ACTA MEDICA PERUANA

The current dengue fever outbreak in Peru: Analysis and Perspectives

Ciro Maguiña Vargas — 2023-07-11

Impact of health insurance in the economics of Peruvian households, 2010-2019

David Fernando Zavala-Curzo — 2023-07-31

Objective: To determine the impact of health insurance in the economy of Peruvian households during the 2010-2019 period. Material and Methods: This is a cross-sectional analytical study that used the database of the National Peruvian Household Surveys from years 2010, 2014, and 2019, aiming to analyze the impact of health insurance in terms of pocket money spending for health issues, catastrophic healthcare spending, and impoverishment in Peruvian households, and also to determine the presence of other associated factors. Results: During the study period, it was observed that Peruvian households reduced their monthly average pocket money spending for health issues (119.9 PEN in 2010 and 107.9 PEN in 2029), as well as the percentage of household with catastrophic healthcare expenses (4.06% in 2010 to 3.47% in 2019), and the percentage of households who became impoverished because of pocket money expenses for health issues (1.78% in 2020 to 1.51% in 2019). Factors associated to catastrophic healthcare expenses and to impoverishment were lower educational level for the household leader, the presence of family members with chronic diseases, and living in a rural area. The absence of health insurance was significantly associated to a greater risk for catastrophic healthcare expenses, but not to impoverishment. Conclusions: Increased healthcare insurance coverage contributes to financial protection of Peruvian households against pocket money spending for health issues; however, barriers for effective access to healthcare services, and other socioeconomical factors may significantly limit this impact.

Microneutralization assay for detection of antibodies against dengue virus serotype 2

Lucas Augusto Sevilla Drozdek — 2023-08-02

Objective: Adapt the microneutralization test (MNT) to detect neutralizing antibodies against dengue serotype 2 virus (DENV-2) in the Vero-76 cell line. Materials and methods. Different cellular concentrations (0.6 x 10⁵ cell / mL, 0.9 x 10⁵ cell / mL, 1.2 x 10⁵ cell / mL) and percentages of fetal bovine serum (FBS) at 2%, 3% and 4%, passages number of virus stock and incubation days were evaluated. The viral seed was confirmed by RT-qPCR. DENV-2 was propagated by carrying out 5 successive passages in the Vero-76 cell line, then the virus was titrated in microplates and 2 methods were evaluated: complete monolayer and cell suspension, and the optimal coloring day was determined. Obtained the results, it was evaluated by the MNT for DENV-2: 5 sera negative to DENV-2 and YFV, 5 sera negative to DENV-2 and seropositive to YFV and 5 seropositive sera to DENV-2 confirmed by plaque reduction neutralization test. The samples were evaluated in triplicate and virus control and cell control were used. Results: The optimal method for MNT uses cells in suspension (0.9 x 10⁵ cell / mL), 2% SBF and viral seed passage 5. The minimum dilution capable of differentiating a DENV-2 seropositive serum from a DENV-2 seronegative sera was 1:40, and the incubation time of the MNT for DENV-2 was 10 days. Conclusion: MNT allows the detection of IgG antibodies against DENV-2, provides reliable results and a greater number of samples can be analyzed with material savings.

Histologically diagnosed chorioamnionitis and neurodevelopment in premature children born before 34-week gestational age, Lima-Peru

Judith Vila — 2023-07-31

The objective of this study was to determine the effects of histologically diagnosed chorioamnionitis on neurodevelopment of premature babies born with less than 34-week gestational age who were assessed at two-year corrected age. A secondary case-control study was carried out. Clinical data, placental histological findings, and development indexes assessed using the Bayley III scale were analyzed in 38 exposed children and 53 non-exposed children. Genitourinary infections in mothers and early sepsis were more frequent in the exposed group (p<0.005). Cognitive development, motor development and language were normal in both groups. Those children exposed to the chorionitis subtype had lower scores in the aforementioned variables. Histologically diagnosed chorioamnionitis did not show any influence on neurodevelopment in premature babies born with less than 34-week gestational age when they were assessed at two years. Longitudinal and multicenter studies are advised in order to define the long-term effects.

