Revista de la Facultad de Medicina Humana

The scientific integrity code: necessary and improvable

Alonso Soto — Thu, 03 Apr 2025 00:00:00 -0500

There are many definitions of scientific integrity, all of which share the common denominator of developing good research practices to ensure honesty and scientific rigor. According to the National Science and Technology Council of the United States, scientific integrity can be conceptualized as "adherence to professional practices, ethical behavior, and the principles of honesty and objectivity in conducting, managing, using results, and communicating about science and scientific activities" (1). Ciubotariu identifies scientific rigor, reproducibility, and responsibility as fundamental principles for its development (2). Scientific integrity plays a crucial role in preventing biases, data fabrication, plagiarism, and other forms of scientific misconduct. It is involved not only in the development of scientific research but also in its communication and use.

Considerations on microbial contamination of chicken meat commercialized in Peru

Mon, 31 Mar 2025 00:00:00 -0500

Mr. Editor, when reviewing with interest the works that have evaluated sanitation in the processing and distribution of chicken meat in the country, a product of widely consumed animal origin, we find worrying data, which is replicated among countries with different realities, but similar socio-economic conditions. Below we present a brief but significant reflection duly founded on the quality of the meat products that we consume daily, which should alert the country's public health authorities.

Rhinoscleroma as a differential diagnosis of mucormycosis: A case repor

Mon, 31 Mar 2025 00:00:00 -0500

Rhinoscleroma is a chronic granulomatous disease rare in our country but endemic in various parts of the world, covering regions of North Africa, Middle East, Central America, is caused in most cases by Klebsiella rhinoscleromatis affecting mainly the nasal cavity and nasopharynx, the presentation is more common in upper respiratory tract. Symptoms occur months after infection and depend on the stage of infection, these can be: fetid rhinorrhea, nasal obstruction, nasal deformity, destruction of nasal cartilage. The diagnosis is anatomopathological where Mikulicz cells are evidenced. The treatment of rhinoscleroma is with antibiotics for a prolonged period (2-3 months), in cases of airway obstruction surgical intervention should be performed.

We present the case of a 60-year-old woman with a history of diabetes mellitus type 2 and arterial hypertension, who arrives at the hospital with a pathological anatomy report showing thin and septate hyphae, suggestive of infection by Mucor. Subsequent hospital biopsy ruled out mucormycosis and confirmed the diagnosis of rhinoscleroma.

Gallbladder adenomyomatosis as an incidental finding: A report of seven cases

Mon, 31 Mar 2025 00:00:00 -0500

Gallbladder adenomyomatosis is a benign lesion, characterized by hyperplasia of the gallbladder epithelium alternating with hypertrophy of the smooth muscle layer, in whose thickness there are epithelial projections that can reach the subserosa/adventitia of the organ, causing thickening of the gallbladder wall and possible confusion with neoplasia. The entity has been detected in 2 to 8% of all cholecystectomies and up to 5% of necropsies. It is usually asymptomatic and when it does generate symptoms, they are usually those of coexisting cholecystitis/cholelithiasis. It is more common in adults and very rarely in the pediatric population. An interesting factor is its probable relationship with gallbladder cancer. We present 7 cases of vesicular adenomyomatosis, one of them with epithelial dysplasia, considered a precursor lesion to cancer.

Keywords: Adenomyomatosis, gallbladder, dysplasia, gallbladder cancer.

Efficacy of etilefrine and norepinephrine in preventing maternal hypotension during cesarean section under spinal anesthesia: an observational study

