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 It covers current issues, with original and unpublished articles, related to the various specialties of the biomedical and Public Health area.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 Approach to the intoxicated pediatric patient in the emergency services. https://revistas.urp.edu.pe/index.php/RFMH/article/view/5091 <p>Intoxications in the pediatric population account for a significant portion of the causes of care in emergency services, but they are also fatal in many cases in our country.</p> <p>&nbsp;</p> <p>Exposure to a toxic or poison and its adverse effects can become medical emergencies of great magnitude, which is why many authors consider them "multiple traumas of chemical origin."</p> <p>&nbsp;</p> <p>This is why the management of an intoxicated pediatric patient has a unique approach due to the diagnostic challenge that it represents. Timely and systematized care of a pediatric patient in the context of poisoning can represent the success of timely care, correct assessment, and an adequate care process. The objective of this work is to present a general approach for the intoxicated pediatric patient regarding the initial management, the approach, and the clinical data that can guide us in the emergency department when faced with an intoxicated pediatric patient.</p> Augusto F. Figueroa-Uribe Ivan Ilescas-Martínez Humberto Villanueva-Chávez Rodrigo Saavedra-Luna Gabriela Mendoza-Besares Michelle Fabienne Vela-Díaz Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5091 Evaluation of the reproducibility of the Tronzo classification for intertrochanteric fractures of the femur in an orthopedic service of a Hospital in Ibagué, Colombia. https://revistas.urp.edu.pe/index.php/RFMH/article/view/4994 <p><strong>Introduction: </strong>Hip fractures are a pathology of traumatic origin that generates a high impact on public health. The objective is to evaluate the interobserver reproducibility of the Tronzo classification for intertrochanteric fractures.</p> <p><strong>Methods: </strong>Observational, analytical and retrospective study carried out in Ibagué - Colombia, 48 hip radiographs were analyzed, classified by 10 observed among specialists and training personnel, using the Tronzo classification. Interobserver reproducibility is assessed using the kappa concordance coefficient.</p> <p><strong>Results: </strong>Among all those observed in the study, there is greater agreement in the identification of intertrochanteric fractures of lesser and greater severity (Tronzo I and V), the main exponents of this agreement are the most experienced staff, the staff in training, with intermediate experience they agree when identifying those of intermediate severity and for those with less experience the concordance becomes evident when evaluating the intermediate grades.</p> <p><strong>Conclusion: </strong>The concordance increases with the experience for the identification of the types with high complexity. This classification is not suitable for clinical practice, another system is necessary for this type of fracture in clinical conduct.</p> Paula A. Valencia María del Pilar Quesada Aguilar María Manuela Rodriguez-Gutierrez Alvaro E. Lasso Acosta Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.4994 Noncompliance with the national vaccination scheme in children in the peruvian jungle, year 2019 https://revistas.urp.edu.pe/index.php/RFMH/article/view/4614 <p>In the past decade, levels of coverage on children vaccination had been decreasing nationwide, even more in the Peruvian jungle, reason why is an important public health’s subject to attend. The purpose of this investigation was to analyze maternal and social factors that are associated with incomplete vaccination schedules on children under 5 years old on the Peruvian jungle. It is an observational, analytic investigation, using a secondary source from the Demographic and Family survey (ENDES) from 2019, where is found the information of all the under 5 years old with the healthcare card of oral information given by the mother. Then after selecting the chosen variables, we used the SPSS statistic program for the posterior analysis. Of the 4373 surveys studied; it was shown that 57.5% of children under 5 years have the incomplete vaccination schedule. The multivariate analysis found that non-compliance with the vaccination schedule associated with maternal and social factors such as not having health insurance (ORa 1.72; p&lt;0.01, IC95% 1.39-2,13), poverty (ORa-1,427, p&lt;0.01, IC95% 1.89-1.71), native mother tongue (ORa-1.50, p&lt;0.01, IC-1.13-2,0), problems attending the health center (ORa-1,213, p=0.02, IC95% 1.02-1.44), live outside the city (ORa-1.31, p&lt;0.01, IC95% 1.09- 1.58), age under the age of 24 as a mother/guardian (ORa-1.38, p&lt;0.01, IC95% 1,186-1,619). Not having health insurance, living in poverty, having trouble going to the health center, living outside the city, having a different mother tongue than Spanish and age under 24 are factors associated with non-compliance with the vaccination schedule.</p> Luis T. Kaway Caceda Luis Roldán-Arbieto José M. Vela-Ruiz María Loo-Valverde Rocio Guillen Ponce Consuelo Luna-Muñoz Sussan Lloclla Delgado Copyright (c) 1970 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.4614 Critical values for automated hemograms and peripheral blood smears https://revistas.urp.edu.pe/index.php/RFMH/article/view/4616 <p>The report of critical values ​​is considered a necessary practice in clinical pathology laboratories, since its immediate communication determines therapeutic decisions that can save lives. The choice of critical values ​​and the way in which they are reported must be a joint decision between the laboratory specialists and the clinical professionals of each health facility, since they must be integrated into the dynamics of the services involved. Among the critical values ​​that have been chosen for this review, we have included quantitative parameters, whose processing is carried out in automated hematology analyzers, and morphological findings in peripheral blood smears, which are evaluated by trained professionals.