Multiple intracranial aneurysm embolization in a single session

John F. Vargas-Urbina — 2023-07-31

Objective: To determine clinical and angiographical outcomes in patients with multiple intracranial aneurysms who underwent endovascular therapy in a single session. Materials and Methods: Patients older than 18 years with multiple (≥2) ruptured or non-ruptured aneurysms were included, and all of them underwent endovascular therapy in a single session between 2019 and 2021. Clinical and angiographic data was collected. Immediate occlusion and follow-up data were collected. Rankin modified scale was used for assessing clinical outcomes. Results: Twenty-five patients were treated, and fourteen had subarachnoid hemorrhage. Seventy-eight aneurysms were diagnosed, and 59 of them were treated. The most frequent location was at the ophthalmic segment. Maximum average height was 5.2- mm, which showed significant statistical difference with a ruptured condition (p≤0.02). The main modality for endovascular therapy was the remodeling technique, which was used in 39% of all cases. Immediate Raymond Roy staging was I in 60% of all cases, and IIIa in 35% of all cases. Complication rate was 24%, and mortality rate was 8%. Conclusions: Single session endovascular therapy is an effective and safe option for cases of multiple intracranial aneurysms in our institution. Occlusion and complication rates were acceptable.

User satisfaction in the outpatient clinic for physical and rehabilitation medicine at Edgardo Rebagliati- Martins National Hospital, 2022

Roger De la Cerna-Luna — 2023-08-01

Patient satisfaction is a fundamental indicator of quality in healthcare services. There are few previous studies in Physical Medicine and Rehabilitation (PM&R), a specialty that serves patients with disabilities, who have the right to receive the highest quality healthcare services. The aim of this study was to evaluate user satisfaction in the PM&R outpatient clinic of Edgardo Rebagliati Martins National Hospital (HNERM) from July to September 2022. A descriptive cross-sectional observational study was conducted. Satisfaction was evaluated using the SERVQUAL survey. 93 participants were included, 49.5% had a time of less than 6 months since their first visit to the outpatient clinic and 59.1% received only physical therapy. Overall satisfaction was 72.4%. Satisfaction by dimension was 79.6% for safety, 78.5% for tangible aspects, 76.9% for empathy, 68.8% for reliability, and 58.1% for responsiveness.

Intestinal occlusion caused by intussusception in an adult subject: Report of a case

Gean Zevallos-Delgado — 2023-07-05

Intussusception as a cause of intestinal obstruction in adults is a very rare entity, the majority is secondary to a benign or malignant neoplasm of the small intestine. Lipomas are rare benign tumors, considered neoplasms of mature adipose tissue without pleomorphism that are found in the gastrointestinal tract as well-demarcated tumors of the submucosa, and are most often found within the wall of the small intestine. We present the case of a 72-year-old man who underwent surgery for intestinal obstruction, and an intraoperative diagnosis of small bowel intussusception secondary to a submucosal angiolipoma according to pathology. Intussusception in adults is rare, and the fact that it is due to another unusual benign entity is even rarer. Tomographic study is useful, but most are diagnosed intraoperatively. The resection "in block", is the most recommended due to the suspicion of malignancy.

Giant well-differentiated retroperitoneal liposarcoma, report of a case

Gonzalo Alberto Guarniz Poma — 2023-07-31

Liposarcomas are rare malignant neoplasms that originate in adipose tissue, most frequently in the retroperitoneum. Of all histological variants, differentiated liposarcoma is the most common and has the best prognosis. Diagnosis is established by imaging tests with or without the aid of biopsy. Treatment consists of complete resection of the tumour, which may or may not be accompanied by adjuvant therapy. We present the case of a 41-year-old patient with abdominal distension and weight loss, who was confirmed to have retroperitoneal liposarcoma by abdominal CT scan and underwent successful complete surgical resection. The patient recovered satisfactorily and remained free of recurrence during follow-up. It is concluded that diagnosis and therapy vary according to the characteristics of the tumour and its risk of recurrence, which is why it remains a multidisciplinary challenge to this day.

