguda, ciclina y protamina, relacionados a la espermatogénesis. Resultados: A los 7, 14 y 21 días de dosificación, se vio afectado el conteo de espermatozoides, así como su motilidad progresiva (MP); por otra parte, se observó un retardo en la maduración de los mismos. En cuanto a la expresión génica, no se encontró diferencias significativas entre la expresión de los dos genes estudiados (cytochrome P450 17α-hydroxylase/17,20-lyase, ciclina), Conclusión: El efecto de la mashua no se da a nivel de la expresión de los genes involucrados en la espermatogénesis, sino a nivel de sus funciones como proteína.

Assessment of Mycobacterium Tuberculosis drug-resistance patterns in a public hospital of Lima, Peru during 2022

Jorge Roberto Mosqueira Sanchez — 2023-09-22

Background. Tuberculosis is a public health problem considered to be the world's leading cause of death from an infectious disease among adults. Diagnosis is often challenging and is based on clinical, epidemiological, radiological, bacteriological, histological and biochemical findings. Timely diagnosis, identification of the susceptibility profile and follow-up compliance is important to enable more effective treatment and avoid severe forms of the disease.

Aim. Describe the resistance patterns of Mycobacterium tuberculosis identified in the period of the year 2022 at Hospital María Auxiliadora.

Material and Methods. This is an observational, cross-sectional study of patients diagnosed with tuberculosis throughout the year 2022 in the Tuberculosis Center of Excellence (TB COE), division of the respiratory medicine department at the Hospital Maria Auxiliadora, Lima, Peru. Data was collected from the medical records which was then included for the statistical analysis. The clinical and demographic characteristics were described by absolute frequencies and percentages. Chi-square test and Fisher's exact test were used to evaluate the association between the sensitivity profile of tuberculosis and the independent variables. A p-value < 0.05 was considered as statistically significant.

Results. A total of 261 medical records were included in the present study. The most frequent age group was 17-59 years old, the majority were male (62.1%) and 15.7% were relapses, as established on national technical standard. Of the total, 89.7% were sensitive to first line drugs; 6.1% of the patients were multidrug-resistant (MDR), and 0.8% presented extensively drug-resistance (XDR); likewise, 0.8% and 2.7% presented resistance for rifampicin only and resistance for isoniazid only respectively. HIV infection was found at 14.2%. The most common form of tuberculosis was pulmonary (49%) followed by pleural tuberculosis (21.8%).

Conclusion. Tuberculosis is a worldwide condition whose drug-resistance patterns continue evolving. However, in our hospital, a southern Peru reference Center, most TB patients are still sensitive to first line drugs. Only a small amount of MDR and XDR patients were found. Moreover, the most common clinical presentation was pulmonary followed by pleural tuberculosis.

Leadership styles and job performance in medical professionals at hospital Vitarte – Lima, 2018

José Luis Bedriñana Sotomayor — 2023-09-14

Objective: To determine the relationship between leadership styles and work performance of the medical staff of Hospital Vitarte Lima, 2018. Methods: Descriptive, correlational and cross-sectional study. A non-probabilistic purposive sampling was done by selecting 64 workers. And data collection was done through a previously validated questionnaire and internal consistency by Cronbach's alpha. Results: The descriptive statistics determined a 50 % in the Democratic Leadership Style of the dimensions and a level higher than 60 % for Job Performance, the inferential statistics through the Hypothesis Test by Spearman's correlation coefficient (rho = 0.85) showed a high positive correlation in both variables. Conclusion: There is a positive correlation between the dimensions Democratic Leadership Style and work performance, so it is recommended the creation of quality improvement projects and training for workers.

Frequency of the symptoms of Polycystic Ovary Syndrome and Premenstrual Syndrome, related to academic stress in medical students of a private university in Peru

Diana Carolina Pantigoso Suárez — 2023-09-14

Introduction: Polycystic ovary syndrome (PCOS) and premenstrual syndrome (PMS) are prevalent. Objective: to determine the frequency of the symptoms of polycystic ovary syndrome and premenstrual syndrome and its relationship with stress in medical students. Material and methods: Cross-sectional analytical study. The study population was 322 medical students from the 1st to the 12th cycle, chosen by convenience from a private university in Trujillo. Through a google form, the "SPM" questionnaire, "the SISCO inventory of academic stress", and "the questionnaire on polycystic ovary" were applied; prior informed knowledge, it had the approval of the Bioethics Committee of the university. Results: The SOP presented a high probability of 5.28%, medium of 46.58% and low of 48.13%.The frequency of PMS in the levels, mild, moderate and high were 47.52%, 25.47% and 4 0.04% respectively. The levels of stress were: mild, moderate and deep 4.35%, 65.22% and 30.43%, respectively. A highly significant association was found between stress and SPM; stress and PCOS; p = 0.000915106 and p= 1.8589E-25 respectively Conclusions: The frequency of PMS, the high probability of PCOS and the levels of stress were high and there is a significant association between stress, PMS and PCOS.

