Revista de la Facultad de Medicina Humana

Near-Fatal Asthma: Case Report in the Emergency Department of Hospital Santa Rosa

William Rojas Pérez — 2024-06-28

Introduction: Asthma, classically, is defined as a chronic inflammatory disease of the airways; characterized by a history of respiratory symptoms, such as wheezing, shortness of breath, chest tightness, and cough, that vary over time and in intensity. Near-fatal asthma are situations in which asthma exacerbations can lead to cardiorespiratory arrest, orotracheal intubation and mechanical ventilation, admission to an intensive care unit (ICU); Knowing the characteristics and risk factors that predict this situation in a patient who arrives at the emergency room is very important for early action. Clinical case: We present a 23-year-old patient with a history of asthma since he was 5 years old and irregular treatment; with a stay in the ICU and on mechanical ventilation for almost fatal asthma 8 months before; the clinical signs and the arterial blood gas analysis predicted an almost fatal asthma condition, which is why it was decided to intubate and mechanically ventilate the patient, and then transfer to the ICU with a favorable evolution and discharge 9 days after admission. Conclusion: Patient who already had a previous admission for almost fatal asthma and admission to the ICU, persistence of desaturation in the face of rescue treatment for said pathology; determining factors for deciding rapid sequence orotracheal intubation and transfer to the intensive care unit; with remission of the admission clinical picture and prompt discharge of the patient.

Heart Failure with Recovered Left Ventricle Ejection Fraction. Case Report

Omar Augusto Diaz Cucho — 2024-06-28

Heart failure with recovered ejection fraction is defined as the improvement of left ventricular systolic function (LVEF) to values ≥ 40%, after having presented a reduced LVEF (< 40%) at a previous time and ≥10% absolute improvement in LVEF. It is a chronic and dynamic condition with a high risk of relapse and deterioration, so close monitoring and optimal medical therapy are essential for its management. A case is presented of a young male patient with dilated cardiomyopathy with severe left ventricular systolic dysfunction, who with neurohormonal therapy for heart failure, showed rapid clinical recovery and improvement of ejection fraction and left ventricular remodeling. Further studies are needed to better understand this condition and its long-term treatment.

Surgical therapy in duodenal-jejunal hemorrhagic diverticula, case report and bibliographic review.

Williams Trinidad Rodríguez — 2024-06-28

Summary:

Introduction: Diverticula are intestinal saccular dilations; They can be classified as false or true, congenital or acquired. Complications can be serious, bleeding is the most characteristic sign.

Case report: Female, 68 years old, the condition began with upper digestive bleeding, endoscopic studies did not show any bleeding site; intestinal transit reported 2 duodenal diverticula. Due to multiple transfusions and hospitalizations, surgery was scheduled. Two duodenal diverticula and multiple diverticula were found in the jejunum. Duodenal diverticulectomies and segmental resection of the jejunum with entero-entero anastomosis were performed. During the post-surgery period she presented intestinal fistula, which was resolved with mixed nutrition.

Discussion: Intestinal transit revealed diverticula as a probable cause of bleeding. Since there were no minimally invasive options as determined by the guidelines, less morbid surgical treatment was provided.

Conclusions: In the absence of endoscopic or endovascular options, surgical intervention is a viable option; however, each case must be individualized to offer the lowest morbidity and mortality rate.

Kaposi's Sarcoma and Bartonella Coinfection in HIV-Positive Patient

Roger Antonio Sernaque Mechato — 2024-06-28

Introduction: Kaposi's sarcoma is a multifocal malignant neoplasm of endothelial cells, its etiological agent is HHV-8 and it constitutes one of the defining pathologies of AIDS. It represents approximately 12% of cancers diagnosed in people living with HIV. Bacillary angiomatosis (AB) is a rare infectious disease caused by bacteria of the genus Bartonella spp., transmitted by vectors such as fleas, lice, and mosquitoes. In patients with human immunodeficiency virus (HIV) infection with a CD4+ T-cell count <100 cells/µL, it is associated with angiomatous lesions with neovascularization that involve the skin and, to a lesser extent, mucous membranes, liver, spleen, and bones.

