Revista de la Facultad de Medicina Humana

Echocardiographic Monitoring of Anatomical Changes in the Myocardium of Pediatric Patients with a Diagnosis of Non-Compaction Cardiomyopathy. 2017 – 2021

María Loo-Valverde — 2024-10-31

Background:

Non-compaction cardiomyopathy (NCM) is known as the lack of maturation of the myocardium that is evidenced by prominent trabeculations and the presence of recesses in newborns and infants that can manifest clinically as heart failure.

The purpose of the research is to evaluate the anatomical development of pediatric patients diagnosed with NCM at an early age.

Clinical Case: Retrospective case series study of patients diagnosed with non-compaction cardiomyopathy during the first year of life, confirmed according to Jenni criteria, with echocardiographic follow-up every 6 months, from 2017 - 2021. The patients were diagnosed in the first months of life. life, 3 had associated heart disease, 3 had arrhythmias, 3 died and 1 abandoned the controls at 2 months of age. In the 3 patients who remained, it was evident that the ratio of non-compacted myocardium (NC) / compacted myocardium (C) only remained high in 1 patient. The ejection fraction (EF) improved in all patients, the number of trabeculae only decreased in one patient.

Conclusions: Anatomical changes in patients diagnosed with non-compaction cardiomyopathy can evolve to myocardial maturation and improvement in ventricular function.

Content validity by expert judgment of the NIOSH Worker Well-Being Questionnaire in Spanish for measuring Well-being in wildfire fighters in Mexico

Esmeralda Alcaraz Sánchez — 2024-10-31

Introduction: Firefighting in forests is a dangerous and demanding task, highlighting the need to understand the well-being of these workers through tools such as the NIOSH Worker Well-Being Questionnaire in Spanish. However, this questionnaire has not been adapted and validated for the Mexican context.

Objective: The study aimed to validate the NIOSH Worker Well-Being Questionnaire in Spanish for forest firefighters in Mexico.

Methods: A psychometric design was used, including content validation through expert judgment in validation, health, and work activities related to firefighting. The questionnaire incorporates five domains with a Likert scale, and the Aiken's V coefficient was used for validation.

Results: Most items in the questionnaire showed an Aiken's V coefficient above 0.70, with 95% confidence intervals, indicating high content validity. There was concordance with the original validation of the instrument, enabling its application in the Mexican work context.

Conclusion: The expert validation confirmed the relevance, coherence, and clarity of the NIOSH Worker Well-Being Questionnaire in Spanish for forest firefighters in Mexico. This analysis is a critical component of a broader project, laying the groundwork for subsequent stages including a pilot test and factorial analysis, as well as contributing to improving the safety and quality of life of these workers.

Description of oral intake initiation with coffee in patients undergoing lower gastrointestinal surgery

Álvaro José Montiel-Jarquín — 2024-10-31

This study explored the effects of coffee in patients undergoing lower gastrointestinal surgery. In an observational study involving fourteen patients aged over 18, coffee was administered three times daily, and its impact was evaluated on variables such as time to first bowel movement, tolerance to solid foods, and hospital stay. The mean age was 51.7 years, the average surgical time was 257.3 minutes, and the mean blood loss was 250 ml. Results showed a mean time of 4.5 hours for the first bowel movement, 18 hours for tolerance to solid foods, and 2.5 days of hospital stay. Only 8.3% of patients developed postoperative ileus. It is concluded that these patients experienced short times to the onset of bowel sounds, gas passage, and effective evacuation. Although encouraging, these results should be interpreted with caution and confirmed through larger controlled studies.

Benefits of adjuvant chemotherapy on pT1N0M0 triple-negative breast cancer survival outcomes

Zaida Morante — 2024-10-31

Introduction: Triple-negative breast cancer (TNBC) is notably an aggressive breast cancer (BC) subtype, leading to early relapse and poor prognosis. Effects of adjuvant chemotherapy among early-stage TNBC (pT1N0M0) patients remain unclear in different populations. Objectives: Our study aimed to determine the impact of adjuvant chemotherapy on overall survival (OS) and progression-free survival (PFS) within the specific subset of Peruvian pT1N0M0 TNBC patients (pT1a/b vs. pT1c). Methods: We retrospectively analyzed 2007 TNBC cases diagnosed between 2000-2014 at the Instituto Nacional de Enfermedades Neoplásicas (Lima, Peru). We included only non-metastatic TNBC cases and classified them as pT1N0M0 after surgery. TNBC patients who underwent neoadjuvant chemotherapy were excluded. We describe our population according to the tumor size from the residue disease (pT1a/b vs. pT1c). We used the Kaplan-Meier method test to determine differences in survival curves for OS and PFS. A Univariate Cox proportional hazards model was used to identify risk factors for PFS. Results: Our study cohort included 124 TNBC patients. Around 65.3% (n=81) were undergoing adjuvant chemotherapy. Notably, among pT1c patients, this treatment was more prevalent compared to pT1a/b (72.1% vs. 50.0%). Survival analysis showed no significant OS benefit from chemotherapy (HR:2.46,95%CI:0.74-8.13,p=0.13). However, a marked improvement in PFS was noted exclusively in the pT1c subgroup, with patients not treated with chemotherapy offering a prognostic risk (HR:20.10,95% CI:5.54-73.10,p<0.0001). pT1a/b patients demonstrated no benefit from chemotherapy regarding progression (HR:3.07,95% CI:0.27-34.50,p=0.34). Conclusion: Our study highlights that adjuvant chemotherapy significantly improves PFS in pT1cN0M0 TNBC patients but shows no clear benefit for smaller tumors (pT1a/bN0M0). Future research should focus on personalized chemotherapy strategies in early-stage TNBC to identify predictive markers for survival.