</p> José L. Huerto Aguilar Adrián M. Villaorduña Copyright (c) 1970 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.4616 Incidence of perioperative delirium at the hospital nacional arzobispo loayza, october to December 2021, Lima Peru https://revistas.urp.edu.pe/index.php/RFMH/article/view/5169 <p><strong>OBJECTIVE:</strong> To determine the incidence of perioperative delirium (POD) at the Hospital nacioanl Arzobispo Loayza, from October to December 2021.</p> <p> </p> <p><strong>METHODS:</strong> Qualitative and prospective observational study, carried out in a population of 910 patients, in which the AMT Test Confusion Assessment Method (CAM) and the Pfeiffer questionnaire (Short Portable Mental Status Questionnaire, SPMSQ) were applied. We used Chi<sup>2</sup> to demonstrate the existence of association and Cramer's V and Phi tests to quantify the intensity of said relationship if it existed.</p> <p> </p> <p><strong>RESULTS:</strong></p> <p>Of the total of patients (910), 18.46% presented perioperative delirium. Sex and religion do not influence this. Age does influence the presentation of POD since 50% (145) of the patients 61 years of age or older presented it, unlike those between 36 -60 years of age only 5.31% and those of 18 - 35 only 0.88% presented POD. According to the level of education: 100% with no education, 73.1% with primary education, 18.5% with secondary education and 5.8% with higher education, presented DPO.</p> <p>According to the anesthetic technique, POD was found in 28.9% (60) of the spinal type with sedation, 22.4% (11) of the epidural type with sedation, 16.7% (83) of the General TIVA TCI type, 12.9% (4) of the Block type with sedation, 9.5% (10) of the General balanced type; for the types of general anesthesia manual TIVA, General Multimodal and Spinal anesthesia without sedation there were no cases of POD. According to the operative time: 100% (9) of the patients with more than 6 hours of operative time, 27.1% (38) of the patients who have 3 to 6 hours of operative time and 16.5% (121) of the patients who have 1 to 3 hours of operative time presented cases of POD.</p> <p> </p> <p>According to hospitalization time prior to surgery: 48% (36) of patients with hospitalization time of 16 to 30 days, 20.5% (26) of patients with hospitalization time of 8 to 15 days and 16% (97) of the patients with hospitalization time of 3 to 7 days presented POD. According to the presence of comorbidities: 51.6% (16) with AHT and RD, 41.7% (30) with Diabetes and 40.8% (20) with AHT and DM2 present POD.</p> <p> </p> <p> </p> <p>According to the presence of dementia: 100% (6) of the patients with a history of dementia and 17.9% (162) of the patients with no history of dementia presented POD. According to psychiatric history, 68.4% (13) of those who did have a history of psychiatric disorder and 17.4% (155) of those who did not have a history of psychiatric disorder presented POD. According to history of psychiatric treatment: 100% (6) of those who do have a history of treatment and 17.9% (162) of those who do not have a history of psychiatric treatment presented POD. According to the pre-surgical and post-surgical PFEIFFER questionnaire: 100% of those with mild, moderate or severe cognitive impairment according to the PFEIFFER PRE QX questionnaire presented POD. According to diagnosis of pre-surgical and post-surgical delirium: 100% presented POD.</p> <p> </p> <p><strong>CONCLUSIONS:</strong> There is no association between sex and religion and the presentation of POD. If there is an association between age, educational level, type of anesthesia, operative time, hospitalization time prior to surgery, comorbidities, history of dementia, history of psychiatric disorder, history of psychiatric treatment, pre-, post-surgical Pfeiffer questionnaire, pre-surgical delirium and post-surgical delirium and the presentation of POD,</p> Carlos G. Siu Wong Norma A. Saavedra Vargas Aida M. Arredondo Malca Nataly D. Mostacero Montalvo Isabel Vásquez Suyo Julio A. Ravines Villanueva Gina M P. Altamirano Arauco Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5169 Factors interfering screening for gynecological cancers in peruvian women https://revistas.urp.edu.pe/index.php/RFMH/article/view/5170 <p><strong>Objective:</strong> To identify the factors associated with the interference of gynecological cancer screening in women aged 25-69 years, according to the Demographic and Family Health Survey (ENDES) for the years 2019 and 2020.</p> <p><strong>Materials and methods:</strong>&nbsp; Quantitative, observational, analytical cross- sectional study. It was a secondary database analysis obtained by ENDE for the years 2019 and 2020. Generalized linear Poisson family crude and adjusted models were used to estimate the association. The measure of association. The measure of association used was the adjusted prevalence ratio (Rpa) with 95% confidence interval (95% CI).</p> <p><strong>Results:</strong> We worked with a total of 18,113 women aged 25-69 who were interviewed at the ENDES 2019-2020. In the descriptive analysis, it is observed that 19.3% did not take a PAP smear (PAP) and 53.6% did not perform “screening for breast cancer”. Women with a primary education level have 19% and 58% more opportunities to present interference for taking PAP and screening for breast cancer respectively (RPa: 1,19, 95% CI 1.08-1,31 and RPa:1.58, 95% CI 1:51 – 1:64).</p> <p>Living in the jungle increases 56%and 20%more chance of presenting interference for taking PAP and screening for breast cancer respectively (RPa: 1.46, 95% CI 1.42-1.71 and RPa: 1.20, 95% CI: 1.15- 1.25). The level of knowledge increases the interference for taking PAP and screening for breast cancer by 43% and 3% respectively (RPa: 1.43, 95% CI: 1.34- 1.54 and RPa: 1.03, 95% CI:1.00 -1.06)</p> <p><strong>Conclusions</strong>: Sociodemographic, sociocultural and economic factors have a marked influence on the performance of gynecological cancers such as cervical cancer and breast cancer, so it is necessary to implement strategies to promote the prevention of these pathologies.