Revista de la Facultad de Medicina Humana https://revistas.urp.edu.pe/index.php/RFMH <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 It covers current issues, with original and unpublished articles, related to the various specialties of the biomedical and Public Health area.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="http://creativecommons.org/licenses/by/4.0/" rel="license"><img style="border-width: 0;" src="https://i.creativecommons.org/l/by/4.0/88x31.png" alt="Licencia Creative Commons"></a></p> <p><strong>This work is under a&nbsp;<a href="http://creativecommons.org/licenses/by/4.0/" rel="license">Creative Commons license Attribution 4.0 International (CC BY 4.0)</a>.</strong></p> </center> Standardization and validation of a western blot for the diagnosis of human immunodeficiency virus https://revistas.urp.edu.pe/index.php/RFMH/article/view/4023 <p><strong>Objectives:</strong>&nbsp;To standardize and validate a western blot test for the diagnosis of human immunodeficiency virus.&nbsp;<strong>Methods:</strong>&nbsp;A prospective observational study was carried out during 2017 and 2018. The western blot test was standardized, using the polyacrylamide gel electrophoresis technique with sodium dodecyl sulfate (SDS PAGE), being the nitrocellulose blot strips prepared with an Optimal HIV-1 antigen concentration of 2.71 µg / mm. The western blot was validated in the laboratory against 400 reference samples (300 sera and 100 plasmas): 200 positive and 200 negatives for antibodies against HIV-1, being the reference test the Immunoblot of the Fujirebio brand. Diagnostic performance parameters were estimated using Epidat v3.1 and Excel.&nbsp;<strong>Results:</strong>&nbsp;Eight important bands of the HIV-1 antigen were identified: p17, p24, p31, p39, gp41, p55, p66, and gp120. According to the Consortium for the normalization of serology for retroviruse, those that were taken as specific diagnostic bands were: p24, p31, gp41, and gp120. The sensitivity, specificity, positive and negative predictive value and validity index against sera were: 96.7%, 96.0%, 96.0%, 96.6%, 96.3%; and against plasmas: 98.0%, 100.0%, 100.0%, 98.0%, 99.0% respectively. No false positives and negatives were found, but some were undetermined.&nbsp;<strong>Conclusion:</strong>&nbsp;The development of this western blot test with proprietary technology presented similar diagnostic performance to the reference test, without showing cross-reactions, being useful for confirming HIV.</p> Eduardo Fernando Miranda Ulloa Soledad Romero Ruiz Bernardina Amorín Uscata Kevin Serrano Segura Ronal Briceño Espinoza Fany Cárdenas Bustamante ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-08-20 2021-08-20 21 4 10.25176/RFMH.v21i4.4023 Echocardiographic parameters related to pulmonary arterial hypertension in patients with chronic myeloid leukemia under dasatinib treatment https://revistas.urp.edu.pe/index.php/RFMH/article/view/4265 <p><strong>Introduction:</strong>&nbsp;The use of dasatinib in patients with CML has improved life expectancy and follow-up with transthoracic echocardiography (ECOTT) for early detection of PAH allows modifications to the treatment.&nbsp;<strong>Objective:</strong>&nbsp;To determine the echocardiographic parameters and echocardiographic probability for PAH in patients with CML treated with dasatinib.&nbsp;<strong>Methods:</strong>&nbsp;Correlation, cross-sectional, retrospective, single-center study; patients with CML treated with dasatinib were included. Spearman and Pearson correlation was used.&nbsp;<strong>Results:</strong>&nbsp;16 patients were analyzed, mean age 53.5 years; 62.5% men, 37.5% women. The dasatinib dose was 50 mg / day in 18.7%, and 100 mg / day in 81.2%, mean pulmonary arterial pressure (mPAP) 26.3 mmHg, mean maximum tricuspid regurgitation velocity (VmxRT) 2.9 m / s, mean pulmonary artery systolic pressure (PSAP) 41 mmHg. 56.2% had right ventricular diastolic dysfunction (RVDD). 43% were categorized as low probability for PAH, 18.7% intermediate, and 37.5% as high. Relationship between PAPm and VmxRT with p = 0.012. Relationship between mPAP and RV diastolic function, with p = 0.002. Relationship between probability for PAH and mPAP, with p = 0.008.&nbsp;<strong>Conclusion:</strong>&nbsp;The echocardiographic parameters PAPm, VmxRT, PSAP, DDVD and echocardiographic probability for PAH are useful and necessary for the diagnosis of PAH. The determination of all these parameters should be carried out early and as a follow-up, since a considerable positive relationship was found for each one with the presence of PAH, which is not dependent on the treatment time or the dose of dasatinib.</p> Karla Poot Noh Ernesto Hernández Jiménez María del Rayo Juárez Santiesteban Patricia Zaqoya Martínez Alvaro José Monliel Jarquin Arturo García Galicia David Eduardo Herrera Solano ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-07 2021-09-07 21 4 10.25176/RFMH.v21i4.4265 Clinical epidemiological characteristics of patients diagnosed with SARS-CoV-2. Hospital I Florencia de Mora EsSalud – La Libertad, 2020 https://revistas.urp.edu.pe/index.php/RFMH/article/view/3609 <p><strong>Introduction:</strong>&nbsp;the SARS-CoV-2 pandemic affected a large part of the population of La Libertad, among them, the population of Florencia de Mora whose hospital played an important role in the care of patients diagnosed with COVID-19.&nbsp;<strong>Objective:</strong>&nbsp;to determine the epidemiological clinical characteristics of patients diagnosed with SARS-CoV-2 treated at the care center.&nbsp;<strong>Methods:</strong>&nbsp;Retrospective observational descriptive study, with a population of 2622 patients treated in the COVID-19 triage, taking into account the molecular test and the rapid serology test for the detection of SARS-CoV-2.&nbsp;<strong>Results:</strong>&nbsp;SARS-CoV-2 was detected in 74.90% (1155) of patients. The months with the highest number of cases were June and July with 29.4% (340) and 37.4% (432), respectively. The predominant age group was 27- 59 years with 77.9% (900) and males with 57.5% (664). Regarding the clinical profile, the most frequent comorbidity was hypertension with 6.9% (80), obesity and overweight with 3.7% (43) and the most frequent symptoms were cough 62.9% (726) and odynophagia 55.7% (643).