Clinical case: the case of a 48-year-old male patient with a history of HIV on HAART for 15 years, who was admitted for an outpatient infectious disease clinic due to violaceous nodular lesions in the right and left MMII, upper eyelid. left and oropharynx. During hospitalization, a blood culture report was obtained that was positive for Bartonella and a biopsy result of a lower limb lesion concluded that Kaposi's Sarcoma was present. Upper gastrointestinal endoscopy and chest and abdominal tomography were performed, which showed the visceral and systemic involvement of Kaposi's Sarcoma. The HIV genotype is performed, resulting in resistance to antiretrovirals, so the medication is changed and chemotherapy is started, with the patient showing a good response and improvement.

Conclusion:

HIV-related Kaposi's Sarcoma affects AIDS patients in a much more severe, aggressive, and fulminant manner compared to other immunodeficient groups. However, when presenting characteristic lesions, we must consider its main differential diagnosis: Bacillary Angiomatosis, which, even very uncommonly, may occur simultaneously.

KEYWORDS:

Kaposi sarcoma, HIV, AIDS, Bacillary angiomatosis. (Source: MeSH – NLM)

Acute Benign Childhood Myositis Due to Bartonella henselae: A Rare Pathogen

José Paz-Vargas — 2024-06-28

Acute benign myositis of childhood (ABIM) is an inflammatory pathology of the musculoskeletal system, it usually manifests with pain in the lower limbs associated with elevation of creatine phosphokinase (CPK). It is a rare condition, but if it occurs, it appears after a flu case, frequently associated with influenza A and B viruses. The case of a school-age girl with myalgia in lower limbs, fever and elevated CPK, diagnosed with MABI, with positive IgG to Bartonella henselae. It is considered important to report the case due to the little information available about this disease both in the country and in Latin America, in addition, to review the issue since there are no previous reports in Peru about Bartonella henselae as the etiological agent of MABI; Likewise, discuss management and how to reduce unnecessary hospitalizations.

Weight Stigma and Its Association With Nutritional Status in Students of Health Careers in a Private University in the Region of Ñuble, Chile

Pia Rojas — 2024-06-28

Introduction: Obesity and overweight constitute global public health challenges, negatively impacting more than one billion people. They are accompanied by significant psychological and social consequences, including the stigma associated with weight, with severe repercussions on mental and physical well-being. Health professionals are directly involved with this problem; however, few studies address weight stigma in Chile. Objective: To relate nutritional status (BMI) and the level of weight stigma in university students of health careers in the region of Ñuble, Chile. Methodology: Observational design of correlational and cross-sectional scope. The GAMS-27 scale was applied to assess weight stigma and BMI to evaluate the nutritional status of 156 students of health careers. Chi2 tests of independence and binary logistic regression were applied to evaluate the association between the variables, with the R statistical package version 4.3.0. Results: A statistically significant association was found between weight stigma and nutritional status (p=0.0145). Presenting normal BMI (p=0.0163) and being female (p=0.0156) were associated with a higher probability of presenting weight bias. Conclusions: The present study identified a statistically significant association between weight stigma and nutritional status in college students. It is vital to promote education regarding weight stigma in college students to avoid bias and improve respect for future users.

Kinetics of the Release of Platelet-Derived Growth Factor (PDGF-BB) Derived from Human Umbilical Cord

Pedro Alberto Aro Guardia — 2024-06-28

Introduction: The use of cord blood (UC) offers numerous advantages in regenerative medicine. Platelet-rich plasma (PRP) is a source of growth factors where its dynamics over time have been evaluated in peripheral blood; however, its evaluation in UC blood has not been studied. Objective: To evaluate the kinetics of PDGF-BB release from PRP obtained from UC blood. Materials and methods: In vitro experimental study. UC blood samples were collected from 6 term deliveries of healthy pregnant women between 18 and 36 years of age who attended the Cayetano Heredia Hospital in Lima-Peru. The samples obtained were centrifuged at 900 g for 10 minutes to prepare the PRP. Activation was performed with 10% calcium gluconate (GLu.Ca) and divided into 4 aliquots: (i) without activator; (ii) 1 hour; (iii) 24 hours; (iv) 48 hours. PDGF-BB quantification was evaluated by ELISA method. Results: The mean ± standard deviation of PDGF-BB concentration measured at 1 hour, 24 hours and 48 hours were 6127.9 ± 101.6, 6197.5 ± 34 and 6176.8 ± 63.3 respectively. The kinetics of PDGF-BB released by PRP showed constant values during the 48 hours. Conclusions: PDGF-BB release from PRP obtained from UC blood was rapidly induced and remained constant and sustained during the first 48 hours after activation.