Factors associated with complicated acute appendicitis in a Peruvian pediatric emergency hospital

Alberto Manuel Cruz-Zarate — 2024-10-31

Introduction: A common onset of acute abdomen that requires a quick operation is appendicitis, since it is more frequent in males than in females, affecting pediatric patients and adolescents from 10 to 20 years of age. There is obstruction of the appendicular lumen, due to fecaliths, hyperplasia of the lymphoid follicle, parasites and primary type carcinomas. Children do not express what they feel and this increases the risk of complications. Objectives: To determine the risk factors associated with complicated acute appendicitis in pediatric patients at the Pediatric Emergency Hospital for the period 2019-2021 Methodology: The study design is analytical, observational, retrospective of cases and controls through data collection from clinical histories and operative reports. Results: A relationship was seen with the following variables: leukocytosis (adjusted OR=2.79 CI=0.95; 1.30 – 6.01 p=0.008), time it takes to go to a major emergency at 24h (adjusted OR=1.72; IC=0.95 1.21-2.45; p=0.003), time from appearance of the first symptom until the surgical act between 24 to 48 hours (adjusted OR=2.25 ; CI=0.95 , 1.14-4.44; p=0.018 ), greater than 49 hours (adjusted OR =3.01; CI:0.95 1.54-5.93 ; p=0.001) with the possibility of developing AAC.

Conclusions: The factors related to developing AAC are high leukocyte count, delay in emergency greater than 24 hours, appearance of the first symptom until the surgical act between 24 to 48 hours and greater than 49 hours.

Microbiological profile of antimicrobial sensitivity and resistance in a general hospital in the Peruvian jungle 2021

Jose Amado — 2024-10-31

Introduction: Antimicrobial resistance increases hospital mortality and is a public health problem. Objective: to determine the characteristics of microorganisms isolated from hospitalized patients and to detail antimicrobial sensitivity profiles. Methodology: cross-sectional study Cross-sectional study in a hospital in the Peruvian jungle during 2021. The type of microorganism, antimicrobial sensitivity (VITEK ® 2 bioMérieux), source of isolation, patient age and hospitalization service were identified. Results: 477 positive cultures were included in 453 patients. The samples came from bronchial secretion 54.9%, blood 35.2%, urine 6.5% and others 3.4%. The hospital services of origin were emergency 49.9%, intensive care unit 40.0%, medicine 9.6% and surgery 0.5%. Gram negative bacteria (74.6%), Gram positive bacteria (16.4%) and fungi (9%) were isolated. The most frequently isolated microorganisms were Acinetobacter baumannii complex (32.7%), Klebsiella pneumoniae ssp. (16.8%) and Pseudomonas aeruginosa (13.4%). Antimicrobial resistance for the most frequently isolated microorganisms was: Acinetobacter baumannii complex, XDR in 88.5%; Klebsiella pneumoniae ssp., MDR in 56.3%; Pseudomonas aeruginosa, XDR in 54.7%; Staphylococcus epidermidis, MDR in 92.3%; and Staphylococcus haemolyticus, MDR in 100%. Conclusions: Gram-negative bacteria are the most prevalent, being more affected hospital critical areas, finding a high percentage of antimicrobial resistance.

Implementation of Patient-Specific Quality Control in Radiotherapy Treatments with ArcCheck

Mirko Salomón Alva Sánchez — 2024-10-31

Introduction: Quality control is essential to ensure safety and prevent errors in the administration of ionizing radiation across various radiotherapy techniques. Objective: To evaluate the performance of the ArcCheck detector with the goal of implementing a specific quality control technique for patients treated with dynamic arc therapy. Methods: Fifty patients treated with 6 MV and 10 MV energies on the Clinac® Varian CX were selected. Doses at the isocenter of each treatment plan were analyzed using a PMMA phantom (30 x 30 x 15 cm³) to validate reference values between the treatment planning system and the ionization chamber. The treatment plans were also recreated using the ArcCheck. Results: The mean dose difference at the isocenter was -0.96% and -1.34% for 6 MV and 10 MV, respectively. The average passing rate of the dose distributions in the gamma analysis exceeded 98.0% for both energies. Conclusion: The results demonstrated good concordance with the TG-119 and TG-218 protocols, supporting the use of the detector for quality control in patient-specific treatments.

Knowledge and frequency of use of sunscreen in medical students from a Peruvian university

Luciana Yep — 2024-10-31

Objective: Determine the level of knowledge and frequency of use of sunscreen in g medical students from a Peruvian university.

Materials and methods: Cross-sectional analytical research in 302 students, of both genders and different study cycles. A virtual survey was applied.

Results: High level of knowledge 56%; increased with the study cycle p=0,006. Use of sunscreen was 28,8%, higher in women with 34,5%, it was significantly associated with the level of knowledge p=0,001, but not with the study cycle p=0,065. Mixed skin type (55%) and skin phototype III (58,3%) prevailed. The reason not to use sunscreen was the oily consistency. The question that had more correct answer was ¿Is solar radiation the main cause of skin cancer?.The use of sunscreen was significantly related to phototype p= 0,005.

Conclusions: In the medical students of a Peruvian university, the level of knowledge about the use of sunscreen was high in 56%, higher in women, it increases significantly with the study cycle and favors the use of sunscreen. 28,7% of medical students always used sunscreen. The factors associated with the use of sunscreen were: the female gender, phototype and the level of knowledge.