&nbsp;<strong>Conclusions:</strong>&nbsp;75 out of 100 screened patients had SARS-CoV-2, predominantly males, the age group of 27-59 years, hypertension, obesity and overweight as comorbidity, cough and odynophagia as the most frequent symptoms.</p> Yeny Tejada-López Evelyn del Socorro Goicochea-Ríos Olga Yanet Guzmán-Aybar ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-08 2021-09-08 21 4 10.25176/RFMH.v21i4.3609 Home hospitalization in children and youth with special health care needs (cyshcn): financial perspectives in hospital de alta complexidad, Chile https://revistas.urp.edu.pe/index.php/RFMH/article/view/4267 <p><strong>Introduction.</strong>&nbsp;The absence of home hospitalization (HH) of children and youth with special health care needs (CYSHCN) generates prolonged hospitalizations in closed care (CC).&nbsp;<strong>Objective:</strong>&nbsp;To compare the estimated cost of HH of high complexity CYSHCN versus the actual cost of the same patient in CC and its impact on hospital production.&nbsp;<strong>Methods:</strong>&nbsp;Descriptive and comparative study between costs of both hospitalization modalities of high complexity CYSHCN. From January to December 2016, non-oncological CYSHCN hospitalizations were registered by the Pediatric Service (PS) according to the Ministry of Health-Chile (MINSAL) norm. It was classified for clinical groups and similar consumption of resources according to groups related to diagnosis (DRG). The stay was adjusted, and financial analysis of both modalities (CC) and (HH) was performed to evaluate the impact on hospital production.&nbsp;<strong>Results:</strong>&nbsp;Of 3690 discharges, 126 (3.4%) were related to 27 CYSHCN, the average age was 4.6 years (± 5 SD) with technological dependencies to live. The mean CYSHCN stay was 16 days, compared with 5.9 for patients without special health needs. CYSHCN stays reached 2017 days (8.6%). Disregarding the CYSHCN discharges would have contributed 320 additional discharges, and his HH would have saved US $ 15 / day per patient, which for the total number of stays consumed would have been an annual saving of US $ 29170.&nbsp;<strong>Conclusion:</strong>&nbsp;HH has an estimated cost lower than the CA of high complexity CYSHCN, improves hospital productivity, and frees critical beds with financially viable investment.</p> Francisco Prado Atlagic Carlos Valdebenito Parra Niscka Babaic Müller Pamela Salinas Flores Fernando Muñoz Berríos Marie Jáuregui Abraham Nelson A. Vargas Catalán ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-08 2021-09-08 21 4 10.25176/RFMH.v21i4.4267 Socioeconomic characteristics and costs of rare and orphan diseases in Peru, 2019 https://revistas.urp.edu.pe/index.php/RFMH/article/view/3936 <p><strong>Introduction:</strong>&nbsp;The rare and orphan diseases (ROD) constitute a current challenge due to the lack of investigation.&nbsp;<strong>Objective:</strong>&nbsp;Describe the socioeconomic characteristics of rare and orphan diseases (ROD) in Peru, 2019.&nbsp;<strong>Methods:</strong>&nbsp;Descriptive observational design. The information was obtained from FISSAL administrative records, and an intentional sample of 20 patients was taken to carry out the questionnaire on ROD. For the economic records, a review of the public budget of the MEF was made. The data analysis was descriptive and inferential.&nbsp;<strong>Results:</strong>&nbsp;There were 454 patients with a total of 49 ROD; of these, the most representative age groups were schoolchildren and young adults (18% each), and the most frequent diagnosis was Tetralogy of Fallot (22%). The questionnaire on ROD reports a median of 7 months in the delay of diagnosis and between 3 and 5 doctors were visited. Likewise, 30% considered that it generated a high to very high expense. It was calculated that the ROD budget constitutes 2.25% of the total budget for high-cost diseases. Likewise, the ROD budget was different between 2014 and 2019.&nbsp;<strong>Conclusions:</strong>&nbsp;The population with ROD in Peru is not large; however, it requires greater attention to access to health services and a greater budget allocation.</p> Grecia Claussen-Portocarrero Alfonso Gutierrez-Aguado ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-08-20 2021-08-20 21 4 10.25176/RFMH.v21i4.3936 Relationship between expectations and satisfaction on technical knowledge - an empathic attitude in the clinical practice of nursing students. Hospital de emergencias Grau EsSalud, 2019. https://revistas.urp.edu.pe/index.php/RFMH/article/view/3730 <p><strong>Objective:</strong>&nbsp;To determine the relationship between expectations and satisfaction regarding technical knowledge - empathic attitude in the clinical practices of nursing students at the Grau de EsSalud Emergency Hospital in 2019.&nbsp;<strong>Methods:</strong>&nbsp;A study with a quantitative approach, observational type, and correlational design showed 80 nursing students who carried out their clinical practices at the Hospital de Emergencias Grau participated in 2019.&nbsp;<strong>Results:</strong>&nbsp;Nursing students were characterized by an average age of 21.36 years, 75% were female, and 72.5% were single. The expectations and satisfaction regarding technical knowledge - empathic attitude in the clinical practices of nursing students were high levels in 97.5% and medium level in 60%, respectively. There was no significant relationship between expectations and satisfaction regarding technical knowledge - the empathic attitude of the clinical practices of nursing students (p = 0.661).&nbsp;<strong>Conclusion:</strong>&nbsp;There is no relationship between expectations and satisfaction regarding technical knowledge - empathic attitude in the clinical practices of nursing students at Hospital de Emergencias Grau de EsSalud in 2019.</p> Sonia Eugenia Miguel Sinchez ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-08-20 2021-08-20 21 4 10.25176/RFMH.v21i4.3730 Effect of orchidectomized and exogenous administration of testosterone on the quantification of platelets in male wistar rats https://revistas.urp.edu.pe/index.php/RFMH/article/view/4042 <p><span style="font-weight: 400;"><strong>Introduction:</strong>&nbsp;Anabolic-androgenic steroids (AAS) modify the physiological functioning of the cardiovascular system and have possible effects on the origin of cardiovascular thrombosis.