Stress Level and the Use of Coping Strategies of Parents of Autistic Children

Lorela La Torre Atusparia — 2024-06-28

Introduction: Obesity and overweight constitute global public health challenges, negatively impacting more than one billion people. They are accompanied by significant psychological and social consequences, notably weight stigma, which has severe repercussions on mental and physical well-being. Health professionals are directly involved with this issue; however, few studies address weight stigma in Chile. Objective: To examine the association between nutritional status (BMI) and the level of weight stigma in university students from health-related fields in the Ñuble region, Chile. Methodology: A cross-sectional descriptive observational design was used. The GAMS-27 scale was applied to evaluate weight stigma, and BMI was used to assess the nutritional status of 156 health career students. Chi-square independence tests and binary logistic regression were applied to evaluate the association between variables, using R version 4.3.0 statistical software. Results: A statistically significant association was found between weight stigma and nutritional status (p=0.0145). Having a normal BMI (p=0.0163) and being female (p=0.0156) were associated with a higher likelihood of presenting weight bias. Conclusions: This study identified a statistically significant association between weight stigma and nutritional status in university students. It is vital to promote education regarding weight stigma among university students to prevent prejudice and enhance respect towards future users.

Cervical Cancer During the COVID-19 Pandemic in Rural Communities of Ayacucho

Lucy Orellana de Piscoya — 2024-06-28

Introduction: Due to the COVID-19 pandemic, vulnerable rural women faced significant challenges.

Objective: To explore the situation of cervical cancer during the pandemic from an intercultural perspective among rural women in Ayacucho in 2021.

Methodology: Mixed-method research with a concurrent triangulation design. Sample: Healthcare providers and rural women. Purposeful and reasoned sampling. Techniques: Surveys, in-depth interviews. Data analysis: Data systematization using Excel, SPSS for quantitative data, and Atlas.ti for qualitative data. Level of validity and confidence: triangulation.
Results: Information from surveys and interviews was contrasted, revealing that the problem may have alternative solutions within the knowledge of the same communities.
Conclusion: Women reported lack of awareness, insufficient information in the Quechua language, and undervaluation of their traditional knowledge. Fear and contagion concerns prevented them from seeking healthcare services. Services were reduced, redirected, or discontinued, often due to budget constraints.

Effect of Averrhoa carambola L. on the Skin in an Animal Model of Hypertrophic Scarring

Alberto Córdova-Aguilar — 2024-06-28

Introduction: Hypertrophic scarring in the skin represents a serious global public health problem, as it physically and emotionally affects people who suffer from it. This makes it necessary to investigate new alternatives for its prevention and treatment. The objective of the study was to compare the effect of Averrhoa carambola L. (star fruit) on the skin under an animal model of hypertrophic healing. Methods: Experimental study; 10 male New Zealand breed rabbits were used, between 3 and 4 months old, with an average weight of 3 to 3.5Kg. The creation of hypertrophic scars in the ears of rabbits was induced under the model described by Morris et al. One of the groups received 1 mL of a 10% aqueous solution of the lyophilized star fruit, while the other received 1 mL of triamcinolone acetate; in both groups the application was intralesional and weekly in a month. After the treatment, under sedation, only the hypertrophic scars were extracted using a biopsy punch and the tissues were preserved in 10% formalin for subsequent pathological examination. Results: The group that received star fruit solution significantly improved the dermis and epidermis in the hypertrophic scars on the ears of rabbits that received treatment. When compared with the group that received triamcinolone acetonide, there were no statistically significant differences. Conclusion: The lyophilized aqueous extract of star fruit at 10% demonstrated a similar effect compare to triamcinolone acetonide (treatment of choice) in reducing the fibrosis of hypertrophic scars in the ears of rabbits.

