ACTA MEDICA PERUANA https://amp.cmp.org.pe/index.php/AMP Acta Médica Peruana es la revista científica oficial del Colegio Médico del Perú; tiene como finalidad difundir el conocimiento médico a la comunidad médica y científica a nivel nacional e internacional. Colegio Médico del Perú en-US ACTA MEDICA PERUANA 1018-8800 Gender/Family violence during the quarantine https://amp.cmp.org.pe/index.php/AMP/article/view/2405 Silvana Matassini Eyzaguirre Mariangela Duffoó Rosales Violeta Álvarez Arroyo Jorge Osada Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2405 Risk factors associated with mortality in patients with SARS-CoV-2 pneumonia in a Level I Social Security Hospital, Peru-La Libertad https://amp.cmp.org.pe/index.php/AMP/article/view/2336 <p><strong>Objective</strong>: To identify demographic, clinical, laboratory and treatment characteristics associated with mortality in hospitalized patients with SARS-CoV-2 pneumonia in a Level I Hospital of Peruvian Social Security, at La Libertad Network. <strong>Materials and Method</strong>: Retrospective cohort study. Cox proportional hazards model was used, calculating crude and adjusted hazard ratios (HR), and the Kaplan-Meier estimator was used to evaluate the overall survival curve and for each factor. <strong>Results</strong>: Of the 158 patients, the diagnosis was confirmed in 79.11%. Nearly 70% (68.99%) were men, the global median age was 65 years (IQR: 52-77), and it was higher in deceased subjects 69 years old (IQR: 61-80 years). Little more than half of this population (53.80%) had comorbidities, such as high blood pressure (27.85%), obesity (22.78%), and diabetes mellitus (13.92%). The median duration of symptoms prior to admission was 9 days (IQR: 6-11 days). HRs were determined for oxygen saturation less than 80% on admission with 0.21 FIO2, leukocytosis with associated lymphopenia, oxygen requirement at 0.80 FIO2 on admission, and moderate-severe ARDS. Such values were 1.54, 1.98, 2.07 and 2.91, respectively. <strong>Conclusions</strong>: The development of moderate-severe ARDS on admission, leukocytosis associated with lymphopenia, less than 80% hypoxemia on admission at 0.21 FIO2, and high-flow oxygen requirement since admission with 0.80 FIO2, were the only risk factors for mortality.</p> César Alejandro Arana-Calderón Sandra Paola Chávez-Guevara Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2336 Feasibility and safety of transperineal prostate biopsy in the era of cognitive magnetic resonance imaging/ultrasound fusion in cancer detection https://amp.cmp.org.pe/index.php/AMP/article/view/2331 <p><strong>Objective</strong>: To describe the results of transperineal prostate biopsy by fusion of cognitive magnetic resonance imaging and ultrasound in the detection of cancer. <strong>Materials and methods:</strong> A retrospective case series study conducted at the Delgado Clinic between July 2019 and October 2021. Patients with digital prostate examination and/or abnormal Prostatic Specific Antigen and prostate MRI images with category lesions were included. PI-RADS 4 or 5. Excluding patients with coagulation disorders, rectal injuries, impossibility for abduction, comorbidities for anesthesia. We recorded clinical and demographic characteristics, prostate-specific antigen data, prostate volume, PI-RADS lesions, cancer rates, and complications. <strong>Results:</strong> 18 patients were evaluated, with a mean age of 69.33 ± 7.67 years. The mean prostate specific antigen was 14.94 ± 12.42 ng/mL. The mean prostate volume was 57.72 ± 28.68 cc. At the digital examination of the prostate, 16/18 (88.88%) patients had suspected cancer. Biopsies in patients with PI-RADS lesions 4 in 6/18 (33.33%) and 5 in 12/18 (66.67%). Biopsy with 19 cores in 6/18 (33.33%) and 16 cores in 12/18 (66.67%) patients. Cancer patients 15/18 (83.33%), all acinar adenocarcinoma, with Gleason 6 in 2/18 (11.11%) and Gleason ≥ 7 in 13/18 (72.22%) patients. Mild complications such as hematuria 1/18 (5.6%), terminal dysuria 8/18 (44.4%) and perineal discomfort 7/18 (38.8%) and none infectious. <strong>Conclusions:</strong> transperineal prostate biopsy by fusion of cognitive magnetic resonance imaging and ultrasound is feasible, safe, with high positivity rates and without infections.