</p> Carmen M. Silva-Lopez Wilder Rodrigo-Alvarado Rubén Espinoza-Rojas Manuel Loayza Alarico Patricia Segura-Nuñez Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5170 MAYTENUS MACROCARPA “Chuchuhuasi” decrease the fertility and sperm quality in mice https://revistas.urp.edu.pe/index.php/RFMH/article/view/5115 <p><strong>Introduction</strong><em>: Maytenus macrocarpa</em> (MM) "Chuchuhuasi" is a native plant from the Amazon region of South America, widely used in traditional medicine due its anti-inflammatory, analgesic and anti-tumor properties. However, its effects on reproductive physiology and male fertility have not been elucidated.</p> <p><strong>Methods:</strong> Preclinical experimental study of cases and controls<strong>. </strong>&nbsp;Male mice with eight weeks from birth were administered orally for 70 days (two spermatogenic cycles) an aqueous extract MM: GC (n = 8) 0 mg / kg body weight (bw) control group and treated group GT (n = 8) 1000 mg / kg bw. Later the animals were euthanized, the reproductive organs were weighted, also motility and sperm count were recorded. During the days 60 or 65 of treatment, males were mated and pregnant females were sacrificed in the fourth day of pregnancy for evaluating development, quality and degree of blastulation.</p> <p><strong>Results</strong>: The weights of reproductive organs did not differ significantly between the two groups (p&gt; 0.05). However, progressive motility (32.81 vs. 15.27 ± 4.17% ± 2.08%) and sperm count (7.75 ± 0.34 x 106 / ml vs. 2.56 ± 0.42 x 106 / ml) decreased significantly between GC and GT, respectively. 87.5% (7/8) of the pregnant mice produced 15 litters (GC) and only 50% (4/8) of the pregnant GT yields 4 litters. However, no significant differences were found in the percentage of blastocyst stage embryos, good quality embryos, or embryos with greater than 50% the size of the embryo between the two groups (p&gt; 0.05) blastoceles.</p> <p><strong>Conclusion</strong>: the aqueous extract of Maytenus macrocarpa (1000 mg/kl) could have possesses anti-reproductive action in male mice.</p> Jonathan Vásquez Cavero Pilar Pino Velásquez José Gonzáles Daga Eduardo Pulido-Murillo José L. Pino Gaviño Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5115 Association between anxiety and depression in Medical students at Universidad Ricardo Palma during the year 2021 https://revistas.urp.edu.pe/index.php/RFMH/article/view/4842 <p>The mental health of medical students around the world has been affected by the presence of anxiety and depression. According to the World Health Organization, more than 260 million people suffer from anxiety and approximately 300 million people suffer from depression.</p> <p><strong>Objective</strong>: To determine the association between anxiety and depression in medical students at Ricardo Palma University during the 2021-II academic year.</p> <p><strong>Materials and Methods</strong>: Observational, analytical, cross-sectional and quantitative study. From a population of 2046 medical students from the first to the seventh year of studies, the size of the sample obtained was 110 students. The data obtained was collected through Google Forms.</p> <p><strong>Results</strong>: Of the medical students, 85.46% manifested some degree of anxiety and 50% manifested some degree of depression. These pathologies occurred more frequently in the female sex, low socioeconomic level and in those who had clinical courses. A statistically significant association was found between anxiety and depression (p: 0.038), and between low socioeconomic status and depression (p: 0.004). No statistically significant association was found between female sex and depression, nor between pre-clinical courses and depression.</p> <p><strong>Conclusions</strong>: High prevalences of anxiety and depression were found in medical students at the Ricardo Palma University. In addition, a statistically significant association between anxiety and depression was evidenced (p: 0.038). For this reason, it is recommended to implement a psychological accompaniment throughout the medical university career.</p> Mashiel Leiva Nina Sonia Indacochea Cáceda Luis A. Cano Mariela Medina Chinchon Copyright (c) 1970 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.4842 Hypertriglyceridemic waist and arterial hypertension in adults: a systematic review and meta-analysis https://revistas.urp.edu.pe/index.php/RFMH/article/view/5092 <p><strong>Objective:</strong> To develop a systematic review and meta-analysis to determine the association between hypertriglyceridemic waist (CHTG) and arterial hypertension (HBP) in adults.</p> <p><strong>Materials:</strong> The present study is a systematic review (SR) with meta-analysis of analytical cross-sectional observational studies. Search strategies will be used in different databases, which will be Pubmed, SCOPUS, Web of Science, Embase. The qualitative analysis was presented in a table with the characteristics of each study. For quantitative analysis, random-effects meta-analysis was performed due to the heterogeneity of the studies. These variables were compared using Odds Ratios (OR) as a measure of association with their corresponding 95% confidence interval.</p> <p><strong>Results:</strong> Five studies were included for statistical analysis. Overall, a statistically significant association was found between both variables (OR: 1.36; 95% CI 1.07 to 1.71). In turn, there was a high heterogeneity (I squared 92%).</p> <p><strong>Conclusions:</strong> This SR found that CHTG is associated with the presence of hypertension. However, given the few studies found, it is recommended to carry out more primary studies with a prospective design before carrying out a next SR on the subject, and with standardized cut-off points to make a more homogeneous comparability.</p> Jacqueline M. Reyes Gamonal Robert Malpartida Palomino Fiorella E. Zuzunaga-Montoya Jenny R. Torres-Malca Alfredo J. Chiappe Gonzalez Víctor J. Vera-Ponce Jhony A. De La Cruz-Vargas Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5092 Post-infection sequelae by COVID 19 in patients at Hospital I Florencia de Mora. Trujillo, Peru. https://revistas.urp.edu.pe/index.php/RFMH/article/view/5045 <p><strong>Objectives:</strong> To identify post COVID-19 sequelae in patients with medical discharge for this pathology.