Concern and fear of covid-19 in Peruvian nurses working in emergency services, 2021

Gabina Mamani — 2024-10-31

Introduction: There are few studies that evaluate the worry and fear of covid-19 in healthcare professionals who work in emergency services in low- and middle-income countries. Objective: To characterize the concern for contagion and fear of covid-19 in Peruvian nurses who work in emergency services. Materials and methods: Comparative descriptive, correlational and cross-sectional study. 212 nurses were surveyed in 2021. The correlation coefficient of Pearson and ANOVA test were used. Results: Regarding concern, 41% often think about the probability of getting infected, 45.3% consider that it affected their state of mind, but 82.5% estimated that they had not affected their work abilities. On the other hand, 34.4% strongly agree that they are very afraid and 35.3% are very afraid of losing their lives. In addition, the comparative analysis by item reported that women, those who do face-to-face work, and those who had not received vaccinations show a lower frequency in some items of concern; while men, who do face-to-face work and who have only one dose of the vaccine, have a higher frequency in the fear items. Discussion: The results refer us to a problem little studied in Latin America and makes it possible to understand that nurses are emotionally affected by sanitary conditions. Conclusions: The nurses who work in the emergency services present a medium level of both concern about contagion and fear of COVID-19.

Evaluation of teletherapy and brachytherapy scenarios in three materials comparing two Monte Carlo simulation systems

Paola Zelbrasikowok-Ramon — 2024-10-31

Introdução: Os tratamentos de radioterapia exigem que se garanta a igualdade entre a dose prescrita e a dose entregue ao paciente, sendo a dosimetria utilizada para essa análise. Entretanto, nas técnicas de braquiterapia, um alto gradiente de dose é encontrado em regiões próximas à fonte, tornando a dosimetria experimental complexa. Dessa forma, a simulação de Monte Carlo é recomendada para atender a essa demanda. Objetivo: Dessa forma, este estudo analisou a resposta de dois códigos de Monte Carlo: PENELOPE e TOPAS. Métodos: Foram comparados cenários de teleterapia e braquiterapia, e a resposta dosimétrica foi analisada quando a irradiação ocorreu em três materiais diferentes: água líquida, água sólida e perspex. Para isso, foram realizadas simulações seguindo os mesmos parâmetros em ambos os códigos, mantendo 5x10 ⁸ partículas simuladas em um fantoma de 30 cm de lado. No cenário de teleterapia, foram simulados fótons e elétrons, e no cenário de braquiterapia, foi modelada uma fonte de paládio-103. Resultados: Dessa forma, por meio da análise dos perfis de dose em profundidade para teleterapia, foi possível validar ambos os códigos, pois ambos apresentaram comportamentos condizentes com os valores experimentais. Em relação ao cenário de braquiterapia, as curvas obtidas apresentaram respostas semelhantes, com variação pontual de 4 pp em relação à literatura. Por fim, os sistemas de simulação se mostraram análogos entre as curvas para a mudança do material de composição do phantom, sendo a variação máxima de 4 pp e 15 pp para teleterapia e braquiterapia, respectivamente. Conclusão: Portanto, os códigos de simulação estudados se apresentam como ferramentas promissoras para a realização de dosimetria.

Protective Effect of Colostrum Therapy in Premature Infants Weighing Less Than 1500g at the INMP 2018-2021

Carmen Rosa Dávila-Aliaga — 2024-10-31

Background: Prematurity is a serious public health problem, due to its high morbidity and mortality, with 15 million premature births and one million deaths annually worldwide. The main causes of neonatal mortality in premature infants are necrotizing enterocolitis and late sepsis. In Peru, the percentage of premature births increased from 6.4% in 2020 to 7.5% in 2023, with an average of 30,000 premature newborns annually. In 2023, 70% of neonatal deaths corresponded to premature babies. The National Maternal Perinatal Institute reported high rates of neonatal mortality, especially in premature babies weighing less than 1500 grams. It is worth mentioning that of all neonatal deaths by 2023, 70% corresponded to premature babies and 46.5% to those less than 1500g.

Objective: Determine the protective effect of colostrotherapy in premature newborns with birth weight less than 1500g in the INMP during the period 2018-2021.

Methods: Longitudinal analytical observational and retrospective cohort study. The bivariate analysis was carried out, where the presence of the association between the variables and the administration of colostrotherapy was evidenced. In the multivariate analysis, 3 study models were proposed (model 1: necrotizing enterocolitis, model 2: requirement for mechanical ventilation and model 3: mortality), and Poisson-type multiple logistic regression was used, indicating the adjusted relative risk and its respective 95% confidence intervals.

Results: In the multivariate analysis, the 1st model showed that colostrotherapy (adjusted RR: 0.304, 95% CI: 0.099-0.93) acts as a protective factor against necrotizing enterocolitis. In the 2nd model, colostrotherapy showed no association with the requirement for mechanical ventilation. And finally, in the 3rd model it was shown that colostrotherapy (RR: 0.494, 95% CI: 0.32-0.76) acts as a protective effect with respect to mortality.

Conclusions: The administration of oropharyngeal colostrum is a simple and safe procedure, it can reduce the incidence of necrotizing enterocolitis and mortality in premature neonates less than 1500g.

These Factors associated with intrafamily violence in pregnant women in a Peruvian mother-child center.

Gretty Bejarano — 2024-10-31

Introduction: Domestic violence in pregnant women is considered a serious public health problem that affects the well-being of the mother and child.

Objective: To determine the factors associated with intrafamily violence in pregnant women at the Tablada de Lurín Maternal and Child Center during the period 2021-2022.