Mon, 31 Mar 2025 00:00:00 -0500

Objective: To compare the efficacy and safety of norepinephrine and etilefrine for the prevention of maternal hypotension during cesarean sections under spinal anesthesia at the National Maternal Perinatal Institute in Lima, Peru. Materials and Methods: A prospective study was conducted with 300 pregnant women, with the respective inclusion and exclusion criteria; of which they were divided into three groups: norepinephrine in continuous infusion (NEI), bolus (NEB), and etilefrine in bolus (EB) until delivery. Maternal hemodynamic variables were evaluated: systolic blood pressure, diastolic pressure, mean arterial pressure, heart rate, use of vasopressor, number of rescue boluses, APGAR score of newborns, use of oxygen in immediate care, criteria for admission to the Neonatal Intensive Care Unit; and other demographic variables such as age group, nutritional status, parity.Results: Norepinephrine infusion significantly reduced episodes of hypotension compared to etilefrine (p < 0.001) and norepinephrine bolus (p < 0.001), with no differences in APGAR scores (p = 0.72). Norepinephrine infusion proved superior, reducing hypotension episodes by 39% compared to etilefrine, and by 47% compared to norepinephrine bolus. In addition, it was observed that in the norepinephrine infusion group, maternal systolic blood pressure remained constant, unlike in the other norepinephrine bolus and ethylephrine bolus groups. Regarding heart rate, it was observed that after administration of the EB group bolus, heart rate increased significantly, even above 80 beats per minute, and remained so for twenty minutes thereafter; unlike the average of the other groups, which ranges from 72 to 77 beats per minute. Conclusions: Norepinephrine administered via continuous infusion was more effective than etilefrine in preventing maternal hypotension, without compromising neonatal safety. n our study, it was demonstrated that norepinephrine infusion better maintains maternal hemodynamic parameters such as systolic pressure, mean pressure and heart rate; without repercussions on the APGAR score, nor neonatal compromise such as stay in the Neonatal Care Unit or the use of oxygen in immediate care. The use of norepinephrine infusion as prophylaxis of hypotension after spinal anesthesia in cesarean section was safe and effective in the population studied and had a more stable hemodynamic pattern compared to the drugs studied.

Key words Anesthesia, Spinal, c-section, local anesthesics, hypotension (Source: MESH, NLM).

Determination of the waist circumference threshold for type 2 diabetes risk in Peruvian adults

Alberto Guevara-Tirado — Thu, 03 Apr 2025 00:00:00 -0500

Objective: determine the abdominal perimeter reference point for risk of diabetes mellitus-2 in the Peruvian population.

Methods: analytical and cross-sectional study of the Demographic and Health Survey (ENDES-2022). The entire population was studied (n=28,407). The variables were sex, abdominal circumference (BP) and risk of diabetes mellitus-2 (DM-2) from Bang et al. Diagnostic tests and receiver operating curve (COR) were used. The results were reproduced in the ENDES-2023 population (n=30,782).

Results: in women, the AUC was 0.688 (CI:0.678-0.699; p<0.001), with BP cut-off point for DM-2 risk of 91 cm. In men it was 0.821 (CI: 0.814-0.828; p<0.001), with a cut-off point for DM-2 risk of 88 cm. In men, the international cut-off point (95 cm) and the COR curve (88 cm) had Cramer's V V=0.519;V=0.489), Kappa K=0.507;K=0.496, sensitivity S=64%; S=82%; specificity E=87%; E=61%, respectively. In women, with international parameters (82 cm) and the cut-off point (91 cm), Cramer's V was V=0.115; V=0.240, Kappa=0.060; K=0.203, sensitivity S=88%; S=71%, specificity E=23%;E=57%, respectively. The results were reproduced in ENDES-2023, obtaining similar values.

Conclusions: the abdominal perimeter reference point in the Peruvian population for risk of DM-2 in men was 88 cm and in women 82 cm. The advantages of the PA, which only requires a tape measure, make it a useful tool for DM-2 risk screening for massive epidemiological studies, with the possibility of individualized clinical use in men, being less recommended in women.

Seroprevalence and factors associated with infantile cystic echinococcosis and canine echinococcosis in a district of Huancavelica, Peru

Mon, 31 Mar 2025 00:00:00 -0500

Introducción: La equinococosis es una enfermedad zoonótica causada por el cestodo Echinococcus granulosus, tiene un impacto significativo en la salud de la población rural altoandina, así como en la de su ganado y mascotas. Objetivos: Determinar la seroprevalencia de la enfermedad por equinococosis quística infantil y equinococosis canina, como factores de riesgo de enfermedad asociados a escolares y comuneros del distrito de Ascensión, Huancavelica, Perú. Materiales y métodos: Se realizó un estudio descriptivo de tipo transversal. Las muestras se recolectaron durante 2019. Los escolares (n = 783) fueron evaluados para equinococosis quística mediante técnicas de ELISA e Immunoblot. Los perros (n = 543) fueron evaluados para equinococosis canina mediante técnicas de Copro-PCR y Copro-ELISA. Los factores de riesgo asociados a la enfermedad se evaluaron mediante la aplicación de encuestas epidemiológicas. Resultados: Se determinó una seroprevalencia del 5,18% para la equinococosis quística infantil mediante la prueba ELISA y del 1,60% mediante la prueba Immunoblot. La prevalencia de equinococosis canina entre los perros miembros de la comunidad fue del 9,02% con Copro-PCR y del 7,18% con Copro-ELISA. Algunos factores de riesgo asociados a la equinococosis quística infantil fueron la alimentación con despojos contaminados a los perros (OR=5,60) y la desparasitación regular de perros (OR=1,55). Para la equinococosis canina, los factores de riesgo incluyeron la edad del perro (OR=4,00) y el sueño del perro fuera de casa (OR=82,00). Conclusiones: Se concluye que E. granulosus está presente en escolares y perros del distrito de Ascensión, encontrando una seroprevalencia que confirma que es un área endémica de esta zoonosis helmíntica.