</p> Luis Zegarra-Montes Gustavo Sarria-Bardales David Martínez-Perez Rubén del-Castillo-Pacora Richard Dyer-Velarde-Álvarez Miguel Trelles-De-Belaunde Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2331 Teleorientation in the ophthalmology service in a public hospital from May to August 2020 during the COVID-19 pandemic in Peru https://amp.cmp.org.pe/index.php/AMP/article/view/2322 <p><strong>Objectives</strong>:</p> <p>To identify presumptive diagnoses of patients treated by synchronous teleorientation in the Ophthalmology Service of Cayetano Heredia Hospital (CHH) during the COVID-19 pandemic, describing their demographic characteristics and the percentage of patients referred for a face-to-face evaluation.</p> <p><strong>Methods</strong>:</p> <p>A retrospective observational descriptive study with secondary analysis of a database collected from May to August 2020 consisting of patients treated with teleorientation in the Ophthalmology service at CHH.</p> <p><strong>Results</strong>:</p> <p>Three hundred and eight patients were included in the analysis. The main presumptive diagnoses were dry eye syndrome (24,68%), glaucoma (18.51%), cataract (17,85%), post-operated (5,84%) and viral/bacterial conjunctivitis (5,52%). Most patients were female (64,29%) and they came from Metropolitan Lima (91,88%). The number of older adults was higher than that of non-older adults (51,29% vs 48,70%). Finally, the patients sent to the Ophthalmology service for a face-to-face appointment were 4,55%.&nbsp;</p> <p><strong>Discussion</strong>:</p> <p>During the period of this study, the main presumptive diagnosis was dry eye syndrome. This result obtained is similar to other hospitals. The main presumptive diagnoses that required a face-to-face appointment were acute posterior vitreous detachment, glaucoma, age-related macular degeneration because they needed especial examination, like measuring the intraocular pressure and fundoscopy. Older adults required assistance more frequently compared to the non-older adult group (84.41% vs 59.57%, p&lt; 0,001).</p> <p>&nbsp;</p> Gabriela Huancahuari Ayala Juan Francisco Roman Benate Arturo Hernandez Peña Ray Ticse Aguirre Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2322 Characteristics of the placement and permanence in temporary central venous catheters for hemodialysis in a public hospital 2015-2019 https://amp.cmp.org.pe/index.php/AMP/article/view/2231 <p><strong>Objective</strong>: To describe the characteristics and permanence of temporary central venous catheters (CVCT) for hemodialysis in the Nephrology Service of a public Hospital in the period 2015-2019. <strong>Methods</strong>: Retrospective cohort longitudinal analytical study. 2156 records of CVCT placement procedures for hemodialysis in patients with stage 5 chronic kidney disease (CKD-5) were included, the final condition of the catheters was recorded during the follow-up period. Patients lost to follow-up were excluded. <strong>Results</strong>: Twenty-one hundred and fifty-six procedures were evaluated in 1,650 patients. Locations of catheters were Jugular, 1019 (51,9%); Subclavian, 198 (9,2%); and Femoral 129 (5,9%). Main causes of withdrawal were catheter dysfunction in 730 cases (33,9%) and infection in 410 (19,1%). During the five-year course, changes were observed, such as: variation in starting hemodialysis with AVF from 9.6% to 17,1% (p = 0,042), placement of tunneled CVCs during the first year of starting hemodialysis, from 8% to 23,0% (p 60 years), and diabetic etiology. During the study period, the variations in the proportion of patients who start chronic hemodialysis therapy with AVF are very low.</p> Joanna Yanissa Venegas Justiniano Abdías Hurtado Aréstegui Cesar Loza Muñarriz Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2231 Teaching Teleconsultation Program: perceptions of professors and students of a peruvian medical school https://amp.cmp.org.pe/index.php/AMP/article/view/2243 <p><strong>Introduction</strong>: The occurrence of the COVID-19 pandemic in Peru required an immediate response and multiple changes in both healthcare and health professional training. The School of Medicine in Universidad Peruana Cayetano Heredia implemented the Teleconsultation Faculty Program (FTP), aiming to continue with training medicine students in a virtual environment. However, the acceptance of those involved in virtual education is unknown, a condition that may reflect what has happened in other medical schools in our country. <strong>Main</strong>: our study sought to assess the