</p> <p><strong>Methods:</strong> A prospective descriptive study was conducted between the second and fourth quarter of 2021 with a population of 330 patients diagnosed with COVID-19. Baseline was established at the beginning of the study, followed by follow-up and control consultation to identify post-COVID-19 sequelae and to perform control spirometry.</p> <p><strong>Results:</strong> The frequency of COVID-19 was 29.78% (330 cases/1108 attended). The 43.94% of positive cases were in the 40-59 years age group, 28.8% (95/330) referred as comorbidity: cardiovascular disease, diabetes mellitus II and bronchial asthma. Post COVID-19 sequelae predominated: respiratory (61%), musculoskeletal (43%) and neurological (20%), with dyspnea, dorsalgia and headache, respectively. The duration of sequelae ranged from 21 days to seven months, spirometry showed a mild restrictive pattern in patients aged 41 to 50 years, all female.</p> <p><strong>Conclusions:</strong> It is important to identify post-COVID-19 sequelae for treatment to recover the integral health of individuals.</p> Evelyn del Socorro Goicochea Ríos Ofelia M. Córdova Paz Soldán Néstor I. Gómez Goicochea Jessica Vicuña Villacorta Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5045 Clinical-epidemiological and treatment characteristics of children with COVID-19 in a tertiary referral center in Perú https://revistas.urp.edu.pe/index.php/RFMH/article/view/5094 <p><strong>Introduction: </strong>The COVID-19 pandemic has a great impact on children's health. This study describes the characteristics of hospitalized children at the San Borja National Children's Health Institute in Perú.</p> <p><strong>Methods: </strong>This was a retrospective study of patients with a confirmed diagnosis of COVID-19 from March to July 2020. Demographic, clinical, laboratory, radiological, and treatment information were collected. Data analysis included descriptive statistics and bivariate analysis to determine differences between patients in general wards and the intensive care unit (ICU).</p> <p>&nbsp;</p> <p><strong>Results: </strong>We included 91 patients, 33 being females (36.3%). The most affected age group was children &gt; 2 years of age (63 cases) with a median age of 6 years (IQR 3-10), and 61.5% were from Lima. The previous contact was determined in 30.8% of cases. A positive SARS CoV-2 PCR result was obtained in 50.6%. The presence of comorbidity was 53.8%. The most frequent symptoms were: fever (39.6%), general malaise (23.1%), cough (19.8%), and respiratory distress (14.3%). The presence of multisystem inflammatory syndrome in children (MIS-C) was confirmed in 6 patients. Antibiotics were administered in 76.9%. The most frequent radiological pattern was bilateral interstitial infiltrates (57.7%). Mortality was higher in patients in the ICU than in the hospitalization ward (27.3% vs. 4.3%, respectively; p = 0.020)</p> <p>&nbsp;</p> <p><strong>Conclusions: </strong>COVID-19 in children presents mild and moderate clinical manifestations. The presence of comorbidity is an important factor for hospitalization, and mortality is high upon admission to critical care units.</p> Christian Chiara Chilet Medalit Luna Vilchez Julio Maquera Afaray Blanca Salazar Mesones Diana Portillo Alvarez Ramiro Priale Miranda Franklin Mendoza Aldo Munayco Perez Mitsi S. Abal Jose W. López Revilla Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5094 Limited periauricular facelift how to deal with short scar: a technical contribution https://revistas.urp.edu.pe/index.php/RFMH/article/view/5172 <p>Facelift, currently, is one of the most demanded aesthetic procedures and considered as the Ultimate Facial Rejuvenation Surgery. The purpose of this present technique is to offer an alternative surgical procedure of reduced scars, limited to the peri-auricular area, easily reproducible, without the need of extended incisions far beyond the retro-auricular sulcus neither the need of flaps for the temporal region. Our technique is based on a block reposition of the pre auricular area, cervical flaps movilization and rotation of a retro auricular flap, avoiding flaps and incisions in the temporal and occipital region; therefore, minimizing visible scars (occipital pre-pilose scar), wide-tissue undermining, and in addition reducing the risk of damaging nerve structures with less recovery time for our patients, achieving natural and long lasting results.</p> Patricio Centurion Rivas Cynthia Montenegro Mirez Gerardo Ramos Masson Gonzalo Caballero calixto Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5172 Effects of high intensity-interval training on cardiovascular risk, body mass index and metabolic markers in healthcare workers https://revistas.urp.edu.pe/index.php/RFMH/article/view/4892 <p><strong>Background and Objectives</strong>: The obesity epidemic in Mexico has caused a health crisis. This places great importance in the identification of useful methods to manage it across all populations. In this present study we evaluate the effect of high intensity interval training in healthcare workers.</p> <p><strong>Materials and Methods</strong>: An intervention was carried out that consisted in 60 sessions of high intensity interval training during a 12 week period aimed at health care workers working at the General Hospital in Montemorelos, Mexico. Variables regarding body composition, cholesterol and arterial blood pressure were evaluated for each individual both before and after the intervention. Pearson coefficients were estimated between the initial and final values.</p> <p><strong>Results:</strong> 8 participants were included, 55.6% men aged 32.8 ± 10.9 years with a BMI of 31.69 ± 2.9. A statistically significant difference was found between the initial and final values ​​of weight, BMI, total cholesterol, mean arterial blood pressure, and cardiovascular risk at 10 years.