&nbsp;<strong>Objective:</strong>&nbsp;To determine the impact of the testosterone metabolite on platelet quantification in ORX rats with or without DHT replacement.&nbsp;<strong>Material and methods:</strong>&nbsp;24 male 45-day-old Wistar rats underwent orchidectomy with a simple scrotal incision. At 2.5 months of age, the 24 rats were divided into 4 study groups. Half of the 12 male ORX rats received hormone replacement with dihydrotestosterone propionate (DHT) at a 2 mg/kg dose via subcutaneous injection for 7 days and the other half received a physiological solution (0.9% NaCl). The same occurred in the 12 non-ORX males (SHAM). After 7 days of the administration, blood was collected by orbital puncture, and platelet quantification was performed.&nbsp;<strong>Results:</strong>&nbsp;A significant difference (ANOVA, p &lt; 0.005) was found between the 4 groups. When performing the Dunn Method, a significant difference (p &lt; 0.05) was found in the endogenous administration of DHT between Sham rats and rats ORX + 0.9% NaCl but not with ORX + DHT.&nbsp;<strong>Conclusions:</strong>&nbsp;DHT induces an increase in platelet quantification inrats Sham and not in ORX rats with DHT, which may affect the increase in platelet quantification.</span></p> Milagros Amelia Fuentes Vargas Lilian Clarisa Lovón Caso Marcia Alejandra Paredes Salazar Ana María Apaza Choquehuanca Jheydi Ángeles Cahuana Gutierrez Karla Elena Torres Chavez ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-08 2021-09-08 21 4 10.25176/RFMH.v21i4.4042 Association between prenatal care and peripartum and postpartum maternal obstetric complications. endes 2017 to 2019 https://revistas.urp.edu.pe/index.php/RFMH/article/view/3924 <p><strong>Introduction:</strong>&nbsp;Obstetric complications are an important cause of maternal morbidity and mortality, with prenatal control (PNC) being a strategy for their adequate prevention and treatment.&nbsp;<strong>Objective:</strong>&nbsp;To determine the association between adequate CPN and peripartum and postpartum maternal obstetric complications. Methodology: Quantitative, observational, retrospective, cross-sectional and analytical study, based on information from the ENDES 2017-2019.&nbsp;<strong>Results:</strong>&nbsp;A sample of 41,803 mothers was analyzed, 21,0% and 28,7% had peripartum and postpartum complications respectively, furthermore, it was found that not having a quality NPC (PR = 1.20; 95% CI = 1.14-1.27), residing in metropolitan Lima (PR = 1,38; 95% CI = 1,27-1,49) or in the mountains (PR = 1,25; 95% CI = 1,18-1,33), belong to wealth quintile two (PR = 1,13; 95% CI = 1,04-1,22) or three (PR = 1,11; 95% CI = 1,03-1,20), having been attended only by qualified personnel (PR = 1,81; 95% CI = 1,33-2,48) and only in the public sector (PR = 1,48; 95% CI = 1,31-1,68) were associated with a greater possibility of peripartum complications. Not having a quality NPC (PR = 1,28; 95% CI = 1,22-1,33), residing in metropolitan Lima (PR = 1,12; 95% CI = 1,05-1,20) or in the mountains (PR = 1,06; 95% CI = 1,01-1,12), belong to wealth quintile two (PR = 1,13; 95% CI = 1,05-1,20) or three (PR = 1,12; 95% CI = 1,05-1,19) and having received NPC only in the public sector (PR = 1,28; 95% CI = 1,17-1,41) were associated with a greater possibility of postpartum complications.&nbsp;<strong>Conclusions:</strong>&nbsp;Within the adequate NPC, an association was found between the quality NPC and the peripartum and postpartum maternal obstetric complications.</p> Angela Natalia Méndez Pajares Estefany Jayne Morales Mautino Willer Chanduví Puicón Pedro Arango Ochante ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-08 2021-09-08 21 4 10.25176/RFMH.v21i4.3924 Relationship between the approval of the adoption of children by homosexuals and the attitude towards homosexuality among medical students and graduates https://revistas.urp.edu.pe/index.php/RFMH/article/view/3817 <p><strong>Introduction.</strong>&nbsp;Due to changes in the composition of the family and society, the adoption of children by homosexuals is becoming more frequent. It has been found that opposition to this request is often associated with homophobia. In Peru, no studies exist on these aspects.&nbsp;<strong>Objective:</strong>&nbsp;To determine the correlation between adoption approval and attitude towards homosexuality in medical students and graduates, Lima, Peru. Method: The observational and cross-sectional study was carried out. 205 people over 21 years of age participated. The Attitude Toward Homosexuality Scale (EAH-10) and the question “Should homosexual couples be allowed to adopt children like heterosexual couples?” were used. The relationships were made with the Pearson (r) and Spearman (rs) correlation coefficient.&nbsp;<strong>Results:</strong>&nbsp;Quantitatively, a negative and significant correlation was found between the response with the attitude towards homosexuality (r = -0,727; rs = -0,718) and a positive and significant correlation with the number of homosexual friends (r = 0,402; rs = 0,399). 57,6% indicated approval of the question posed. Greater intolerance attitudes were found in men than in women (r = 0,328; p = 0,000). A multiple linear regression model showed that attitude towards homosexuality, sex, and number of homosexual friends are good predictors of acceptance of homosexual adoption.&nbsp;<strong>Conclusion:</strong>&nbsp;The response was significantly correlated with attitudes of homophobia and with the number of homosexual friends. Furthermore, homophobic attitudes were higher in men.</p> Marco Antonio Tipula Lincol Marx Cruz Aquino María Isabel Vásquez Suyo Maritza Dorila Placencia Medina ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-08 2021-09-08 21 4 10.25176/RFMH.v21i4.3817 Correlation between mortality due to COVID-19, wealth index, human development and population density in districts of Metropolitan Lima during 2020 https://revistas.urp.edu.pe/index.php/RFMH/article/view/3987 <p><strong>OBJECTIVE:</strong>&nbsp;To determine the correlation between mortality due to COVID-19 and incidence of poverty and district human development index (HDI) in the department of Lima.