Methods: Analytical cross-sectional study. The clinical histories of a first level health center were used. The main variable was domestic violence; the independent variables were demographic and social characteristics, number of children and previous illness.

Results: Domestic violence occurred in 15.63%. In the first simple regression analysis, it was found that pregnant women with more than 4 children, with a confidence interval of 2.44, presented a higher frequency of suffering intrafamily violence compared to pregnant women who had less than or equal to 2 children. In the second multiple regression analysis, it was observed that pregnant women with more than 4 children presented a higher frequency of suffering intrafamily violence compared to pregnant women who had less than or equal to 2 children.

Conclusions: It was found that pregnant women who suffered family violence represented 15.6%. Pregnant women with more than 4 children were 239% more likely to suffer domestic violence than women with fewer than 2 children, regardless of maternal age, being married or single, having higher education or having a previous illness.

Associated factors with inadequate lifestyle in medicine students in a Peruvian university

Abel Arroyo — 2024-10-31

Introduction: The inappropriate lifestyle (IL) increases the risk of non-communicable diseases; undergraduate university students are a susceptible population to present an IL. Objectives: To determine if age, sex, marital status, work activity, family responsibilities, study cycle and place of residence were factors associated with an inappropriate lifestyle (IL) in medical students. Secondarily, the dimensions most frequently associated with IL were identified. Methods: A cross-sectional, and analytical study was carried out on students from the School of Human Medicine of the Antenor Orrego Private University of Trujillo in Peru, during the first semester of 2023, using the FANTASTICO anonymous survey, an instrument that has 10 dimensions. Surveys that were not answered in their entirety were excluded. The prevalence of predetermined risk factors was compared between students with IALS and those with an adequate lifestyle, using the chi-square test and the prevalence ratio; we were considered significant if p < 0.05. Results: Of the 258 participating students, 112 (43.4%) showed IL. No statistical association was found between the proposed factors and the IL in the students. The 4 prevalent dimensions in the IL were: health control, sleep and stress, introspection, and physical activity. Conclusion: Age, sex, marital status, work activity, having a family responsibility, the study cycle, the place of residence and the study cycle were not factors associated with IL in medical students.

Factors associated on head, face and neck region injuries in recreational surfers in Acapulco, Mexico.

Carlos Alberto Juárez Medel — 2024-10-31

Introduction: Surfing carries potential and significant risk of head and face injuries in almost half of the surfers admitted to emergency departments. Objective: To estimate the frequency of head, face and neck injuries and identify associated factors in recreational surfers in Acapulco, Mexico. Material and methods: Cross-sectional study of 125 surfers during the period January - August 2023. With the Mantel-Haenszel process, the odds ratio (OR) along its confidence interval of 95% (95%CI) were estimated for explanatory factors associated with injuries with the CIETmap statistical package. Results: In the last year, the 37.6% (n=47) of surfers have experienced at least one injury to the head, face and neck region. The highest proportion of injuries were superficial scrapes (51.1%; n=24/47) caused by the impact with the surfboard (82.9%; n=39/47). Three factors were associated with independent effect in the final multivariate model: practice ≤ 10 years (aOR= 0.32; CI95%= 0.11-0.94), wave size ≥ 2 meters (aOR= 0.27; CI95%= 0.09 - 0.82) and not use of the board leash (aOR= 3.64; CI95= 1.70 - 8.94). Conclusion: The findings underline the importance of promoting safety measures such as the use of leashes on the board, even among more experienced surfers, to reduce the risk of injury in this sport.

Factors associated with poor adherence to haart in patients with HIV during the COVID-19 pandemic

David Rene Rodríguez Díaz — 2024-10-31

Introduction: In the COVID-19 pandemic, the fear of contagion and the risk of poor evolution were conditions that circumscribed HIV-infected patients, potentially influencing adherence to HAART (A-HAART). Objective: To determine the factors associated with poor adherence to HAART (PA-TARGA) in patients with HIV during the COVID-19 pandemic in a hospital in northern Peru during April-October 2021. Material and Methods: A study was developed cross-sectional analytical study in 162 patients with a confirmed diagnosis of HIV infection on HAART. To establish A-HAART, the Morisky-Green-Levine Test was used. The association between sociodemographic, personal/family factors of COVID-19, health, and PA-HAART was evaluated using the Pearson Chi-square test, considering statistical significance for a p value < 0.05. The risk statistic was the Odds ratio (OR) > 1. Results: The prevalence of PA-HAART was 32%, the mean age 45.8±8.3 and 44.6±7.3 years (with poor and good adherence to HAART), predominantly male. Factors associated with PA-HAART were living alone (p=0,036, OR:3,1), personal history of COVID-19 (p=0,027, OR: 2,42), history of a close relative with COVID-19 (p =0,038, OR 3,42), depression (p=0,036, OR: 2,18) and comorbidity (p=0,027, OR: 2,21). Conclusion: In patients with HIV, living alone, a personal history of COVID-19, a history of a close relative with COVID-19, depression and presenting comorbidity are factors associated with PA-HAART.

Experience of a program for the reduction of cardiovascular risk factors in secondary school teachers.