</p> <p><strong>Conclusions:</strong> These results reveal a significant decrease in our variables related to obesity in healthcare workers after a HIIT intervention in an uncontrolled setting. We recommend the further implementation of similar studies with greater sample size, intensity and duration to target obesity which is the root cause of chronic non-communicable diseases. Further studies are required to confirm the effect of this intervention in the prevention, treatment of obesity in health care workers and to describe its long term effects.</p> Alejandro D. Gracida Hernandez Gadi J. Gonzalez Zavala Luis M. Renteria Ramirez Jacqueline E. Cervantes Escamilla Amin A. Valencia Leal Copyright (c) 1970 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.4892 Clinical, biochemical, endoscopic and histopathological evaluation of biological treatment in ulcerative colitis https://revistas.urp.edu.pe/index.php/RFMH/article/view/4995 <p><strong>Background:</strong> Biological treatment is currently used as an alternative for the treatment of ulcerative colitis in patient’s refractory to conventional treatment.</p> <p><strong>Objective:</strong> To evaluate biological treatment in patients with ulcerative colitis refractory to conventional treatment in a 3<sup>rd</sup> level care Hospital.</p> <p><strong>Methods:</strong> A descriptive, retrospective, longitudinal study was carried out in patients with UC who were refractory to conventional treatment and who received biological treatment. The variables were evaluated in 3 moments: <em>basal state</em> (without biological treatment), at <em>six</em> and <em>twelve</em> <em>months</em> from the start of biological treatment. Descriptive statistics were used to characterize general population, later the 3 states mentioned above were described with their respective variables.</p> <p><strong>Results:</strong> Eighteen patients with a mean age of 41.2 years were included. Evaluations at baseline and at 6 and 12 months showed: presence of blood in stools and abdominal pain in 94.4%%, 22.2% and 11.1% respectively; hemoglobin concentration &gt;10.5 g/dl in 50%, 83.3% and 88.9%; serum albumin concentration &gt;3.2 g/dl in 72.2%, 83.3% and 88.9%; the visual Mayo endoscopic scale 38.9%, 33.3% and 16.7% presented Mayo 2 and 61.1%, 16.7% and 1.7% Mayo 3. The histological activity in the baseline evaluation reached a severe level (11.1%), while in evaluations at 6 and 12 months they reached moderate in 55.6% and 27.8% respectively.</p> <p><strong>Conclusions:</strong> Biological therapy as a treatment in patients with ulcerative colitis showed improvement in clinical, biochemical, endoscopic and histological manifestations, so far none with deep remission of the disease, no adverse reactions to treatment have been presented.</p> Carlos A. López-Bernal Arturo García-Galicia Francisco J. Quezada-Juárez Moisés F. Rojas-Illanes Briseida Rubio-Martínez Álvaro J. Montiel-Jarquín Ingrid Jiménez-Luna Jorge Loria-Castellanos Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.4995 Association between the anatomical profile and the severity of Obstructive Sleep Apnea in a sample of Peruvian patients. https://revistas.urp.edu.pe/index.php/RFMH/article/view/5069 <p><strong>Introduction</strong>: Obstructive Sleep Apnea (OSA) is the total or partial limitation of the passage of air through the upper respiratory tract during sleep, it has two forms of presentation: central and obstructive (related to anatomical profile).</p> <p><strong>Objective</strong>: To determine the relationship between the anatomical profile and severity of Obstructive Sleep Apnea in adult patients of a Private Clinic in Lima Norte, Lima, 2020-2022.</p> <p><strong>Methods</strong>: Cross-sectional analytical study. We used medical records of patients diagnosed with OSA during the period 2020-2022 in a private clinic in Lima, Peru. Our variable was the severity of OSA, in addition to apnea-hypopnea per hour (AHI), in addition we also took oxygen desaturation index (ODI), Epworth Scale, CT90%, body mass index (BMI), minimum saturation and snoring and of the newborn reported in the clinical history. The response variable was OSA .</p> <p><strong>Results:</strong> a total of 120 clinical histories were studied. The predominant OSA was mild (29.2%), followed by very severe (26.7%). In very severe OSA, patients with retrognathia had 3.0 higher frequency, those with long face had 30.0 lower frequency and those with short face had 4.0 higher frequency, compared to patients with normal face (40 vs 7 vs 41 vs 37; p&lt;0.01).</p> <p><strong>Conclusions:</strong> OSA is associated with the anatomical profile. The ANGLE scale was the one most associated with OSA compared to the Friedman Score. OSA was associated with BMI, IDO, minimum saturation, and maximum heart rate.</p> Wendy E. Quispe Sapacayo Violeta M. Valdez Pajuelo Rocio del Pilar Ramírez Campos Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5069 Scales SOFA and qSOFA as prognosis of mortality in patients diagnosed with sepsis from a Peruvian clinic https://revistas.urp.edu.pe/index.php/RFMH/article/view/5066 <p><strong>Introduction: </strong>Sepsis is a clinical condition that seriously threatens the body’s balance and is still a significant cause of death. Therefore, clinical management is aimed at a timely classification and implementation of emergency measures based on systems of scales for detection that helps reduce complications in patients. That is the importance of using SOFA (Sequential Organ Failure Assessment) and qSOFA (quick SOFA) in the different services for hospitalized patients.</p> <p><strong>Objective: </strong>To evaluate the usefulness of SOFA and qSOFA scale as a predictor of mortality in patients with sepsis hospitalized in the intensive care unit (ICU) of the Good Hope Clinic from January to December 2015.</p> <p><strong>Materials and methods: </strong>Retrospective study of adult patients hospitalized in ICU/NICU with sepsis diagnoses. Epidemiological, clinical, and laboratory data were collected to apply the SOFA and qSOFA scales. We performed a description of the variables studied, an analysis of the variables, and the scoring systems compared in the ROC curve.