&nbsp;<strong>METHODOLOGY:</strong>&nbsp;An observational, ecological, correlational study. The population were patients who died from COVID-19 in Lima Metropolitana. We included all patients reported dead in the open data base of the Ministerio de Salud. The dependent variable was mortality due to COVID-19, calculated by dividing the number of deaths by the total district population, and the independent variables were the incidence of poverty and HDI. We carried out a secondary analysis evaluating the fatality by COVID-19. The correlation was calculated through Spearman’s non-parametric method.&nbsp;<strong>RESULTS:</strong>&nbsp;13 154 people died of COVID-19 during the period between March and September, the majority was of masculine gender with an average age of 66 years. We did not find a significant correlation between mortality and incidence of poverty (rho=-0,2230; p=0,15). We found a significant correlation between mortality due to COVID-19 and HDI (rho= 0,4466; p=0,002). Mortality was correlated with population density (rho=0,7616; p=&lt;0,001). We found a positive (rho=0,32) and significant (p=0,037) correlation between fatality and incidence of poverty. We found a significant correlation between fatality due to COVID-19 and population density (rho=0,7616; p=&lt;0,001). We did not find a significant correlation between fatality and HDI.&nbsp;<strong>CONCLUSIONS:</strong>&nbsp;Population density was a factor associated in the most consistent manner with mortality and fatality due to COVID. Poverty was associated to greater fatality, but not to greater mortality.</p> Zalia Elizabeth Dorregaray Farge Alonso Soto Tarazona Jhonny De La Cruz Vargas ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-08 2021-09-08 21 4 10.25176/RFMH.v21i4.3987 WhatsApp assessment for communication and organization of group work in resident physicians https://revistas.urp.edu.pe/index.php/RFMH/article/view/3884 <p><strong>Introduction:</strong>&nbsp;The use of dasatinib in patients with CML has improved life expectancy and follow-up with transthoracic echocardiography (ECOTT) for early detection of PAH allows modifications to the treatment.&nbsp;<strong>Objective:</strong>&nbsp;To determine the echocardiographic parameters and echocardiographic probability for PAH in patients with CML treated with dasatinib.&nbsp;<strong>Methods:</strong>&nbsp;Correlation, cross-sectional, retrospective, single-center study; patients with CML treated with dasatinib were included. Spearman and Pearson correlation was used.&nbsp;<strong>Results:</strong>&nbsp;16 patients were analyzed, mean age 53.5 years; 62.5% men, 37.5% women. The dasatinib dose was 50 mg / day in 18.7%, and 100 mg / day in 81.2%, mean pulmonary arterial pressure (mPAP) 26.3 mmHg, mean maximum tricuspid regurgitation velocity (VmxRT) 2.9 m / s, mean pulmonary artery systolic pressure (PSAP) 41 mmHg. 56.2% had right ventricular diastolic dysfunction (RVDD). 43% were categorized as low probability for PAH, 18.7% intermediate, and 37.5% as high. Relationship between PAPm and VmxRT with p = 0.012. Relationship between mPAP and RV diastolic function, with p = 0.002. Relationship between probability for PAH and mPAP, with p = 0.008.&nbsp;<strong>Conclusion:</strong>&nbsp;The echocardiographic parameters PAPm, VmxRT, PSAP, DDVD and echocardiographic probability for PAH are useful and necessary for the diagnosis of PAH. The determination of all these parameters should be carried out early and as a follow-up, since a considerable positive relationship was found for each one with the presence of PAH, which is not dependent on the treatment time or the dose of dasatinib.</p> Luisa Ecaterina Villar Meza Hugo F. Gutiérrez Crespo Juan P. Matzumura Kasano ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-08-20 2021-08-20 21 4 10.25176/RFMH.v21i4.3884 Accuracy of ASGE 2010 predictive criteria for high risk of choledocholithiasis: a single center experience in the Colombian Caribbean https://revistas.urp.edu.pe/index.php/RFMH/article/view/4045 <p><strong>Introducción:</strong> La colangiopancreatografía retrógrada endoscópica (CPRE) se ha convertido en el estándar de oro para el diagnóstico y tratamiento de la coledocolitiasis. La Sociedad Americana de Endoscopia Gastrointestinal (ASGE) propuso en 2010 estratificar a los pacientes en 3 niveles de riesgo; sin embargo, los estudios han encontrado resultados controvertidos sobre los parámetros predictivos de estos criterios diagnósticos.</p> <p><strong>Objetivos:</strong> Determinar el desempeño de los criterios predictivos de alto riesgo de la ASGE 2010 en el diagnóstico de coledocolitiasis en una población del Caribe colombiano.</p> <p><strong>Métodos:</strong> Estudio transversal retrospectivo, en el que se incluyeron pacientes con sospecha de coledocolitiasis, y que fueron llevados a evaluación por CPRE, cumpliendo los criterios propuestos por la ASGE de alta probabilidad. El resultado obtenido se comparó con la presencia de coledocolitiasis en la CPRE, a partir de la cual se estimaron los valores y los intervalos de confianza del 95% para la sensibilidad, la especificidad, el valor predictivo positivo y negativo, y la razón de probabilidad positiva y negativa.</p> <p><strong>Resultados:</strong> En este estudio se incluyeron los datos de 118 pacientes. La edad media de los pacientes era de 46 años (RIQ= 31; 17- 89); el 78% (n= 92) eran mujeres. El 65,3% (n= 77) eran mayores de 55 años. El resultado de la CPRE fue positivo en el 81,4% (n= 96) de los pacientes. La presencia de un perfil hepático alterado (90%) resultó ser la prueba más sensible, la colangitis clínica (86%) la más específica, la presencia de litiasis ductal por US (85%) fue la prueba con mayor valor predictivo positivo, y la presencia de litiasis ductal por US (35%) fue la prueba con mayor valor predictivo negativo</p> <p><strong>Conclusiones:</strong> Los parámetros predictivos de los criterios de la ASGE 2010 para el diagnóstico de coledocolitiasis muestran variabilidad con respecto al rendimiento propuesto en las guías.