Management of hyperglycemia in the emergency department and its impact on mortality and adverse outcomes

Thu, 03 Apr 2025 00:00:00 -0500

Objectives: To determine the proportion of patients who achieved glycemic control within 24 hours of admission to the emergency department in three Peruvian hospitals, as well as to assess the relationship between the achievement of glycemic control at 24 hours and mortality and unfavorable outcomes.

Methodology: An observational analytical cohort study was conducted in three Peruvian hospitals, including 730 patients admitted for hyperglycemia. Variables such as glycemic control, mortality, and unfavorable outcomes were examined using descriptive and multivariate statistical analyses.

Results: The average age of the patients was 60 years, with a majority being male. 85.1% had a history of diabetes mellitus, and hypertension was the most prevalent comorbidity. 4% of patients died. Glycemic control was achieved in 45% of the patients. 34% received fixed doses of insulin. No association was found between glycemic control and mortality, the need for mechanical ventilation, or hemodialysis. Patients who achieved glycemic control had significantly shorter hospital stays compared to those who did not achieve control (51% vs. 60%; p=0.02).

Conclusion: Glycemic control was achieved in 45% of patients admitted with hyperglycemia to the emergency department. The majority of patients received insulin in sliding scale regimens rather than fixed doses. Glycemic control within 24 hours was associated with a lower proportion of patients with prolonged hospital stays, although it was not associated with reduced mortality or the need for mechanical ventilation.

Health impact of Public Health Emergencies of International Concern in the context of the International Health Regulations (2005) in Peru

Mon, 31 Mar 2025 00:00:00 -0500

Introduction. Public health emergencies of international concern (PHEIC) are events that constitute a risk to public health due to their international spread. They are declared as such by the World Health Organization (WHO). Objective. To analyze the response to PHEIC and its impact in Peru. Methods. Descriptive study, unit of analysis the PHEIC, which have occurred since the adoption of the International Health Regulations (IHR-2005). Data from publicly available secondary sources were used. Results. Since the adoption of the IHR-2005, WHO declared 08 PHEIC, two of which evolved into pandemics: influenza A H1N1-2009 and COVID-19, two currently in progress: Poliomyelitis-2014 and Monkeypox-2024; in the remaining ones: Ebola-2014, Zika Microcephaly-2015, Ebola-2019 and Monkeypox-2019, the WHO announced their end. In Peru, the 02 pandemics arrived between 15 to 35 days after the PHEIC were announced, affecting all departments causing cases and deaths. Influenza A H1N1-2009 was the first and COVID-19 had the greatest impact in terms of morbidity and mortality, with a cumulative mortality rate of 6.7/1000 inhabitants, the highest in the world. Both viruses currently circulate seasonally. Cases of Monkeypox were also reported throughout the country. All PHEICs involved surveillance and response actions.

Conclusion: The PHEICs have had a great impact on our country from an economic, social, political and health point of view, the latter in terms of morbidity and mortality: PHEIC due to influenza AH1N1-2009, COVID-10 and Monkeypox; they have been an opportunity to accelerate the development and implementation of basic capacities established in the RSI-2005.

Frequency of self-medication with antibiotics and its associated factors among children at a public hospital in Metropolitan Lima

Mon, 31 Mar 2025 00:00:00 -0500

Introduction: Self-medication with antibiotics is a global problem, particularly prevalent in low and middle-income countries. It mainly affects children, significantly contributing to bacterial resistance. The present study aims to determine the frequency, associated factors, and characterization of self-medication with antibiotics in children.