</p> <p><strong>Results: </strong>The main infectious focus was respiratory (41.5%). The patients died was 28.3%. The variables serum creatinine and lactate were statistically significant with OR = 11.67 (95% CI 2.58-52.85, p&lt;0.001) and OR = 5.78 (CI 95% 1.45-23.03, p = 0.009), respectively. The AUC for SOFA was 0.698, p = 0.026, 95% CI (0.54-0.85), showing to be statistically significant. A cutoff point of 7.5 was found with a sensitivity of 46.7% and 86.8% specificity. QSOFA did not show a statistically significant association.</p> <p><strong>Conclusions:</strong> The SOFA scale showed a probability of death in patients with sepsis admitted to ICU/NICU.</p> Ottavia Scarsi-Mejia Katerine M. Garcia-Moreno Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-21 2022-10-21 22 4 10.25176/RFMH.v22i4.5066 Peruvian cultural diversity: Ally or enemy of mental health? https://revistas.urp.edu.pe/index.php/RFMH/article/view/5251 <p><strong>Sr. Editor</strong></p> <p>El Perú cuenta con 4 millones de personas pertenecientes a pueblos indígenas u originarios <sup>1</sup>; en donde la salud, entendida como un derecho fundamental que debe ser garantizado para todos y de manera integral, aún presenta obstáculos para ser otorgada de manera equitativa e intercultural.</p> <p>La situación mental, fundamento primordial de la salud, está definida como un estado de bienestar en el que la persona es capaz de hacer frente al estrés normal de la vida, de trabajar de forma productiva y de contribuir a su comunidad.<sup>2</sup> Cabe resaltar que este concepto va a estar influenciado por diferentes determinantes biológicos y sociales, en especial por la cultura, los indicadores de pobreza y el bajo nivel educativo. <sup>2</sup></p> Athenas P. Ortiz-Melgar Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-11-07 2022-11-07 22 4 10.25176/RFMH.v22i4.5251 The pandemic's blow to mental health in college students. https://revistas.urp.edu.pe/index.php/RFMH/article/view/4294 <p>The pandemic's blow to mental health in college students.</p> Rossi L. Lacuta Borda Copyright (c) 1970 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-11-07 2022-11-07 22 4 10.25176/RFMH.v22i4.4294 Dating apps are an impact on young people's sexual health https://revistas.urp.edu.pe/index.php/RFMH/article/view/3982 <pre id="tw-target-text" class="tw-data-text tw-text-large XcVN5d tw-ta" dir="ltr" data-placeholder="Traducción"><span class="Y2IQFc" lang="en">With the proliferation of apps, increased use of these apps can make it easier to find casual sexual partners, resulting in unsafe sexual practices. It was identified if dating applications favor risky behaviors in young people over 18 years of age. A systematic review was carried out using articles in English and Spanish published from November 1, 2014 to November 19, 2020 on the search sites PubMed, Scielo, Google Scholar. Of the 35 articles found, 22 articles were discarded because they did not meet our criteria for combinations of keywords in the title or abstract. Thirteen studies were included for this study. Reviewing the information obtained in the research does not reach any conclusion about whether seeking sexual partners through dating applications leads to sexual risk behaviors to contract STIs / HIV. Even so, more studies are needed with a heterosexual population since it has been frequently described in MSM populations, requiring more studies, especially national studies, to better characterize risk behaviors.</span></pre> Milagros del rocio Vallejos-Gonzales Copyright (c) 1970 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-11-07 2022-11-07 22 4 10.25176/RFMH.v22i4.3982 Gastric Adenomyoma in adult a case report. https://revistas.urp.edu.pe/index.php/RFMH/article/view/4762 <p><strong>Objective: </strong>Report the clinical case of Gastric Adenomyoma as etiology of pyloric syndrome.</p> <p><strong>Clinical case:</strong> We present a 52 years old man who attended the emergency room due pyloric syndrome and who underwent a distal gastrectomy. The pathological report revealed a gastric adenomyoma with ulcerative lesion.</p> <p><strong>Discussion: </strong>This pathology is an unusual finding, and the literature describe it with extremely low rate of malignant transformation.</p> <p><strong>Conclusion: </strong>Gastric adenomyoma is a infrequent pathology and should be taken into account when endoscopic studies are not enough to determine the etiology of a pyloric syndrome.</p> Pedro L. Zamora Gonzales José Somocurcio Peralta Carmen E. Yagui Uku Ronald A. Goicochea Copyright (c) 1970 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.4762 Portal thrombosis in antiphospholipid syndrome: Case report https://revistas.urp.edu.pe/index.php/RFMH/article/view/4746 <p>Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by arterial, venous, or small vessel thrombosis and recurrent early pregnancy loss, fetal loss, or pregnancy morbidity in the context of persistent antiphospholipid antibodies. Characterized by the development of multiple thrombotic manifestations, simultaneously or within a short period of time; being portal vein thrombosis (DVT) a rare and serious clinical manifestation and a predictor of poor prognosis.The case of an elderly patient with abdominal pain and portal vein thrombosis associated with APS with antithrombotic treatment and analgesics of favorable evolution is presented.</p> Elkin J. Pelaes Cruz Yomayra S. Chigne Castro Wagner B. Rios Pereda Yran E. Rebaza Castillo Magaly del Pilar Rodríguez Raza Brooke M. Rodríguez Cárdenas Camilo F. Peña-Quispe Copyright (c) 1970 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-17 2022-10-17 22 4 10.25176/RFMH.v22i4.4746 Near-fatal asthma as clinical manifestation in onset diabetic patient: Case report https://revistas.urp.edu.pe/index.php/RFMH/article/view/4751 <p>Near-fatal asthma (NFA) is defined as the most severe form of asthma characterized by a refractory asthma attack with an arterial carbon dioxide tension (PaCO2) greater than 45 mmHg and altered consciousness, requiring mechanical ventilation. We reported the case of 40-year-old female patient, obese and asthmatic with irregular treatment who presented dyspnea accompanied by severe oppressive chest pain and loss of consciousness, with generalized cyanosis and severe shortness of breath, for which she underwent emergency endotracheal intubation and mechanical ventilation. Laboratory tests show decompensated respiratory acidosis, glycemia of 258 mg / dl and HbA1C of 7.94%; her diagnosing diabetes mellitus. Asthmatic patients with type 2 diabetes mellitus who have irregular treatment for both diseases are at increased risk of manifesting near-fatal asthma.