</p> Maria Manuela Rodriguez-Gutierrez Willfrant Jhonnathan Muñoz-Murillo Ivan David Lozada-Martinez Amileth Suarez-Causado Maria Paz Bolaño-Romero Yelson Alejandro Picón-Jaimes ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-22 2021-09-22 21 4 10.25176/RFMH.v21i4.4045 Factors associated with depression anxiety and stress in the context of covid-19 pandemic in police officers of metropolitan lima, Peru https://revistas.urp.edu.pe/index.php/RFMH/article/view/4227 <p><strong>Objective:</strong>&nbsp;To determine the factors associated with the development of depression, anxiety and stress in the context of the COVID-19 pandemic in police officers in Lima, Peru.&nbsp;<strong>Methods:</strong>&nbsp;Analytical cross-sectional study conducted in 210 police officers who were administered the Depression Anxiety and Stress Scale-21 (DASS-21) in October 2020, as well as a form, via Google Forms, to obtain sociodemographic and clinical data. A bivariate and a multivariate analysis were performed using crude and adjusted prevalence ratios, with a confidence interval &gt;95% and a significance level of p≤0.05.&nbsp;<strong>Results:</strong>&nbsp;Depression, anxiety and stress prevalence rates were 11.43%, 10% and 7.62%, respectively. In the bivariate analysis, anxiety was associated with the number of children (cPR:3.18; 95% CI [1.10-9.17]; p:0.032) and history of disease (cPR:2.50; 95%CI[1.08-5.75]; p:0.031). For depression and stress, no significantly associated factors were found. In the multivariate analysis, an association between depression and age (aPR:2.50; 95%CI[1.02-6.10]; p:0.044) was found, as well as an association between stress and emotional situation (aPR:3.10; 95%CI[1.08-8.95]; p:0.034), COVID-19 diagnosis (aPR:3.18; 95%CI[1.02-9.92]; p:0.045) and history of disease (aPR:4.19; 95%CI[1.22-14.36]; p:0.022).&nbsp;<strong>Conclusions:</strong>&nbsp;A low prevalence of depression, anxiety and stress was observed in the study population. In addition, according to the multivariate analysis, the risk factors for stress were being single, having been diagnosed with COVID-19 and having a history of disease, while being 40 years old or younger was a risk factor for depression.</p> Katherine Danae Apaza Llantoy Lucy Cedillo Ramirez Lucy Elena Correa-López ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-21 2021-09-21 21 4 10.25176/RFMH.v21i4.4227 Epidemiological statistics of adolescent suicide during confinement due to the Covid-19 pandemic in Ecuador https://revistas.urp.edu.pe/index.php/RFMH/article/view/3984 <p><em>Objective:</em> To collect and present the information regarding the epidemiological characteristics and statistics of adolescent suicide, during the period of confinement due to pandemic in the year 2020 in Ecuador. <em>Method:</em> An observational, descriptive, cross-sectional retrospective study was carried out with the information from the database of violent deaths of the Ministry of Government, from March 17 to September 13, which lasted the state of exception. The analysis was carried out by province, sex, age, suicide method and frequency in days after the event occurred. The suicide mortality rate (per 100,000 inhabitants) was estimated for each province. <em>Results:</em> During the confinement due to a state of exception in 2020 in Ecuador, 97 suicides were registered in adolescents between 10 and 19 years of age. The highest number was estimated in males between 15 and 19 years of age, with the most frequent age being 19. The most frequent day of removal of corpses was on Mondays, and the preferred mode of suicide was hanging with 81 reported cases. followed by far by intoxication and poisoning.<em> Conclusions:</em> Adolescent suicide deserves special attention in our environment, as it is a public health problem, influenced by various psychological and emotional factors, which can be exacerbated or neglected in a context of pandemic and isolation. Significant differences are observed in variables such as sex, age group, and geographic region. Therefore, psychosocial interventions aimed at mitigating the mental effects of the pandemic and confinement are essential, as well as promoting prevention and mental health programs in the adolescent population.</p> Andres Joaquin Guarnizo Chávez Nathaly Alejandra Romero Heredia ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-21 2021-09-21 21 4 10.25176/RFMH.v21i4.3984 Association between educational level and knowledge on transmission of hiv/aids in adolescent women in Peru-ENDES 2019 https://revistas.urp.edu.pe/index.php/RFMH/article/view/4266 <p><strong>Introduction:</strong><span style="font-weight: 400;">&nbsp;Knowledge about the transmission of HIV in adolescent women is important due to the great risk of contracting said infection.&nbsp;</span><strong>Objective:</strong><span style="font-weight: 400;">&nbsp;To determine the association between the educational level and knowledge about the transmission of HIV in female adolescents according to the ENDES year 2019.&nbsp;</span><strong>Methods:</strong><span style="font-weight: 400;">&nbsp;Quantitative, observational, retrospective, cross-sectional and analytical study based on the public availability data of the ENDES 2019.&nbsp;</span><strong>Results:</strong><span style="font-weight: 400;">&nbsp;Of the 4 668 women in the age range of 15 to 19 years. 30.6% had adequate knowledge about HIV and 69.4% had inadequate knowledge. No association was found between educational level and level of knowledge about HIV transmission. In the multivariate analysis, regarding the wealth index, being non-poor compared to being in extreme poverty has a positive influence on adequate knowledge about HIV (OR: 1.25 95% CI: 1.14–1.38).&nbsp;</span><strong>Conclusion:</strong><span style="font-weight: 400;">&nbsp;Knowledge about HIV transmission in adolescent women in Peru is not adequate, no association was found between educational level and knowledge about HIV transmission, nor with place of residence; but if an association was found with the wealth index.</span></p> Nathalie Amado Cornejo Consuelo Luna-Muñoz ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-07 2021-09-07 21 4 10.25176/RFMH.v21i4.4266 Knowledge and Attitudes about organ donation in students of Health Sciences from a National University of Lambayeque - 2019 https://revistas.urp.edu.pe/index.php/RFMH/article/view/4027 <p><strong>Objective:</strong>&nbsp;Determine the level of knowledge and attitudes about organ donation and xenotransplantation in students from a National University of Lambayeque.