Raul Montalvo — 2024-11-22

Introduction: Physical inactivity among secondary school teachers increases cardiovascular and metabolic risks, highlighting the need for effective intervention strategies. Objective: To compare changes in body composition, lipid profile, and blood pressure following a physical exercise and nutritional education program. Methods: A prospective observational study was conducted with 556 teachers, divided into a program group (274) and a no-program group (282). The program included guided weekly exercises and nutritional workshops over three months. Baseline and final measurements assessed weight, body mass index (BMI), blood pressure, lipid profile, and body composition using tetrapolar bioimpedance. Statistical analyses used Student's t-test to compare deltas between groups, with p<0.05 considered significant. Results: The program group showed reductions in systolic blood pressure (SBP) (-7.0±10.6 mmHg; p<0.001), body fat (-3.0±15.4%; p<0.001), and total cholesterol (-12.2±45.6 mg/dL; p=0.002). HDL cholesterol increased (+8.8±40.8 mg/dL; p=0.007). No significant changes were observed in these indicators in the no-program group. Weight and BMI did not vary significantly in either group. Conclusion: The program improved cardiovascular risk factors and body composition in teachers. Further studies are recommended to assess long-term sustainability and to consider follow-up strategies after program completion

Computer aided diagnosis in mammograms for breast cancer screening

Marlene Alejandra Lorenzo-Ramírez — 2024-10-31

Securing access to quality healthcare services, particularly for essential screening tests like mammograms, presents a significant challenge in developing nations. Women often encounter extensive waiting periods, sometimes extending for several months, to undergo a mammogram. This crucial test plays a pivotal role in the early detection of breast cancer, where timely diagnosis is crucial for effective treatment and enhanced survival prospects. Delays in obtaining a diagnosis can significantly impact the health of patients and their well-being, underscoring the importance of early detection. Compounding these challenges is the scarcity of resources and healthcare professionals, which hinders swift and efficient access to preventive care. Such constraints underscore the pressing need for improvements in the interpretation of radiological studies and a reduction in the workload of imaging specialists. These improvements would not only optimize interdisciplinary collaboration but also enhance patient care, particularly for critical screenings like mammograms (3).

Technological advancements, particularly in artificial intelligence (AI), have significantly influenced numerous sectors, including healthcare (4). Yet, in areas such as Latin America, where the healthcare infrastructure and resources may not fully support the integration of advanced diagnostic techniques based on informatic tools, the potential of these innovations seems to be underutilized. A promising application of technology is in Computer-Aided Diagnosis (CAD) for breast cancer screening with mammograms. CAD leverages vast datasets and pattern recognition algorithms to detect anomalies within mammograms, potentially facilitating the early identification of lesions. Given that breast cancer ranks among the most prevalent diseases affecting women globally, early detection is vital for enhancing patient survival rates and quality of life. Given these challenges, our study aims to examine the latest developments in artificial intelligence technology as a supplementary tool in CAD strategies for mammograms. Our goal is to foster better interdisciplinary collaboration among clinicians, radiologists, and pathologists through a state of the art (SOTA) review of the topic. By doing so, we anticipate streamlining the diagnostic workflow and elevating the efficiency of breast cancer detection and treatment processes.

Congenital microtia and congenital aural atresia: A literature review

Diego Marin Marin — 2024-10-31

Permanent hearing loss is common at birth, and the negative consequences for language, cognitive, and social-emotional skills are particularly important. Microtia and congenital aural atresia is a disorder of the external ear that can occur in isolation or in association with another malformation. The objective of the present study was to know and compile the current evidence on microtia and aural atresia. The PubMed, Scopus, and SciELO databases were consulted, from the year 2010 to the year 2023. All the bibliographic references were searched in relation to the keywords: microtia, and aural atresia. Were evaluated review and research articles, which in general, were less than 05 years published. It was limited to articles in Spanish and English and were identified by titles. Were identified once the articles of interest, the following were considered as inclusion criteria: 1. That they examine the diagnosis and treatment of microtia and congenital aural atresia 2. They address the subject according to a systematic methodology (quantitative, qualitative, and others). The causes of these disorders are not fully understood. In conclusion, auditory evoked potentials and audiometry are the test of choice for cases of microtia and congenital aural atresia. Surgical correction is often not the preferred treatment; the hearing result is no better than that of bone conduction devices. Likewise, the functional aspect should be prioritized over the aesthetic one since early hearing loss intervenes in the development of language in the child.

Evolution of photodynamic therapy in the management of actinic keratosis: how effective and safe is it according to current evidence?

Laura Valentina Vargas-Monroy — 2024-10-31

Actinic keratosis is a premalignant dermatological condition characterized by the potential to progress to squamous cell carcinoma. To date, there is no treatment with an adequate benefit-risk balance. Photodynamic therapy is proposed as one of the most effective therapeutic tools. However, there is still divergence regarding the quality of available evidence. The objective of this review is to analyze the most recent evidence on the therapeutic performance of photodynamic therapy in the management of actinic keratosis. A literature search was conducted in the PubMed, Scopus, and MEDLINE databases. Based on the most recent randomized controlled trial comparing the use of dynamic phototherapy combined with aminolevulinic acid without incubation versus incubation for one hour, it was found that the intervention group had a higher percentage of lesion resolution compared to the control group (49.5% vs. 34.9%, p=0.002), as well as less pain in the intervention group (p=0.03). In addition, a similar trend was observed in other studies, suggesting that this therapy could be effective and beneficial in the management of actinic keratosis. Despite the limited and heterogeneous evidence regarding the use of dynamic phototherapy and its various combined regimens for the management of actinic keratosis, there is a clear trend towards potential benefits compared to other therapies.

Breastfeeding, adequate weight and a healthy lifestyle as preventive factors for breast cancer and recognition of some risk factors

Greysa Dianet Silva-Sagastegui — 2024-10-31

Cancer is a global health problem. When this pathology originates in the breast, a process occurs where healthy cells degenerate and become tumor cells. These cells proliferate to form tumors that can metastasize and cause significant damage to the body. Given the high incidence in our country, it was considered important to give more visibility to those factors that can protect women, who are significantly vulnerable, from developing this pathology. Through an exhaustive review of current scientific sources, it has been possible to identify those daily habits or practices that protect or reduce the risk of developing a malignant neoplasia in the breasts and at the same time those factors that can be modified or prevented have been recognized as they predispose to the population to a small or large extent to develop the disease. This will simultaneously provide a clear and updated vision of the topic to health professionals, to take action in the future and reinforce health promotion.