Keywords: Averrhoa carambola L., triamcinolone, hypertrophic scar, animal models. (MeSH/NLM)

Self-medication in students of the medical school of a university in northern Peru 2023

Olivia Santamaría Veliz — 2024-06-28

Objective: Describe self-medication and its relationship with sociodemographic characteristics in students of the medical school of a university in northern Peru 2023. Methodology: An observational, cross-sectional and prospective design was used with 301 participants, using the CAuM-ovr questionnaire to collect data. Results: 83.4% of the students self-medicated. The bivariate analysis revealed that belonging to medical school significantly increased the probability of self-medication (p=0.0001, OR=26.4), as did having a salary greater than 1,500 soles (p=0.01, OR= 2,26). The main reasons included symptoms not considered serious enough to see a doctor (39%). Regarding the level of knowledge, a high percentage (94.8%) did not request information about medications and 94% believed in the influence of advertising on their purchasing decisions. Attitudinally, 60.6% occasionally consulted a specialist for health problems, while 58.6% bought medications recommended by advertising. Conclusion: The frequency of self-medication is high among these students, which indicates a continuous risk practice despite their health training.

Key words: Self Medication; Students; Schools Medical; Attitudes; Knowledge. (source: MeSH NLM)

Association Between Informal Employment and Positive COVID-19 Cases in Peru

Miguel Cabanillas — 2024-06-28

Objetivos: Identificar la asociación entre el número de empleados informales y el número de casos positivos de COVID-19 en el Perú.

Métodos: Se utilizaron datos del Instituto Nacional de Estadística e Informática del Perú y de la Base de Datos Nacional de COVID-19. Se realizó una regresión lineal bivariada y multivariada para evaluar el número de empleados informales, la densidad de la población y la altitud en relación con el número de casos positivos de COVID-19.

Resultados: El análisis bivariado mostró que el número de empleados informales estuvo significativamente asociado con los casos positivos en regiones de alta y baja altitud (p<0.001). En cuanto al análisis multivariado, se encontró que los empleados informales (p<0.001), la densidad poblacional (p=0.02) y la altitud (p<0.001) estuvieron asociados con el número de casos positivos de COVID-19.

Conclusiones: Los empleados informales son comunes en países de bajos y medianos ingresos en donde no se cuenta con seguridad social y dependen económicamente del salario diario. Su situación empeoró debido a la restricción de la movilización social, por lo que fueron obligados a seguir trabajando y, en consecuencia, infectarse rápidamente, más aún, convirtiéndose en un foco de contagio.

Descripción de los factores genéticos asociados a la conducta suicida y suicidio: una revisión de tema

Sandra Constanza-Cañón — 2024-06-28

Introducción: El suicidio y las conductas suicidas (CS) son un fenómeno complejo y multideterminado en el que interactúan diferentes factores genéticos, ambientales e individuales. El objetivo de este estudio fue realizar una revisión de los factores genéticos asociados a la conducta suicida descritos en la literatura de los últimos 10 años. Métodos: Se realizó una búsqueda de todos los artículos disponibles tanto artículos de revisión, como reportes de caso y guías de manejo bajo los descriptores en ciencias de la salud (DeCS) Conducta suicida, suicidio, depresión, exoma, marcadores genéticos, variación genética, genoma humano, serotonina, norepinefrina, dopamina, biología computacionalen las bases de Google scholar, LILACS, PubMed y ClinicalKe, se consultaron sitios web oficiales como los de Organización Mundial de la Salud (OMS) y Ministerio de Salud y Protección Social de Colombia. Desarrollo: Los estudios genéticos de las CS, llevan décadas intentando encontrar el “gen del suicidio”, con el fin de identificar de manera prematura aquellas personas con mayor riesgo de realizar intentos suicidas y prevenir que se conviertan en víctimas; sin embargo, estos estudios fallaron en encontrar un gen o grupo de éstos que diferenciara entre sujetos suicidas y no suicidas. A este tipo de tecnología surgieron los estudios de asociación del genoma completo (GWAS), con los cuales algunos autores quisieron demostrar las diferencias del genoma de pacientes con ideas suicidas. Conclusiones: El conocimiento de los factores genéticos implicados puede llevar a que sea posible identificar los individuos con mayor riesgo de desarrollar comportamiento suicida, de esta forma tener mejores herramientas y recibir una visión más mecanicista para explorar la red intermolecular subyacente y prevenir las muertes por esta causa.