&nbsp;<strong>Methods:</strong>&nbsp;The sampling carried out was probabilistic of a simple random type and the sample was made up of 100 university students. An observational, descriptive and cross-sectional study was conducted to assess levels of knowledge and attitudes about organ donation. A survey of 20 dichotomous key questions was applied.&nbsp;<strong>Results:</strong>&nbsp;53 women (53.0%) and 47 (47.0%) men were interviewed. It was observed that 76% do not know about the Law on the Promotion of Solidarity Donation of Human Organs and Tissues in Peru. Likewise, 96% know the organs and tissues that can be donated, 61% of the students have talked with their family about the subject of organ donation. 76% would be willing to donate their organs or tissues after life, and 88% would donate their relatives' organs to save the life of another relative.&nbsp;<strong>Conclusions:</strong>&nbsp;In the Faculty of Biological Sciences of the University it was observed that the knowledge of young people about organ donation was acceptable, although certain aspects need to be clarified.</p> César Alberto Cabrejos Montalvo katherine Erika Ipanaqué Muñoz Ana Maria Del Socorro Vásquez del Castillo ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-21 2021-09-21 21 4 10.25176/RFMH.v21i4.4027 The social representations of patients of Quechua origin with Type 2 Diabetes about their disease and treatment in two hospitals in Cusco https://revistas.urp.edu.pe/index.php/RFMH/article/view/4232 <p><span style="font-weight: 400;"><strong>Objectives:</strong>&nbsp;To achieve an approximation the social representations of patients about their disease. and about its treatment.&nbsp;<strong>Methodology:</strong>&nbsp;This is a qualitative study on social representations based on the interpretive paradigm and through an in-depth interview, for which a guide of topics or categories was used, based on the objectives of the study. The study population was made up of patients treated in the Endocrinology Units of the Antonio Lorena and Regional Hospitals of Cusco, diagnosed with type 2 diabetes and of Quechua origin evidenced by their mother tongue. The sample is non-probabilistic for convenience, the representativeness of the discourse was sought for this, reaching 30 interviews based on the saturation criterion. The information analysis included 1. The transcription (from oral Quechua to written Quechua) and the translation of the interviews and 2. The computerized processing of the interviews, for which purpose the RQDA (Research qualitative data analysis) computer program was used.&nbsp;<strong>Results:</strong>&nbsp;The ideas that patients have about the cause of their disease and the changes that it produces reflect the influence of Modern Medicine and Andean and Popular Medicine. On the other hand, for the treatment of their disease, they consider it useful to combine the medications that have been indicated in the health service with the resources of Andean and Popular Medicine (medicinal herbs and other natural products).&nbsp;<strong>Conclusion:</strong>&nbsp;The patients in our study have an intercultural approach to approach and treat.</span></p> Ramón Figueroa Mujica Guisela Yábar Torres ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-21 2021-09-21 21 4 10.25176/RFMH.v21i4.4232 Hantavirus in the peruvian jungle: a systematic review of series and cases reported https://revistas.urp.edu.pe/index.php/RFMH/article/view/3650 <p>Hantavirosis is a zoonotic infection transmitted mainly by rodents. In Peru, a lethality of 40–60% is calculated in inhabitants of the Peruvian Amazon jungle, especially in Loreto. Despite this, this disease continues to be under-diagnosed despite the fact that it represents a serious problem for public health in Latin America. We present a sistematic revision of case reports and seris of cases of Hantavirus infection in the Peruvian jungle. The most important characteristic of the cases presented are mean age 25.7 years, predominance of females (5/6), clinical presentation of headache, myalgias, nausea and vomiting (6/6) and unfavorable evolution to acute respiratory to acute respiratory distress (ARDS), renal failure, septic shock and multiple organ failure in 3of the cases presented.</p> Marcos Saavedra Velasco Alvaro Oyarce-Calderón Natalia Vargas Herrera Rafael Pichardo-Rodriguez Carlos M. Moreno-Arteaga ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-07-10 2021-07-10 21 4 10.25176/RFMH.v21i4.3650 Jaw region endometriosis: case report https://revistas.urp.edu.pe/index.php/RFMH/article/view/4033 <p><strong>Introduction:</strong>&nbsp;Endometriosis is a chronic gynecological disease, which refers to the presence of endometrial glands and stroma outside the uterine endometrium. This entity has a frequency of 10 to 15% in women of reproductive age, and its most common site of presentation is the ovary. At the extrapelvic level, the most common location is the gastrointestinal and genitourinary location. However, it can occur in any location.&nbsp;<strong>Presentation:</strong>&nbsp;The case of a 40-year-old female patient with a face tumor in the mandibular region is described, presenting with a disease time of 2 years. Among the important antecedents, two months before the appearance of the tumor region, the patient underwent endodontic surgery of a lower molar tooth, contiguous to the mandibular. Likewise, one month before the appearance of the tumor, the patient underwent an exploratory laparoscopy for electrofulguration of endometriotic foci in the uterine myometrium. The patient underwent a surgical resection of the tumor in the mandibular region described; and after reviewing the histological and immunohistochemical slides at the institution, the diagnosis of endometriosis was established.&nbsp;<strong>Conclusion:</strong>&nbsp;Extrapelvic endometriosis is rare in our country, and its diagnosis requires experience and visual training in the recognition of normal endometrial tissue. The presentation of this case was considered important because it would be the first case reported in Peru and in the world, of an endometriosis located in the mandibular region.