Psychological Adjustment as an indicator of Mental Health

Patricia Matos-Ramírez — 2024-11-18

Psychological adjustment is fundamentally conceptualized as the balance, interaction or dynamic and dialectical adaptation that each individual maintains with his environment, for which an intrapsychic dimension (biopsychological) and an interpsychic dimension (psychosocial) are taken into account, ruled by principles and laws of learning; this balance is seen in behavior which is psychosocial in nature. Method: Literature review study. Journals were consulted from the following databases: American Psychological Association, SCOPUS, SciELO and Google Scholar. Result: The review of documents whose common name is psychological adjustment, allows us to recognize the following associated variables such as anxiety, depression, psychological well-being, and personality.Conclusion: The term psychological adjustment refers to a profile of indicators associated with the mental health of an individual.

Universidad Ricardo Palma grants the "Doctor Honoris Causa" distinction to Prof. Dr. Herbert Michael (Bob) Pinedo

Jhony A. De La Cruz-Vargas — 2024-11-19

The "Doctor Honoris Causa" is the highest honorary title awarded by Ricardo Palma University to eminent individuals. It is conferred with great care and rigor by our institution to highly distinguished figures from national and international spheres, whose work and personal achievements honor culture, science, and humanity.

Based on the remarkable academic trajectory ofDoctor Bob Pinedo, his invaluable scientific contributions, and, notably, his distinguished spirit of collaboration with Peru, Latin America and the Caribbean, and notably with our university, a ceremony was held in which Universidad Ricardo Palmaawarded him the academic distinction of Doctor Honoris Causa, during the 2024 International Congress on Cancer and Public Health. Additionally, during the same ceremony, he received recognition and an award from the Colegio Médico del Perú.

The Latin American Lymphoma Study Group (GELL): A Model of Collaborative Research in Latin America

Rafael Pichardo-Rodriguez — 2024-11-19

Introduction

Collaborative health research has proven to be an effective approach to addressing regional and international challenges in the diagnosis, treatment, and management of diseases (1–4). In Latin America, a region characterized by geographic, socioeconomic, and epidemiological diversity, the creation of research networks is essential to unify efforts and generate knowledge applicable locally and internationally (1–4). In this context, the Latin American Lymphoma Study Group (GELL) emerges as a key player in lymphoma research—a family of hematologic cancers with high clinical and molecular heterogeneity.

Origins and Structure of GELL

Founded in 2018, GELL is a collaborative research network comprising 14 Latin American countries, supported by prestigious international institutions such as the Dana Farber Institute, MD Anderson Cancer Center, and Tampa General Hospital. The group’s primary objective is to conduct multicenter studies that provide high-quality epidemiological, clinical, and molecular data on various lymphoma subtypes.

GELL's leadership includes Dr. Brady Beltrán (Peru) as president, Dr. María Torres (Venezuela) as vice president, and Dr. Denisse Castro (Peru) as treasurer. This organizational structure enables efficient coordination among member countries, ensuring the planning and execution of clinical and translational studies across the region.

Objectives and Achievements of GELL

One of GELL's main objectives is to determine the epidemiology of different lymphoma subtypes in Latin America, including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, nasal-type T/NK-cell lymphoma, and Epstein-Barr virus (EBV)-associated lymphoma. The group also aims to develop retrospective and prospective studies on inflammatory biomarkers and novel prognostic scores (5–7). These studies help identify risk factors and clinical parameters that predict treatment response and prognosis in lymphoma patients.

To date, GELL has collected data on more than 6,400 patients in retrospective studies, including:

1,500 patients with DLBCL (6,8).
1,000 patients with peripheral T-cell lymphoma (PTCL-NOS) (9).
800 patients with follicular lymphoma (10).
2,000 patients with adult T-cell leukemia/lymphoma (ATLL) (11).

These retrospective studies are crucial for generating hypotheses that guide future prospective studies, contributing to a better understanding of lymphomas in the region.

Scientific Production and Knowledge Dissemination

GELL has achieved remarkable scientific output, contributing 37 works that include:

6 articles published in high-impact journals.
30 posters presented at international conferences such as ASH, EHA, and the World HTLV-1 Congress.
4 oral sessions at international scientific events.

Among its most significant scientific achievements is the multicenter validation of the prognostic value of the neutrophil-to-lymphocyte ratio in DLBCL patients (12), published in collaboration with other international institutions. Additionally, GELL has developed consensus on relevant topics such as the management of patients with unspecified peripheral T-cell lymphoma (PTCL-NOS), which is in the process of publication, and the impact of COVID-19 on lymphoma patients (13).

The impact of GELL's scientific production is measured not only in terms of publications and presentations but also in its ability to influence clinical practice at the regional level. The creation of consensuses and participation in clinical trials ensure that GELL's findings are immediately applicable to patient care in Latin America.

Future Projects and GELL's Expansion

GELL is not content with its achievements and continues to expand its horizons towards new research projects. One of the most ambitious projects underway is a molecular study on the genetic profile of DLBCL in Latin America, which will analyze over 400 genes using the Foundation One–Heme platform. This will be the first study of its kind in the region, providing a detailed understanding of the genetic alterations characterizing lymphomas in Latin American patients.