Investigación global sobre uso de inteligencia artificial en imagenología para la detección de cáncer de mama: análisis bibliométrico

Juan Guillermo Murillo León — 2024-06-28

Introducción: El cáncer de mama sigue siendo uno de los cánceres más frecuentes a nivel global, específicamente, el más frecuente en el sexo femenino. El uso de inteligencia artificial promete contribuir al diagnóstico precoz, a través de la imagenología. Previamente, no se ha descrito el panorama y avance de esta producción científica.

Métodos: Estudio bibliométrico de corte transversal, que usó Scopus como fuente de datos. Se utilizó el paquete bibliometrix de R para el cálculo de indicadores bibliométricos y visualización de los resultados.

Resultados: Se seleccionaron 1292 documentos, publicados entre 1989 y 2024. El 75,3% (n=973) fueron artículos con datos primarios, seguido de un 16,2% (n=209) correspondiente a revisiones. Se identificó una colaboración internacional del 26,5%, y un crecimiento anual de la producción del 10,78%. Se observó que, la clasificación de riesgo por screening, tomosíntesis digital de la mama, aprendizaje por transferencia, segmentación y selección por características, son las palabras clave más comúnmente usadas. En los últimos cinco años, el aprendizaje profundo y la mamografía, han sido los temas con mayor popularidad. La colaboración internacional, ha sido liderada por Estados Unidos, China y Reino Unido.

Conclusiones: Se identificó un crecimiento notable en la investigación global sobre el uso de inteligencia artificial en imagenología para la detección de cáncer de mama, marcado a partir de la década del 2010, esencialmente por medio de publicación de artículos con datos primarios. La relación entre inteligencia artificial e imagenología para diagnóstico de cáncer de mama, se ha centrado en riesgo y predicción.

Diuréticos tiazídicos para aumentar la diuresis en pacientes con falla cardiaca: ¿qué tan seguro es?

Jorge Andres Almanza Romero — 2024-06-28

Las enfermedades cardiovasculares, siguen siendo la principal causa de morbilidad, mortalidad y carga de enfermedad en el mundo. La falla cardiaca, es uno de los fenotipos de enfermedad cardiovascular más prevalentes del mundo, describiéndose más de 60 millones de casos a nivel global. Puntualmente, los diuréticos tiazídicos son un grupo farmacológico importante y de común uso, para la sobrecarga de volumen en el manejo de la falla cardiaca, así como de la hipertensión arterial. Sin embargo, muy recientemente, evidencia novedosa, resalta la presencia de un evento adverso importante en el uso de los diuréticos tiazídicos para el manejo de la falla cardiaca, sobre todo de tipo descompensada. El objetivo de esta revisión consiste en analizar la evolución de la evidencia sobre la seguridad y eficacia de los diuréticos tiazídicos en el abordaje de la falla cardiaca. Se ejecutó una búsqueda bibliográfica en los motores de búsqueda y bases de datos bases de datos PubMed, ScienceDirect, Embase, EBSCO y MEDLINE hasta 2024. Se identificó que, aunque la evidencia es escasa y limitada, existe una tendencia sobre la eficacia del uso de tiazídicos para la disminución de la sobrecarga hídrica, medido esencialmente por la pérdida de peso a corto plazo, comparado al uso de diuréticos de asa como monoterapia. Sin embargo y, a pesar que las alteraciones metabólicas e hidroelectrolíticas suelen ser las más frecuentemente reportadas y temidas, se ha encontrado que, la alteración de la función renal podría ser el evento más relevante presentado con el uso de tiazídicos.

Is It Enough to Know That Tobacco Consumption Is Associated With Gastric Cancer?