</p> Katherine Luisa Contreras Gala Mónica Villafuerte Rozas ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-13 2021-09-13 21 4 10.25176/RFMH.v21i4.4033 Posner – Schlossman Syndrome: case report https://revistas.urp.edu.pe/index.php/RFMH/article/view/3902 <p><strong>Introduction:</strong>&nbsp;Posner - Schlossman Syndrome (PSS) is a rare disease, more prevalent in men between 20 and 50 years old, characterized by recurrent attacks of anterior uveitis and ocular hypertension.&nbsp;<strong>Clinical case:</strong>&nbsp;We report the case of a 42-year-old patient with a single eye. He came to the consultation presenting decreased visual acuity, photobobia, halos around the lights, and intense pain in his left eye. The ophthalmological examination revealed inflammatory signs in the anterior segment, elevated intraocular pressure and damage to the optic nerve. Medical treatment was started with corticosteroids and topical antiglaucoma drugs, oral acetazolamide and intravenous mannitol, obtaining no response and it was decided to perform a surgical intervention (Ahmed valve implantation) in the left eye, subsequently achieving a good clinical evolution and resolution of the case.&nbsp;<strong>Conclusion:</strong>&nbsp;This report highlights that the episodic and recurrent nature of SPS requires strict monitoring.</p> Diego José Mamani Maquera Nahuel Pantoja Dávalos ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-08-20 2021-08-20 21 4 10.25176/RFMH.v21i4.3902 Clinical performance of a new prediction rule of systemic loxoscellism. case report https://revistas.urp.edu.pe/index.php/RFMH/article/view/3956 <p>Systemic or cutaneous-visceral loxoscelism is the most severe clinical presentation of loxoscelism. Currently there is no validated laboratory diagnostic method that allows us to confirm the presence of this disease in the face of arachneism. However, there is a clinical prediction rule (CPR), which allows us to predict the evolution of a bite towards a systemic condition and which would be useful in emergency rooms. We present the case of a woman who developed the systemic picture of loxoscelism to whom a new CPR was applied for the early detection of systemic loxoscelism, presenting adequate performance for early evaluation in emergency services.</p> Rafael Martin de Jesus Pichardo Pichardo Rodriguez Marcos Saavedra Velazco Cesar Enrique Sánchez Alvarez Juan Jesús Bracamonte Hernández Abel Aldave Visurraga Oscar Emilio Ruiz Franco ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-07-13 2021-07-13 21 4 10.25176/RFMH.v21i4.3956 Shock Cryptic, emerging diagnostic https://revistas.urp.edu.pe/index.php/RFMH/article/view/3799 <p>Cryptic shock is a poorly identified clinical entity, and it still describes a patient with signs of tissue hypoperfusion without affecting blood pressure. In the emergency department, it is important to identify signs of hypoperfusion and evaluate various hidden sources of infection by taking a complete medical history, a thorough physical examination, and, if necessary advanced imaging. It is necessary to conclude that the importance of the timely diagnosis of this clinical entity helps to improve the prognosis significantly.</p> Ricardo Jonathan Ayala García Sandra Soto Ticse Stephany Matos Santiváñez Allison Ortiz de Orue ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-08-20 2021-08-20 21 4 10.25176/RFMH.v21i4.3799 Atrial Fibrillation that required Cardioversion in the Post Anesthetic Recovery Unit in Ambulatory Surgery. A case report https://revistas.urp.edu.pe/index.php/RFMH/article/view/4041 <p>In recent years, the profile of patients who can undergo ambulatory surgery procedures in independent ambulatory surgical centers has changed. It is very important to consider the availability, skills and experience of the care staff, as well as the integral study of the patient, the resolution capacity of these centers and evaluations with quality care indicators to obtain optimal results. The present case was of a 34-year-old male, first presentation of rapid and symptomatic atrial fibrillation documented in the immediate postoperative period. Patient care, diagnostic strategy and treatment were described, since the patient required electrical cardioversion.</p> Miryam Elizabeth Céspedes Morón Rosina Ruiz Roque Fredy Chipa Ccasani ##submission.copyrightStatement## 2021-09-13 2021-09-13 21 4 10.25176/RFMH.v21i4.4041 Cotard Syndrome in recurrent depressive disorder: case report https://revistas.urp.edu.pe/index.php/RFMH/article/view/3303 <p>The Cotard Syndrome, also known as delirium of negation or nihilistic delirium, was described by the French neurologist, Julius Cotard, on June 1880. From that time until the end of the 20th century, in scientific literature, approximately 100 cases were reported that presented symptoms of depression, anxiety, nihilist delusions concerning the body and existence, hypochondriacal and immortality delusions, as well as auditory and visual hallucinations. We present the case of a female patient, 73-years old, from Ayacucho, with a history of sexual assault at the age of 12 and suicidal attempts on 2 occasions, diagnosed with depression at 40 years of age, received treatment with quetiapine, trazadone and clonazepam. She remained with fluctuating medical progress, with symptoms worsening with stressors such as the death of her mother and husband and when she underwent surgeries. Currently, she presents sad and anxious mood, daily crying, ideas of guilt, disability and death, insomnia of conciliation, nihilistic delusive ideas concerning the body, referring that her stomach and bladder do not work, reason why she doesn’t want to eat or drink water. Due to the total refusal of food intake and persistent suicidal ideation, she was hospitalized to receive psychiatric treatment and nutritional support. It is concluded that there are few cases reported on the use of psychotherapy in Cotard's syndrome. Therefore, this case in which psychotherapy was indicated to reduce anxious-affective symptoms, to avoid isolation of the person and to redirect his personal and social life, is important.