</p> César A. Chávez Paredes Cristel Castillo Huerta Alicia E. Chavez Cerna Anthony F. Gutiérrez Salcedo Katerine J. Hilario Vásquez Eduardo R. Lam Cabanillas Arnold F. Rodríguez Benites Copyright (c) 1970 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.4751 Decreasing hypoglycemia unawareness in a patient with type 1 diabetes mellitus after continuous glucose monitoring: tools for self-care. https://revistas.urp.edu.pe/index.php/RFMH/article/view/5046 <p>Diabetes mellitus is a public health problem that causes early and late complications. Continuous glucose monitoring (CGM) has become the main technological tool for real-time glycemic control and has the potential to prevent complications. However, its use has not spread in low- and middle-income countries.</p> <p>We present the experience in the management of a patient with type 1 diabetes with hypoglycemia unawareness in whom the use of real-time CGM achieved both: less hypoglycemic episodes and optimization of insulin regimen.</p> <p>The benefit of real-time CGM in addition to the use of analog insulins and diabetes education resulted in better metabolic control. CGM is a useful tool to consider in patients with hypoglycemia unawareness and to minimize the risk of complications in the future.</p> Sonia H. Perez Cavero Helard Manrique-Hurtado Julio Leey-Casella Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-17 2022-10-17 22 4 10.25176/RFMH.v22i4.5046 Xanthogranulomatous appendicitis; a diagnostic challenge: Clinical Case https://revistas.urp.edu.pe/index.php/RFMH/article/view/5184 <p><strong>Introduction:</strong> Xanthogranulomatous inflammation is a chronic inflammatory process, rarely located in the appendix. A case of xanthogranulomatous appendicitis is presented.</p> <p><strong>Clinical case</strong>. A 77-year-old male presents with intermittent pain in the right hemiabdomen and hyperthermia of one month's evolution. Physical examination showed a tumor in the iliac fossa and right abdomen. He underwent surgery for a probable incarcerated right inguinal hernia, acute perforated appendicitis was found, with inflammation and adhesions, purulent fluid in the right hemiabdomen and abdominal wall dissection. The histopathological result was xanthogranulomatous appendicitis. The evolution of the patient was favorable.</p> <p><strong>Conclusion</strong>. Xanthogranulomatous appendicitis simulates a typical picture of acute appendicitis. Histopathologically, pathologies such as Crohn's disease, malacoplakia and tuberculous appendicitis were ruled out.</p> Alan A. Hernández-Morán Gisela Alonso-Torres Álvaro J. Montiel-Jarquín Claudia T. Gutiérrez-Quiroz Nancy R. Bertado-Ramírez Arturo García-Galicia Sandra Maldonado-Castañeda Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-13 2022-10-13 22 4 10.25176/RFMH.v22i4.5184 Charcot neuroarthropathy: Differential diagnosis of monoarthritis of the knee in patients with type 2 diabetes mellitus https://revistas.urp.edu.pe/index.php/RFMH/article/view/5107 <p>A 46-year-old man with long-standing, poorly controlled diabetes is hospitalized for right knee monoarthritis after trauma. His clinical evaluation found joint deformity, synovitis in the right knee and absence of multiple toes due to a history of amputation. With the radiological evaluation that showed bone destruction and the synovial fluid analysis that ruled out infectious causes and microcrystal arthritis, the diagnosis of Charcot neuroarthropathy of the knee was made. Conservative management was indicated with the use of a felt insole for unloading and the use of a walker, the case being followed up to define behavior according to evolution. Despite being rare, it is important to consider Charcot neuroarthropathy in all diabetic patients with monoarthritis of the knee, in order to make an early diagnosis and avoid important complications and sequelae, always ruling out infectious causes and arthritis due to microcrystals.</p> Gino Patrón-Ordóñez María Isabel Anticona-Sayán Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5107 Effectiveness of intermittent fasting on biochemical and anthropometric markers in obese adults with cardiovascular risk. A systematic review https://revistas.urp.edu.pe/index.php/RFMH/article/view/5053 <p>Background. Obesity is a problem present in almost all societies, which has led to the search for different methods to combat it. One of them is intermittent fasting (IF), characterized by periods without eating (16 to 24 hours), limited or no caloric intake, combined with normal eating windows. Target. To determine the effectiveness of intermittent fasting on biochemical and anthropometric markers in obese adults. Materials and methods. A systematic review was proposed that postulated to study blinded or open clinical trials of IA interventions, compared with a control group. The response variables were: systolic and diastolic blood pressure, total cholesterol, LDL, HDL and triglycerides, blood glucose, fat mass, weight, waist circumference, BMI and heart rate. The search and identification of studies was masked. The risks of bias for the Cochrane collaboration were assessed. They underwent meta-analysis (random effect), with R 4.0.0. Results. Six studies were included, involving 10-48 weeks of intervention with alternate-day fasting and time-restricted feeding, reporting some statistically significant changes for different variables. Conclusion. Intermittent fasting could intervene in the reduction of cardiovascular risk due to improvement in BMI and biochemical parameters.