perception of students and teachers regarding FTP. <strong>Methods</strong>: observational, descriptive, cross-sectional study. A questionnaire was developed to explore perceptions of telemedicine in a teaching scenario. <strong>Results</strong>: More than 80% of teachers and 60% of students considered that the FTP could be used as a teaching tool. More than 90% of teachers and students consider that performing telemedicine was not more difficult than doing a face-to-face consultation. Sixty percent of students and 80% of teachers perceive that students must develop skills in telemedicine; 80% of teachers and students consider that FTP constitutes a service with social responsibility. Teachers and students consider that the success in the implementation of an FTP is influenced by the level of acceptance of the population (20.2%), the use of electronic medical records (19.4%), and training in digital skills (18.6%). <strong>Conclusion</strong>: Teachers and students using FTP perceive telemedicine as a useful tool for assessing health problems. Both perceive that through telemedicine sessions, skills required to complete the medical school graduate profile could be acquired.&nbsp;</p> Pavel Jaime Contreras Carmona Miriam Castillo-Narro Jorge Huerta-Mercado Maria Sofía Cuba-Fuentes Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2243 Importance of the JAK/STAT signaling pathway in sepsis https://amp.cmp.org.pe/index.php/AMP/article/view/2240 <p>The Janus-Kinase signal transducer and the transcription activation pathway known as JAK /STAT is a major signaling pathway for the transduction of information in many inflammatory cytokines involved during sepsis. The JAK / STAT pathway has been shown to be strongly related to multiorgan failure, and many cytokines can exert their biological effects through this pathway. In recent years, considerable progress has been made in understanding functions of this complex; however, its role in sepsis as a therapeutic target remains under experimentation. This review describes the specific functions of the JAK / STAT pathway, its role in sepsis, and presents a translational approach to the therapeutic perspective aiming to inhibit this signaling pathway during sepsis and its interaction with inflammatory diseases such as COVID-19.</p> Daniel Alfonso Torres-Carpio Enrique Santiago Lanas-Mendoza Fernando Enrique Rueda-Barragán Pablo Andrés Vélez Páez Pedro René Torres-Cabezas Fernando Esteban Jara González Mario Patricio Montalvo Villagómez Santiago Xavier Aguayo Moscoso Jorge Luis Vélez-Páez Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2240 Methodology of pharmacogenetics research: Casecontrol studies https://amp.cmp.org.pe/index.php/AMP/article/view/2346 <p>Pharmacogenetics studies the association between the pharmacological phenotype of an individual with his/her genetic constitution. Case-control studies is a commonly used methodology when performing pharmacogenetics research. This design analyses the frequency of genetic variants in cases; that is, of those patients who have a particular phenotype (outcomes or results) compared with controls. For obtaining adequate methodological quality in pharmacogenetic case-control studies, it is important to work with precise phenotypes, have adequate case and control selection and appropriate sample size; select an adequate methodology for the identification of genetic variants, analyze the results using Hardy-Weinberg Equilibrium (HWE); and interpret the results considering the possibility of a phenoconversion phenomenon.</p> Teodoro J. Oscanoa Jose Amado-Tineo Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2346 Emergency cholecystectomy with an intraoperative hemobilia diagnosis: case report https://amp.cmp.org.pe/index.php/AMP/article/view/2229 <p>Hemobilia (HB) is the presence of blood in or through the biliary tract. Its most common causes are iatrogenic, traumatic, neoplasms, and cholangiovenous or arterio-biliary fistulas. Also, gallstones account for 5-15% of such cases. We present the case of a 28-year-old woman, with no remarkable history or anticoagulant use, who was initially diagnosed with acute cholecystitis, and required emergency open cholecystectomy. During the operation, a clot adhered to the gallbladder lumen and two calculi were evidenced. The diagnosis was confirmed with histopathological findings. Due to its clinical similarity, HB should be considered in patients with a history of anticoagulant therapy, trauma, malignancy, or with findings consistent with alithiasic cholecystitis. HB may also occur in patients with no remarkable history, and it be associated with cholelithiasis. Treatment depends on the patient’s hemodynamic status and etiology. Surgery is required in cholecystitis, because of its high mortality rate and occurrence of gallbladder perforation (2-15%).