Materials and Methods: An analytical cross-sectional study was conducted based on a survey administered at the Santa Rosa Hospital, Lima, between December 2023 and February 2024. Parents who attended outpatient consultations and lived with their children were included. The sample size was 414 participants. Descriptive, bivariate, and multivariate analyses were performed. All ethical aspects were respected.

Results: Of the 402 parents interviewed, 39.1% reported having self-medicated their child at some point. The main reasons were sore throat and fever, with amoxicillin being the most commonly used antibiotic (59.1%). The factors significantly associated with self-medication were the child’s age, family income, and the number of children.

Conclusions: 4 in 10 children have self-medicated at some point in their lives. Our findings highlight the need to implement educational interventions targeted at families with lower incomes and multiple children, who are more prone to self-medication.

Factors associated with non-attendance at prenatal care in the first and second trimesters of pregnancy in a tertiary-level hospital in Lima, Peru, 2023

Mon, 31 Mar 2025 00:00:00 -0500

Objective: To compare the factors associated with inadequate prenatal care in the first and second trimesters of pregnancy in women attending the outpatient clinic of the National Maternal Perinatal Institute, a referral hospital in Lima, Peru.

Methodology:

A retrospective analytical cross-sectional study was designed with pregnant women attended at the National Maternal Perinatal Institute in Lima, Peru. The study included 256 pregnant women with more than 26 weeks and 6 days of gestation. Demographic factors, gynecological history, social aspects, and institutional factors related to prenatal care attendance were collected through a questionnaire. Inadequate prenatal care was defined as fewer than 1 visit in the first trimester and fewer than 2 in the second. The strength of association was estimated using a Poisson regression model with a 95% confidence interval and a significance p-value of 0.05.

Results: Multivariate analysis revealed that in the first trimester, single women and those with primary and secondary education had a higher risk of inadequate attendance, as did those attended by midwives and those living far from the hospital. Women with high-risk pregnancies had a lower risk. In the second trimester, the higher risk persisted for single women and those with lower education, but women born in provinces had a lower risk, while those with three or more children had a higher risk of inadequate attendance.

Conclusions: These findings highlight key differences between trimesters in the factors associated with inadequate prenatal attendance.

Keywords: Risk, prenatal care, education, pregnancy, trimester.

Epidemiological surveillance of dengue during the COVID-19 pandemic in the Lambayeque Region, Peru (2019–2020)

Zhou-Chau K, Silva-Fiestas J, Peña-Sanchez E — Thu, 03 Apr 2025 00:00:00 -0500

Objetivo: Describir el objetivo y las características de la vigilancia del dengue en la región Lambayeque antes y durante la pandemia, describir la distribución de las notificaciones de casos de dengue en la región Lambayeque antes y durante la COVID-19, y también una comparación entre provincias de la región Lambayeque antes y durante la pandemia de COVID-19. Método: Se realizó un estudio descriptivo transversal, utilizando la base de datos del sistema de notificación epidemiológica de la Gerencia Regional de Salud, Lambayeque (noti.sp). Los datos se procesaron en Excel para tablas, gráficos, diagramas, utilizando estadística descriptiva. Se emplearon pruebas no paramétricas en el software Stata versión 16. Resultados: Las provincias con menor tiempo de notificación fueron Chiclayo y Lambayeque, con períodos de notificación promedio de 6 y 10,5 días, respectivamente. La provincia con mayor tiempo hasta ser notificada bajo investigación y registro de casos de dengue es Ferreñafe, seguida de Chiclayo. La provincia de Lambayeque está en mejor posición en comparación con Chiclayo y Ferreñafe. Conclusiones: Debido al covid 19, puede haber causado retrasos en la identificación de casos de dengue.

Correlation between oral health morbidity and Google search trends in Peru, 2021–2022

Mon, 31 Mar 2025 00:00:00 -0500

Introduction: Diseases of the oral cavity increasingly affect the world population, especially developing countries such as Peru. Objective: Determine the association between morbidity and search interest in oral health in Peru, 2021-2022. Methods: Observational, analytical, cross-sectional, retrospective study. The website of the Single National Repository of Health Information was entered, with the purpose of accessing the database of oral health morbidity in patients who attended a health facility belonging to the Ministry of Health. Next, the Google Trends platform was accessed to determine the search interest of the main oral diseases carried out through Google in Peru. To determine the association between quantitative variables, Spearman's correlation coefficient was used with a significance level of p < 0.05. Results: A very low positive correlation was found without statistically significant differences between the relative search volume (VRB) on dental wear, tooth loss and dental malocclusion with their corresponding numbers of cases (Spearman's Rho= 0.176, p= 0.412; Rho Spearman's = 0.241, p = 0.257; Spearman's rho = 0.142, p = 0.507); respectively. In contrast, the VRB on dental caries shows a strong positive correlation with statistically significant differences with the number of cases (Spearman's rho= 0.751, p= 0.001). Conclusion: Our study found that the VRB of dental caries was the only term that presented a strong statistical correlation and was associated with the number of visits for dental caries.