Another significant project involves conducting prospective clinical trials on nasal-type T/NK-cell lymphoma and a meta-analysis on inflammatory biomarkers in lymphomas. These studies not only contribute to advancing scientific knowledge but also allow patients access to innovative treatments through clinical trials, promoting equity in access to advanced therapies.

International Collaboration

GELL has established collaborations with research groups from Japan, Brazil, and Italy, enabling it to build one of the largest global databases on T-cell lymphomas and EBV-associated DLBCL. These collaborations reflect the growing relevance of studies conducted in Latin America and position GELL as a global leader in lymphoma research.

Conclusion

The Latin American Lymphoma Study Group (GELL) has demonstrated that scientific collaboration in Latin America can generate valuable knowledge applicable globally. Its efforts to unify data from multiple countries, conduct prospective and retrospective studies, and promote participation in clinical trials have significantly improved the care of lymphoma patients in the region. With ambitious projects on the horizon, such as the molecular analysis of DLBCL and new clinical trials, GELL is well-positioned to continue leading lymphoma research in Latin America and beyond.

Peripheral pnet of the inguinal region with favorable response to QT-Thalidomide Neoadjuvant

Rolig Aliaga-Chávez — 2024-10-31

Introduction: Primitive neuroectodermal tumours are a family of neoplasms that derive from the neural crest. They are classified into 3 groups: 1) central PNET, 2) Neuroblastoma and 3) peripheral PNET in peripheral nerves. The aim is to describe the characteristics of the case of a 32-year-old female patient who presented with an inguinal tumour with immunohistochemical profile for peripheral primitive neuroectodermal tumour. Case presentation: 32 year old female patient who presented with a tumour in the inguinal region, the biopsy indicated: small nuclei, hyperchromatic and monomorphous cell neoplasm, the immunohistochemical profile was: synaptophysin positive, neurofilament positive, SOX-11 positive and Ki-67: 70%. Conclusions: pPNTEs can occur in any extracerebral location, should be suspected in patients with round cell neoplasm, small blue. And request immunohistochemical markers: CD45, CD99, FLI-1, neurofilament, synaptophysin, chromogranin, SOX 11, myogenic markers and Ki 67.

Keywords: Groin, Neuroectodermal Tumors, Primitive, Peripheral (source: MeSH - NLM)

Doege-Potter Syndrome: A case report

Patricia Segura Nuñez — 2024-10-31

Doege-Potter syndrome is a rare paraneoplastic syndrome characterized by a benign or malignant mesenchymal tumor associated with persistent hypoglycemia. We present the case of a 70-year-old woman with a 4-year illness characterized by productive cough, oppressive pain in the left hemithorax, and progressively increasing dyspnea. The chest tomography revealed an extensive solid tumor in the lower 2/3 of the left hemithorax. An ultrasound-guided transthoracic biopsy of the tumor was performed. The histopathological study reports a solitary fibrous tumor and immunohistochemistry: STAT6 positive. Therefore, she underwent a thoracotomy with excision of the tumor. After surgery, glucose values normalized. The patient met the criteria for Doege-Potter syndrome, a rare entity.

Dengue infection in a patient with systemic lupus erythematosus: a case report

Carlos Alberto Franco-López — 2024-10-31

Systemic Lupus Erythematosus (SLE) is an autoimmune disease caused by an autoreactive B and T cell response with loss of immune tolerance to self-antigens. It manifests with asthenia, fever, myalgias, arthralgias, skin rash and fatal organ damage. Dengue is a zoonotic disease caused by the dengue virus (DENV), transmitted by mosquitoes of the Aedes aegypti species. Diagnostic suspicion is made in the presence of acute febrile syndrome with clinical manifestations and demographic history. Confirmation is by detection of the virus by PCR-RT, or of the structural protein NS1. The present case report is a 58-year-old woman with data of lupus exacerbation and with clinical manifestations suggestive of Dengue fever, with a history of travel to an endemic area. The confirmatory PCR-RT test leads to appropriate medical treatment. The importance of the case lies in differentiating the diagnosis in a timely manner.

Unusual cause of abdominal pain and jaundice in emergency: case report

Jessica Milagros Calcino-Cuela — 2024-10-31

We analyzed a young man with a history of jaundice since childhood and cholelithiasis, who presented with abdominal pain, jaundice and splenomegaly. Initially, a diagnosis of dengue was considered, given the prevalence of this disease in the patient's geographic region. However, additional testing identified hereditary spherocytosis, a genetic hemolytic disorder. The importance of considering alternative diagnoses in the face of common symptoms in emergencies is emphasized. Initial dengue-oriented management was followed by targeted treatment for hereditary spherocytosis after the diagnosis was confirmed, resulting in significant improvement in the patient. This case emphasizes the need for thorough anamnesis and meticulous diagnostic evaluation to prevent diagnostic errors and inappropriate treatment, highlighting how inherited diseases can mimic infectious conditions in complex clinical scenarios.

Vitamin D intoxication-induced hypercalcemia in a geriatric patient: a case report

Sergio Armando Dextre-Vilchez — 2024-10-31

Introduction: Hypercalcemia secondary to vitamin D intoxication is a rare condition resulting from inadequate prescription. It is characterized by nonspecific symptomatology and can produce severe neurological, muscular, gastrointestinal, renal, and cardiovascular manifestations. Clinical case: We describe the case of an 86-year-old woman with a history of vitamin D supplementation for three months after hip arthroplasty. The initial presentation was gastrointestinal symptoms and sensorimotor disturbance. Hypercalcemia was found upon evaluation. After ruling out the main organic causes, vitamin D intoxication was suspected, which was confirmed after testing for 25-hydroxyvitamin D levels. Correction of hypercalcemia was performed, and the patient had a favorable clinical evolution. Conclusion: It is important to consider vitamin D intoxication as a differential diagnosis of hypercalcemia in geriatric patients and to ensure adequate monitoring of the prescription of vitamin supplements.