&nbsp;</p> Christian Ruiz Angelo Chuctaya Angel F. Vera-Portilla Walter Vera Portilla Elvis Calizaya Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2229 Arteriovenous fistula with basilic vein elevation. Case series https://amp.cmp.org.pe/index.php/AMP/article/view/2182 <p>Arteriovenous fistula (AVF) is necessary for hemodialysis access. The preferred configurations are radial-cephalic, brachial-cephalic, and brachial-basilic with elevation or transposition and tunneling. The purpose of this study was to present our experience for creating arteriovenous fistulae using the elevation of the basilic vein technique. Between June 2017 and March 2020, thirteen brachial–basilic fistulae with elevation of the basilic vein were performed in seven male and six female subjects. Their mean age was 65.7 years. During the early post-op period, there were two cases of forearm hematoma, wound infection in two cases, and edema in one case. During the follow-up period, three fistulae did not have a good progression, and three patients died; the remaining AVFs are still working. In conclusion, brachial–basilic AVF with elevation of the basilic vein is an alternative in patients who have already exhausted other access options.</p> Oswaldo Silva Rodríguez Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2182 Case report: Paratesticular mammary myofibroblastoma https://amp.cmp.org.pe/index.php/AMP/article/view/2294 <p>There is a variety of epithelial, mesothelial, and soft tissue tumors that can develop in the testicular and paratesticular area. We present the case of a patient with a right paratesticular tumor that was diagnosed as paratesticular mammary myofibroblastoma. It is important to emphasize the embryonic origin variety for the development of these tumors, as well as having a timely diagnosis for treatment and decisive follow–up.</p> Miguel Ángel Salazar Arenas Fernando Díaz Gallegos Mauricio Postigo Mac Dowall Mónica Ruiz Ballón Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2294 Painful violaceous pigmentation, a clinical challenge and diagnostic approach in a tropical country https://amp.cmp.org.pe/index.php/AMP/article/view/2307 <p>Millipedes are not considered poisonous animals, although in some cases their chemical defense mechanisms may be deleterious for human beings, manifesting as erythematous, purpuric and/ or cyanotic lesions alongside local pain and paresthesia. According to the exposure, the clinical condition may progress to moderate and severe lesions such as ulcers and blisters. We describe a case of a male child from the Andean region in Colombia, an area with daily temperatures between 15° and 30° C and 72% average humidity. The boy accidentally stepped on a millipede, and this occurrence became a challenge for its diagnosis amongst staff who provided emergency health care.</p> Oscar Fabián Rojas-Gómez Natalia Delgado-Ortiz Adriana Zamora-Suarez Álvaro Eduardo Mondragón-Cardona Freddy Escobar-Montealegre Carlos Eduardo Jiménez-Canizales Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2307 Severe hypercortisolism and recurring hypokalemia https://amp.cmp.org.pe/index.php/AMP/article/view/2363 <p>Endogenous Cushing syndrome derives from a chronic, inappropriate, and sustained increase in glucocorticoids, mainly in response to remarkably high serum concentrations of adrenocorticotropic hormone (ACTH) secreted from an adenohypophyseal tumor, Cushing's disease, or due to ectopic production by neuroendocrine tumors. Adrenal Cushing’s disease is caused by tumors of the adrenal cortex that autonomously produce cortisol and this is independent from ACTH action. Clinical course, treatment, prognosis, and possible complications depend on correctly identifying the triggering lesion; this situation frequently becomes a challenging experience for clinicians.</p> <p>We present the case of a 62-year-old woman, admitted for constitutional symptoms with severe hypokalemia that was difficult to correct and severe hypercortisolism.