Successful outcomes of surgery procedures in patient with Glanzmann´s Thrombasthenia

Bruno Renato Guerrero Arismendiz — 2023-07-31

We report a 35-year-old female patient with Glanzmann's thrombasthenia (GT) and severe anemia due to abnormal uterine bleeding secondary to uterine myomatosis. She required several admissions of red blood cells and platelet transfusions. An elective subtotal hysterectomy with salpingo-oophorectomy was proposed and recombinant factor VII was required. Surgical and postoperative outcomes were successful, without surgical complications, bleeding, or hemogram alterations. 4 years later, she required tooth extraction because of periodontal disease and pulp necrosis. In Peru, reports of GT patients requiring major and minor surgical procedures are lacking, given the low disease prevalence and the difficulties related to surgery. The report of these successful cases becomes relevant to continue improving GT management.

Acute pancreatitis associated to an intragastric balloon: report of a case and literature review

Siomara Aransuzú Chávez Sánchez — 2023-07-31

Obesity is a pathology of importance worldwide because it leads to a high burden of mortality and morbidity. The intragastric balloon represents a non-surgical technique used more and more frequently to achieve weight loss. Although this is considered a safe method, some complications have been reported, from nausea and vomiting to serious adverse events, such as perforation. Acute pancreatitis is a very rare complication of the intragastric balloon, and its effect is attributed to the direct compression it exerts on the pancreas. We present the case of a 21-year-old female patient who, after 7 months of intragastric balloon placement, developed abdominal pain, nausea, and vomiting, associated with elevated pancreatic enzymes. A diagnosis of acute pancreatitis was made and compression of the tail of the pancreas was confirmed by tomographic study. It was decided to remove the balloon by endoscopy, which then progressed favorably.

Dilated myocardiopathy, thoracic aorta dissection, and hypothyroidism: report of a case

Alfonso Luis León Burgos — 2023-07-31

Hypothyroidism produces profound cardiovascular effects, being a rare cause of dilated cardiomyopathy; however, its association with aortic dissection is not well established.

We report the case of a 48-year-old female patient, without comorbidities, who presented epigastric pain and dysphagia associated with dyspnea. Tomography revealed a Stanford type B aortic dissection, with severe dilatation of the left heart chambers; LVEF of 30% and pericardial effusion were observed on the echocardiography; and serum analysis showed TSH 157.6 uU/ml and FT4 0.10 ng/dL. The patient initiated treatment with bisoprolol 2.5mg/day, spironolactone 25mg/day, furosemide 40mg/day and levothyroxine 50ug/day. At her controls she manifested a decrease in her symptoms; and after 7 months, the echocardiography showed non-dilated chambers and LVEF of 58%, while TSH was 3.5uU/ml at the serum analysis. This case illustrates a rare event where three events as dilated cardiomyopathy, thoracic aortic dissection, and hypothyroidism concur.

The importance of measuring blood viscosity: challenges and limitations

Charles Huamaní — 2023-07-31

Blood is a mixture of components that has its own identity. One of the physical properties that it acquires is its viscosity, which is the resistance it offers to move. Unlike its components (such as glucose, hemoglobin, cholesterol, etc.), blood does not have a single level of viscosity, but it is variable due to various factors. We present some physical principles that will allow us to better understand these dynamics of blood viscosity, and its possible application in some hemodynamic phenomena, as well as the complexity of its measurement in routine clinical practice.

Using the Sarnat Scale for classifying hypoxic-ischemic encephalopathy

Luis F. — 2023-08-01

Structured Videoconference for Case Discussions with a Specialist: a pilot trial

Janelis Gonzalez — 2023-06-30

Instructions for authors

Acta Médica Peruana — 2023-08-10