Keywords: Polycystic ovary syndrome, Premenstrual syndrome, stress, medical students (MESH).

Characterization of diet in Biochemical and anthropometric profiles whit the analysis of main components in obese patients, Guayaquil – Ecuador

Yuliana Yessy Gomez Rutti — 2023-09-15

Objectives: Determine the characterization of the diet in biochemical and anthropometric profiles with the analysis of the principal components in obese Ecuadorian patients. Methods: Descriptive, comparative, longitudinal studies; we had access to the institutional health clinical history database and a study group was formed, they were offered a low-carbohydrate diet. The sample consisted of 110 obese patients from the Hospital of Guayaquil-Ecuador. Results: The patients were between the ages of 25 to 65 years. The results showed a significant loss of BMI (kg/m²) (Δ-2,6±1.9) (p<0,001), waist circumference (cm) (Δ-5,1±4,7) (p<0,001), body fat (%) (Δ-3,6±3,6) (p<0,001), triglycerides (mg/dL) (Δ-25,4±72,9) (p<0,001) and glucose (mg/dL) (Δ-6,8±9,6) (p<0,001). Conclusion: The low carbohydrate diet reduces BMI, waist circumference, body fat, triglycerides and glucose in obese patients.

Risk factors associated with prolonged hospital stay in Neonatal Intensive Care: a case-control study.

Gladys Edith Victorio Arribasplata — 2023-09-22

Objective: Identify neonatal pathologies or conditions that influence the prolongation of hospital stay in a Neonatal Intensive Care Unit (NICU).

Materials and methods: An observational, retrospective, case-control study was carried out; in neonates hospitalized in the NICU, during the period 2015-2019, considering their perinatal and postnatal diagnoses as factors to be evaluated, as well as hospital stay. Two groups were divided: cases (prolonged stay) and controls (non-prolonged stay). The collected data were processed in the SPSS v.23 program, obtaining the OR and the Binary Logistic Regression.

Results: 361 neonates (91 cases and 270 controls) were included, finding significance in perinatal factors (p<0.05): Birth weight (1000g to <1500g, ORa 8.2: CI3.1 - 21.2) and gestational age (28 to 31 weeks , ORa 18.6: CI4.8-71.4; 32-33 weeks, ORa 8.1: CI3.5 – 18.4); and postnatal factors (p<0.05): RDS (ORa 10.3: CI 4.8-22.2), PHT (OR 32.2: CI 1.8-559.0), sepsis (ORa 7.1: CI 3.1-16.0), Neonatal malnutrition (ORa 10.2: CI 4.7 -22.1) and anemia of prematurity (aOR 8.3: CI 2.4-28.1). The following did not reach significance: asphyxia, transient tachypnea of the newborn, pneumonia, pneumothorax, bronchopulmonary dysplasia, meconium aspiration syndrome, patent ductus arteriosus, congenital heart disease, hyperbilirubinemia, hypoglycemia, necrotizing enterocolitis, and apnea of prematurity.

Conclusions: Birth weight, gestational age, RDS, PHPT, sepsis, neonatal malnutrition and anemia of prematurity are risk factors for prolonged hospital stay.

Cytogenetic findings and maternal age in patients with Down syndrome in a pediatric referral hospital from Peru

Yesica Llimpe Mitma de Barrón — 2023-09-20

Introduction: Down syndrome is a congenital disorder caused by a total or partial trisomy of chromosome 21 and is considered the most common genetic cause of congenital malformations and intellectual disability. The objective of this study was to describe the cytogenetic alterations of patients with Down syndrome and their relationship with maternal age.

Methods: Cross-sectional, descriptive-analytical study. 436 patients with Down syndrome admitted to the Instituto Nacional de Salud del Niño during the 2017-2019 period were included. The variables analyzed were: cytogenetic diagnosis and maternal age.