Keywords: Google trends; oral health; internet access; dental care; dental caries; gingivitis; malocclusion; Peru. (Source. DeCS-Bireme)

Characteristics and trends of clinical trials on leukemia treatments: Analysis of the Peruvian Clinical Trial Registry (1995–2024)

Mon, 31 Mar 2025 00:00:00 -0500

Introduction: Clinical trials are essential in the fight against cancer, especially in the approach to Leukemias. The characteristics and trends of clinical trials on medical interventions are a relevant point to know due to the need for new treatments for the management of this disease. Objective: To describe the characteristics and trends of clinical trials on leukemia treatments reflected in REPEC. Methods: A descriptive study of the clinical trials of leukemias registered in the REPEC between 1995 and July 2024 was carried out. Data were collected on variables such as sponsor, phase of trial, type of leukaemia, design approach and type of outcome assessed. Results: Of the 2058 clinical trials located, 30 that met the inclusion criteria were included. The most studied type of leukemia was chronic, within this, myeloid had a higher percentage. Most of the studies were sponsored by the pharmaceutical industry, mostly foreign, and most were in phase 2 and 3. The most frequently evaluated outcome was progression-free survival, with most surrogate outcomes. Conclusions: The analysis of clinical trials on leukemias in REPEC reveals a high frequency and tendency to increase clinical studies on chronic leukemias.

Iron-deficient diet as an experimental model to induce anemia in Balb/c mice

Mon, 31 Mar 2025 00:00:00 -0500

In order to develop an experimental model of anemia in Balb/c mice using an iron-deficient diet, an experimental and longitudinal study was conducted with 16 male Balb/c mice, four weeks old, divided into two groups: one with a standard diet and the other with an iron-deficient diet (2.83 mg/Kg). Hemoglobin levels and weight were measured at baseline and after 30 days using an EKF Diagnostic® hemoglobinometer and a Soehnle® digital scale. The Student’s t-test for independent samples was used for statistical analysis, with p<0.05 as the significance level. No significant differences were found initially; however, after 30 days, the iron-deficient diet group showed a significant reduction in

hemoglobin (5.30±1.67 g/dL vs. 15.65±0.96 g/dL; p<0.001) and weight (28.63±6.19 g vs. 38.13±2.167 g; p<0.003). The experimental model successfully induced anemia in Balb/c mice, providing a reproducible tool for preclinical studies.

Regulations and standards in good laboratory practices for cell cultures: a review

Mon, 31 Mar 2025 00:00:00 -0500

Good Laboratory Practices (GLP) in cell culture are essential to ensure the quality and reproducibility of results in scientific and biomedical research. This review aimed to comprehensively analyze the regulations and standards related to GLP in the management of cell cultures, emphasizing their importance for the quality and reliability of scientific findings. A literature review was conducted, encompassing 33 articles published between 1994 and 2023 in academically relevant databases such as Scopus, ProQuest, ResearchGate, ScienceDirect, Springer, among others. Search terms included "Good Laboratory Practices," "GLP," "regulations," and "cell cultures," with specific selection criteria applied. Extracted data covered regulatory frameworks, governing bodies, and areas of application. The findings highlight that guidelines issued by organizations such as the Organisation for Economic Co-operation and Development (OECD), the U.S. Food and Drug Administration (FDA), and the European Medicines Agency (EMA) are essential for the proper implementation of GLP in laboratories working with cell cultures. Furthermore, critical aspects such as precise documentation of procedures, continuous staff training, and implementation of quality and sterility control measures are addressed. The review concludes that the rigorous application of GLP is crucial for ensuring reproducibility, quality, and safety of results, as well as for compliance with regulatory standards—thereby strengthening scientific integrity and fostering advances in biotechnology and biomedicine.