Oscar Gregory Meza Gamboa — 2024-06-28

I sincerely appreciate the publication of the article on the prevention of gastric cancer in patients from Lima, Peru. It is encouraging to see research that addresses crucial issues for public health, especially in our national context.

Gastric cancer remains a global concern, with significant incidence and mortality, and tobacco consumption emerges as one of the most important risk factors after Helicobacter pylori infection.

In Peru, the situation is no different. Despite efforts to combat this disease, the incidence and mortality from gastric cancer remain worryingly high. Recent data show that gastric cancer accounts for a considerable proportion of cancer deaths in our country.

It is essential that gastric cancer prevention is prioritized, focusing on raising awareness about the risks of smoking and promoting healthy lifestyles. This requires not only financial resources, but also a coordinated and committed approach by health authorities and society as a whole.

I hope this letter serves as a call to action to more effectively address gastric cancer prevention in Peru.

The Thin Line of Relationship Between Intimate Partner Violence and Depression

Romina Pinedo Linasca — 2024-06-28

La violencia de pareja y la depresión son problemas graves y generalizados en todo el mundo. Según un análisis de los datos sobre su prevalencia en 161 países entre 2000 y 2018, por la OMS, una de cada tres mujeres ha sufrido violencia física y/o sexual por su pareja o violencia sexual por alguien que no era su pareja, o ambas. En el Pacífico Occidental hay un 20% de prevalencia y un 22% en la Región de Europa y países de ingresos elevados ^(1).

En nuestro país, según los resultados de Endes 2018, 63,2 % de las mujeres de 15 a 49 años fueron víctimas de violencia familiar alguna vez en su vida por parte del esposo o compañero. De acuerdo con el tipo de violencia ejercida, el 30,7 % de las víctimas sufrió violencia física, 58,9 %, psicológica o verbal y el 6,8 %, violencia sexual

Environment, Policies, and Addictions to Social Networks Among University Students

Alvaro Valdez Roca — 2024-06-28

The two main topics were essentially addressed. Firstly, and of great concern in the university setting, is related to addictive behaviors in the use of social media by students. Secondly, less explored in the country, is the various policies being implemented to address this phenomenon.

Drug dependence and suicide, a growing problem

Hector Leon Soto — 2024-06-28

Both nationally and internationally, drug dependence and suicide are problems with a high prevalence rate and in recent years have had an upward trend, bringing with them multiple social and health consequences. The relationship between drug dependence and suicide is statistically significant, with drug-dependent patients having a risk up to six times higher of attempting suicide compared to the general population. Therefore, it is important to know the risk factors associated with suicidal behavior in drug-dependent patients, in order to improve the prevention, treatment and prognosis of both problems. Although it is true that many of the risk factors associated with suicidal behavior are already known, these factors in the context of drug-dependent patients are still a subject that has not been investigated as much, and particularly at the national level, the variability of the factors according to the different regions, multiculturalism, socioeconomic strata, etc., are not taken into account. Therefore, it is recommended to increase the research budget, emphasizing on the variables and populations already mentioned, in order to have better qualified health personnel in the problem in question.

Ácido úrico y enfermedades neurodegenerativas: encontrando un predictor del deterioro cognitivo

Patricia Pernia — 2024-06-28

El ácido úrico, potente antioxidante endogeno, ha sido recientemente investigado por su posible relación con enfermedades neurodegenerativas. En esta carta, se propone que el ácido úrico podría servir como un marcador predictivo del deterioro cognitivo en condiciones neurodegenerativas. Se revisan estudios recientes que sugieren una correlación entre niveles elevados de ácido úrico y un menor riesgo de deterioro cognitivo, abogando por la necesidad de más investigaciones para confirmar estos hallazgos. Además, se discuten las implicaciones clínicas de utilizar el ácido úrico como un biomarcador potencial en la práctica neurológica.

Dimensions of Well-being: Exploring Quality of Life in Cancer Patients in a Pain Therapy Unit

Jimena Alexandra Villacorta Ramos — 2024-06-28

Given that preserving the feeling of well-being in cancer patients in palliative care is a predominant objective in cancer control, there are various instruments for measuring quality of life; However, it remains a challenge to quantify it and compare it between individuals, so it is essential to be diligent when selecting an instrument.