Results: It was found that 99,3% (n=433) of patients presented some type of cytogenetic alteration and three patients presented a normal karyotype. The age of the patients at the time of sampling was between 0,03 and 17 years, the male/female ratio was 1.2:1. The most frequent cytogenetic alteration was free trisomy 21 (94,7%), followed by Robertsonian translocation (n=16) and mosaicism (n=6). In the case of maternal age, a median of 37 years was found (range: 13-47).

Conclusions: Free trisomy 21 is the most common cytogenetic condition in Down syndrome; however, the Robertsonian translocation and mosaicisms were more frequent in patients whose mothers were les than 35 years old, suggesting that there are other risk factors than advanced maternal age in this group.

Keywords: Down syndrome, cytogenetic analysis, maternal age, pediatrics.

Vaginal estrogen therapy and the risk of recurrence in women with a history of breast cancer

María Alejandra Boada Fuentes — 2023-09-20

Breast cancer remains the most common malignant neoplasm and one of the leading causes of mortality in women, making it a significant target for global health efforts and a public health priority. Through the use of innovative therapies, survival rates have improved, leading to the emergence of associated conditions such as genitourinary menopausal syndrome. Hormonal therapy is employed for managing this condition, significantly alleviating its symptoms and, in some cases, serving as the sole solution. The most commonly utilized approach is vaginal estrogen therapy. Nevertheless, there have been reports of a potential risk of breast cancer recurrence associated with its use. In the Spanish-speaking context, there is limited evidence discussing this topic. A search was conducted across PubMed, ScienceDirect, and MEDLINE databases, using the terms "Vaginal Estrogen Therapy," "Recurrence," and "Breast Cancer." It was determined that, on a global scale, vaginal estrogen therapy is an effective and safe therapeutic option for managing genitourinary menopausal syndrome in women with a history of breast cancer. This therapy does not appear to increase the risk of recurrence, with the exception of those undergoing treatment with aromatase inhibitors. For these individuals, alternative therapies are recommended to mitigate this potential risk.

The difficult pathway of natriuretic peptides in heart failure

Omar Augusto Diaz Cucho — 2023-09-18

This review is carried out on the role of natriuretic peptides and attempts to use them properly, as a treatment, their functioning in the pathophysiology of heart failure with depressed systolic function was better understood. It is recounts its journey through multiple failed studies, explaining the reasons for its failures, until it achieved the desired success with the combination of sacubitril/valsartan. This produced a paradigm shift in the management of heart failure.

Oral health practices during first 1000 days of life: Literature review

Kamila Sihuay-Torres — 2023-09-18

Objective: To review the updated narrative literature on good oral health practices during the first 1000 days of life, that is, from gestation to two years of age. Materials and methods: A literature search was carried out in Pubmed and Scopus databases on february and march 2022. Original articles, and systematic reviews with or without meta-analysis, from 2016 to 2022 were included. For this purpose, search strategies were used with keywords in English taken from MeSH, such as: "prenatal care" AND ("dentistry" OR "oral health") / ("Pregnancy" OR "Infant") AND ("Oral Hygiene" OR "Toothbrushing" OR "Toothpaste") / (“Pregnancy” OR “Infant”) AND (“Prenatal nutrition” OR “Child Nutrition” OR "Breast feeding") / (“Pregnancy” OR “Infant”) AND “sugar intake” / “Infant” AND ("sucking behavior" OR "Nail biting") AND "dental occlusion" / (“Pregnancy” OR “Infant”) AND ("dental care" OR “Pediatric dentistry”). Results: Using the search criteria, 72 articles were selected to describe good oral health practices during the first 1000 days. This was divided into good oral hygiene practices, good dietary practices, parafunctional habits, and visits to the dentist. Conclusion: For good oral health during the first 1000 days of life, brush your baby's teeth with fluoride toothpaste from the first tooth eruption, avoid the consumption of free sugars, encourage breastfeeding instead of bottle-feeding, and visit the dentist since the pregnancy.

Medical vocation, beyond the duty of care: a review of literature from ethical and philosophical perspectives

Ricardo Jonathan Ayala Garcia — 2023-09-22

This review article explores medical vocation as a phenomenon that extends beyond the mere duty of caring for patients, focusing on the significance of ethical commitment, empathy, and resilience in medical practice. The implications for medical training and clinical practice are discussed.