</p> Alejandro Pinzon-Tovar Marly Oviedo-Cali Silvana Jimenez-Salazar Harold Mendez Kenny Buitrago-Toro Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2363 Challenges for managing health infodemics in COVID-19 times https://amp.cmp.org.pe/index.php/AMP/article/view/2332 <p>In February 2020, at the time the COVID-19 pandemic was declared, the World Health Organization warned of massive infodemics, that is, a large amount of information that in some cases may be correct (in other cases not), and that may make it difficult for people to find reliable sources and appropriate guidance when required. Infodemics is spreading extremely fast, particularly with the rise of social media. Infodemiology is the science studying the distribution and determinants of information in electronic media, such as Internet, or in a population, for the purpose of informing on public health and public policies. During the period from 2002 to 2021, 484 publications on infodemiology were registered in the MEDLINE database (via PubMed), and 71.9% of the publications (348/484) appeared during 2020 and 2021. Just as the fast spread of epidemics may be controlled if acting on a timely fashion, infodemics may also be mitigated. However, there are challenges that add an additional burden in management of pandemics, and therefore there is an urgent need to educate the population and implement training programs for healthcare workers aiming to efficiently manage infodemics. The objective of this special paper is to describe the challenges for managing health infodemics in COVID-19 times.</p> Elizabeth Espinoza-Portilla Milagro Henríquez-Suárez Felipe Henríquez-Ayin Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2332 Clinical Practice Guidelines for diagnosis and treatment of Duchenne muscular dystrophy. Peruvian Neurology Society. Short Version https://amp.cmp.org.pe/index.php/AMP/article/view/2376 <p><strong>Objective</strong>: to provide evidence-based clinical recommendations for the diagnosis and treatment of Duchenne Muscular Dystrophy. <strong>Methods</strong>: a guideline development group (GEG) was formed that included specialized physicians in the fields of neurology, neuropediatrics, genetics, and methodology. The GEG asked eight clinical questions to be answered by recommendations in this clinical practice guidelines (CPG). We conducted a systematic search and - when deemed relevant - primary studies in Medline, Scopus, and the Cochrane Controlled Register of Trials during 2021 were reviewed. Evidence was selected to answer each of the clinical questions posed. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate recommendations, points of good clinical practice, and a diagnosis and treatment flowchart. <strong>Results</strong>: this CPG addressed eight clinical questions, divided into three topics: screening, diagnosis, and treatment. Based on these questions, fifteen recommendations were formulated (10 strong, 5 conditional) and 11 points for good clinical practice. <strong>Conclusion</strong>: this paper summarizes the methodology and evidence-based conclusions of the CPG for the diagnosis and treatment of Duchenne muscular dystrophy.</p> <p>&nbsp;</p> Peggy Martínez-Esteban Daniel Guillén-Pinto Alfredo Alfonso Duran-Padros Daniel Koc-Gonzales Julio Flores-Bravo Carlos Méndez-Dávalos Caroll Suyo Suyo-Suyo Elizabeth R. Espíritu-Rojas Nathaly Caballero-Bedón Vilma Giuliana Chávez-Pasco Katia Granados-Guibovich Jessica Milagros Graña-Espinoza Luis E. Celis-García Carlos Alva-Diaz Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2376 Elections during the COVID-19 pandemic in Perú. Incidence of cases https://amp.cmp.org.pe/index.php/AMP/article/view/2318 Jorge E. Silva-Fiestas Diana Celis-Cortez Alfredo Chiappe-Gonzalez Eduardo A. Pastor-Revilla Juan J. Montenegro-Idrogo Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-13 2022-08-13 39 2 10.35663/amp.2022.392.2318 Pneumocystis jirovecii and Aspergillus fumigatus coinfection pneumonia in a non-HIV patient: Case report https://amp.cmp.org.pe/index.php/AMP/article/view/2378 Eduardo Gotuzzo Herencia Juan Pablo Rojas Hernández Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-17 2022-08-17 39 2 10.35663/amp.2022.392.2378 Fe de erratas https://amp.cmp.org.pe/index.php/AMP/article/view/2445 Comite Editorial Acta Medica Peruana Copyright (c) 2022 ACTA MEDICA PERUANA 2022-08-17 2022-08-17 39 2 10.35663/amp.2022.392.2445