Unraveling the neurological enigma: central diabetes insipidus and extrapontine osmotic demyelination caused by covid-19 case report

Mateo Aguirre-Flórez — 2024-10-31

Background: COVID-19 infection produces various symptoms and affects multiple systems, including the endocrine system. Lesions have been documented at the hypothalamic and pituitary axis, hypothetically explained by the presence of angiotensin II receptors in these structures and by direct immune-mediated viral lesions. These manifest with electrolyte and hormonal alterations.

Case report: We present the case of a female patient who, after infection by SARS-CoV-2, presented with hypernatremia refractory to conventional management. Her diagnostic study documented hyposthenuria, high serum osmolarity, and low urinary osmolarity. The condition was corrected with desmopressin, leading to a diagnosis of central diabetes insipidus. A brain MRI revealed a lesion in the pituitary gland, confirming the clinical findings. The only etiological hypothesis for this lesion is its association with SARS-CoV-2 infection.

Conclusions: Understanding the complications secondary to COVID-19 infection in the endocrine setting is essential for early diagnosis and targeted treatment. This knowledge can significantly improve the quality of life for patients affected by such complications.

Growing Teratoma Syndrome as Retroperitoneal Mass: Case Report

Enrique Bedoya-Ismodes — 2024-11-25

Growing Teratoma Syndrome (GTS) is characterized by the enlargement of tumors during or after chemotherapy for nonseminomatous germ cell tumors accompanied by the normalization of previously elevated tumor marker levels and the presence of mature teratoma components upon histological examination. We present a case involving a 25-year-old male diagnosed with a Mixed Germ Cell Tumor. The patient underwent surgery and chemotherapy. However, a year later he was diagnosed with Growing Teratoma Syndrome (GTS) due to the presence of a retroperitoneal mass that failed to respond to a second regimen of chemotherapy.

Importance of physiotherapy in sequelae of post-Covid-19 patients

Juan Pablo Salazar Trujillo — 2024-10-31

Dear Editor,

As nursing students, we have read with great interest the article titled "Functionality before and after physiotherapy in post-COVID-19 patients" (1), published in volume 23, issue 3 (2023) of the Revista de la Facultad de Medicina Humana. This study highlights the importance of functional physical therapy in patients with post-COVID-19 sequelae. We consider it relevant to express our concern regarding the increase in these sequelae in our country, which aligns with the findings of Goicochea et al. (2), who report that 28.8% of post-COVID patients experienced sequelae, predominantly respiratory, musculoskeletal, and neurological, as shown in Table 1. This increase may be related to the large percentage of unvaccinated individuals. The objective of that article was to highlight the physical and respiratory functional effects in post-COVID-19 patients, with the goal of improving and alleviating the symptoms associated with this condition.

ChatGPT applied to solve virtual medical scenarios

Gonzalo Vidangos-Paredes — 2024-10-31

Dear Editor:

Currently, patients tend to seek information about their illnesses on the internet. While many of these sources
are reliable, others are not. ChatGPT, as an arti

cial intelligence (AI) tool, has the potential to discern between
these sources and provide more accurate answers. In recent years, the use of AI in the medical
eld has

signi
cantly increased. Numerous studies have evaluated ChatGPT’s ability to answer medical questions,
ranging from simple to complex, similar to those used in medical licensing exams.

Impact of addiction to social networks on the mental health of human medicine students, in times of covid-19

Romina Rosario del Pilar Nuñez-Rojas — 2024-10-31

Dear Editor,
I am writing to you regarding the article titled "Determination of the association
between social network addiction and mental health consequences in Human
Medicine students at Universidad Ricardo Palma in 2021," published in volume 23,
issue 4, 2023. In the aforementioned study, Ortiz V et al. (1) found a strong
association between social network addiction and the mental health consequences of
medical students. However, I would like to propose an alternative perspective for
interpreting these findings.

Considerations on the association between anxiety and depression in medical students.

Carlos Heber Contreras-Pizarro — 2024-10-31

Dear Editor,
We have carefully read the article titled "Association between Anxiety and
Depression in Medical Students at Universidad Ricardo Palma during 2021" (1),
published in the fourth issue of volume 22 (2022) of the Revista de la Facultad
de Medicina Humana. The authors conducted a cross-sectional study with the
objective of determining the association between anxiety and depression in
medical students at Universidad Ricardo Palma. Below, we present some
comments that we consider pertinent

Mixed reality in surgical mechatronics: Innovations and challenges in bioengineering education and clinical practice

Adrian Nacarino — 2024-10-31

Background: Mixed reality (MR), a combination of augmented reality (AR) and virtual reality (VR), has emerged as a key tool in surgical mechatronics, improving precision and visualization in clinical procedures. Methods: This study presents a literature review of recent MR advances from the Scopus database, taking into account its impact on surgery and medical education. Technologies such as Microsoft HoloLens and Magic Leap, as well as neurosurgery and orthopedic simulators, are reviewed. Results: MR enhances surgical precision and reduces operating times, with an average decrease from 121.34 to 97.62 minutes. Despite its potential, challenges include discomfort from prolonged device use and low battery autonomy. Conclusions: MR has the potential to transform surgery and medical education; however, its widespread adoption will depend on overcoming technological and financial barriers, especially in Latin America, where infrastructure is still limited.