</p> Héctor Ocampo Ramos Richard Jeremy Febres Ramos Sheron Arestegui Saavedra Rosa Bravo Torres Danitza Cardenas Peralta ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-08-20 2021-08-20 21 4 10.25176/RFMH.v21i4.3303 Parapharyngeal Schawannnoma. Case Report https://revistas.urp.edu.pe/index.php/RFMH/article/view/3985 <p>Parapharyngeal tumor lesions present a low incidence, representing between 0,5 and 0,8% of all head and neck tumors. Approximately 80% show benign behavior. The uniqueness of these lesions derives from their complex anatomical situation and the symptoms with which they usually appear, being in most cases nonspecific and almost always derived from the compressive effect produced by the lesion on the oropharynx and the oropharynx. Schwannomas of the parapharyngeal space are very rare tumors that originate from the sheath of schawnn, generally slow growing, and are usually asymptomatic. Treatment is surgical, often complex due to the anatomical location.The case of a 42-year-old female patient with a diagnosis of Schwannoma in the left parapharyngeal region, demonstrated by incisional biopsy, is presented; undergoing surgical treatment, which was carried out without complications.</p> Enrique Moyano Navarro Manuel Inostroza Fernández Pedro Paolo Sotelo Ethel Vargas Carrillo Alan La Torre Zúñiga Luis González Domínguez ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-13 2021-09-13 21 4 10.25176/RFMH.v21i4.3985 The reality of patients in hemodialysis before COVID-19 pandemic https://revistas.urp.edu.pe/index.php/RFMH/article/view/4084 <p>In a pilot test carried out in the department of Lambayeque (Peru) about the profile of patients who entered hemodialysis for the first time with grade five chronic kidney disease (CKD 5), evidence was found different from other Latin American.</p> <p>The treatment modality for CKD 5 patients increased through hemodialysis according to the Latin American Registry of Dialysis and Kidney Transplantation from 2000 to 2008. In Peru, 84.75% of patients are registered with this form of treatment still in force in our country and others.</p> Mónica Vásquez Bambaren Víctor Alberto Soto-Cáceres Víctor Serna-Alarcón ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-06 2021-09-06 21 4 10.25176/RFMH.v21i4.4084 Pediatric diseases more frequently: a peruvian perspective https://revistas.urp.edu.pe/index.php/RFMH/article/view/4014 <p><strong>Dear Editor</strong></p> <p>We have read with great interest the article "Pediatric diseases with greater frequency in an international airport in Mexico" by Figueroa-Uribe A, et. al. where they show us the most registered diseases in medical attention in the emergency medical service of an international airport in Mexico.&nbsp;<sup>(<a href="http://127.0.0.1:5501/N4/CARTA%20AL%20EDITOR/Enfermedades%20pediatricas/Pediatric_Diseases.html#1">1</a>)</sup>&nbsp;When analyzing the data shown, we realize that it is possible to compare the results shown in their study in the Peruvian territory, since there is evidence from the Dirección de Epidemiología of the Dirección Regional de Salud (DIRESA) - Amazonas<sup>(<a href="http://127.0.0.1:5501/N4/CARTA%20AL%20EDITOR/Enfermedades%20pediatricas/Pediatric_Diseases.html#2">2</a>)</sup>&nbsp;which mentions a high prevalence of respiratory and digestive diseases, which are considered, as in the study conducted at the Mexican airport, to be more frequent.</p> Javier Alexander Jimenez Hans Lenin Contreras Pulache ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-13 2021-09-13 21 4 10.25176/RFMH.v21i4.4014 Telerehabilitation in knee arthroplasty, therapeutic alternative and ethical challenge https://revistas.urp.edu.pe/index.php/RFMH/article/view/3731 <p>a</p> Carlos Vicente Bahamondes Avila Bernarda Macarena Cifuentes Cea ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-20 2021-09-20 21 4 10.25176/RFMH.v21i4.3731 Timely and early respiratory rehabilitation in patients with covid 19 pneumonia in a referral hospital https://revistas.urp.edu.pe/index.php/RFMH/article/view/3821 <p>El SARS-CoV-2 es un beta-coronavirus del mismo subgénero que los virus SARS y MERS, comparten el mismo receptor de unión del gen, la enzima convertidora de angiotensina (ACE2).<sup>(<a href="http://127.0.0.1:5500/Carlos/Cartas%20al%20Editor/Rehabilitaci%C3%B3n%20respiratoria%20oportuna%20y%20precoz%20en%20pacientes%20con%20neumon%C3%ADa%20covid-19%20en%20un%20hospital%20referencial.html#1">1</a>)</sup>El espectro de severidad de la enfermedad es variado, siendo la forma leve la más frecuente (81%), y la enfermedad severa presente en el 14% de los casos, estando la presentación crítica en el 5%, con una mortalidad del 2,3%.<br><br>La secuela respiratoria post neumonía causada por los beta-Coronavirus es el daño alveolar difuso con lesiones fibróticas; el mecanismo fisiopatológico es multifactorial, el cual implica la activación del factor de crecimiento transformante beta (TGF-β)<sup>(<a href="http://127.0.0.1:5500/Carlos/Cartas%20al%20Editor/Rehabilitaci%C3%B3n%20respiratoria%20oportuna%20y%20precoz%20en%20pacientes%20con%20neumon%C3%ADa%20covid-19%20en%20un%20hospital%20referencial.html#3">3</a>)</sup>, IL1, IL6, MCP1 y TNF-α secundarios a la injuria epitelial e inflamación subsecuente. Además, la exposición a altas concentraciones de O2 y efectos del barotrauma, provocados por un soporte oxígeno/ventilatorio avanzado, activan la vía pro-fibrótica del TGF-β, lo que origina una reparación aberrante caracterizada por el depósito exagerado de fibroblastos, miofibroblastos y colágeno. El 47% y 25% de pacientes que sobrevivieron a neumonía por COVID-19 moderada a severa cursan con disminución en la difusión del monóxido de carbono y en la capacidad pulmonar total predicha, respectivamente.<sup>(<a href="http://127.0.0.1:5500/Carlos/Cartas%20al%20Editor/Rehabilitaci%C3%B3n%20respiratoria%20oportuna%20y%20precoz%20en%20pacientes%20con%20neumon%C3%ADa%20covid-19%20en%20un%20hospital%20referencial.html#4">4</a>)</sup></p> Antonio O. Morales Avalos Felix K. Llanos Tejada Juan Antonio Salas Lopez Aldo Renato Casanova Mendoza ##submission.copyrightStatement## http://creativecommons.org/licenses/by/4.0 2021-09-22 2021-09-22 21 4 10.25176/RFMH.v21i4.3821