</p> Miguel Á. López-Espinoza Francisca Osses-Carrasco Francisca Gómez-Zúñiga Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5053 Navigating mysterious lands regarding the predictive value of the SOFA score: the race dilemma https://revistas.urp.edu.pe/index.php/RFMH/article/view/5036 <p>Critical syndromes are conditions that carry a high global burden of disease. Scoring systems are practical and reproducible aids that allow patients with more severe disease to be quickly identified and admitted to intensive care and to initiate structured and aggressive therapy. The Sequential Organ Failure Assessment (SOFA) score is one of the most widely used in the world, as there are several versions and it is simple. However, with the appearance of the COVID-19, several studies showed that there was a disparity in the estimation of mortality and associated outcomes, with respect to race, which culminated in an excess of preventable mortality in certain racial groups. Constant evaluation of the performance of these scoring systems must be performed due to definitional updates, which may vary the accuracy of the predictive value. There is a very large evidence gap in this regard, as the existing studies are from high-income countries where the predominant racial group is Caucasian, which should draw attention to the magnitude of the problem. Based on the above, the objective of this review is to discuss evidence on the performance of critical care scoring systems, particularly SOFA, and the impact that race has had on its predictive value.</p> Ivan D. Lozada Martinez Stefhany Hernandez Muñoz Ailyn Z. Angulo Lara Estefanía Ruiz Benítez Cindy S. Buitrago Almanza Jhon A. Hernández Gallego Laura C. Carreño Mancilla Nathalia C. Ordóñez Veloza Yohan S. Reyes Triviño Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-17 2022-10-17 22 4 10.25176/RFMH.v22i4.5036 Genetic studies to determine the risk of non-ischemic sudden death: review article https://revistas.urp.edu.pe/index.php/RFMH/article/view/5098 <p>Heart disease is the cause of sudden death in more than 80% of cases. Ischemic heart disease is the cause for 90% of all sudden cardiac deaths, while in the remaining 10% of cases, heart diseases have a hereditary origin and comprise a wide spectrum of disorders that include cardiomyopathies and channelopathies. The aim of this review is to highlight the importance of genetic counseling for patients with hereditary cardiovascular disease and its evaluation by a multidisciplinary team.</p> María del Carmen Castro-Mujica Juan C. Gómez de la Torre Jorge E. La Serna-Infantes Daniella Arenas Siles Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.5098 Complications associated with remote work during the COVID-19 pandemic: a rapid review https://revistas.urp.edu.pe/index.php/RFMH/article/view/4806 <p>This review identifies and describes the main outcomes and complications associated with remote work during the COVID-19 pandemic<strong>. </strong>A systematic review of the literature was carried out. This included observational studies whose population or partly carried out remote work, published between March 1, 2020, and November 30, 2020. The descriptors were adapted to MEDLINE (Ovid), EMBASE, Scopus and PsycINFO databases. We found 139 studies; 15 articles were included in this synthesis. A total of 18,818 remote workers were reported, of which women represented between 18.2%-100%. The findings describe the increased use of electronic devices, sedentary lifestyle, anxiety, depression, feelings of loneliness, sleep disorders and the presence of musculoskeletal pain in remote workers. Therefore, it is necessary to provide assistance and education to the remote worker in order to improve their conditions, reduce the associated complications and positively impact their lifestyle.</p> Liliana Cruz-Ausejo Jaime Rosales Rimache Copyright (c) 1970 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.4806 Therapeutic dietary approach to children with autistic spectrum disorder https://revistas.urp.edu.pe/index.php/RFMH/article/view/4729 <p>Autism spectrum disorder (ASD) is a neuropsychiatric disease, characterized by deficits in social communication, presence of restricted interests and repetitive behaviors. This review aims to address the different nutrients that can be included in the diet of patients with ASD in order to reduce the different signs and symptoms present in this disorder. Different bibliographic sources were reviewed, such as PubMed, MEDLINE, ScienceDirect, Embase, and SciELO, using the keywords "Probiotics", "Vitamin B", Vitamin C", "Gluten", “Omega-3" and “Autism Spectrum Disorder”. It was found that probiotics and gluten improve gastrointestinal symptoms and, in addition, like vitamins B6, B9, B12 and C, as well as omega 3, help improve neurobehavioral symptoms, language and social behavior of children with ASD.</p> Franco C. Isla Torres Adán C D. Guerrero Medina Sandro L. Gutiérrez Toribio Kerly K. Julián Guevara Kevyn B. León Risco Juan J. Huamán Saavedra Copyright (c) 1970 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-10-12 2022-10-12 22 4 10.25176/RFMH.v22i4.4729 COP27 Climate Change Conference: urgent action needed for Africa and the world https://revistas.urp.edu.pe/index.php/RFMH/article/view/5247 <p><em>Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change</em></p> <p>&nbsp;</p> <p>The 2022 report of the Intergovernmental Panel on Climate Change (IPCC) paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction, and climate hazards such as heatwaves and floods (1). These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals argued together in 2021—that the rise in global temperature must be limited to less than 1.5<sup>o</sup>C compared with pre-industrial levels.</p> Lukoye Atwoli Gregory E. Erhabor Aiah A. Gbakima Abraham Haileamlak Jean-Marie Kayembe Ntumba James Kigera Laurie Laybourn-Langton Bob Mash Joy Muhia Fhumulani Mavis Mulaudzi David Ofori-Adjei Friday Okonofua Arash Rashidian Siaka Sidibé Abdelmadjid Snouber James Tumwine Mohammad Sahar Yassien Paul Yonga Lilia Zakhama Chris Zielinski Jhony A. De La Cruz Vargas Copyright (c) 2022 Revista de la Facultad de Medicina Humana http://creativecommons.org/licenses/by/4.0 2022-11-02 2022-11-02 22 4 10.25176/RFMH.v22i4.5247