ACTA MEDICA PERUANA

Climate disasters could be unpredictable, but their health effects are not

Roger V. Araujo-Castillo — 2023-05-03

Correlation between salivary glucose level against fasting blood glucose, glycated hemoglobin, and C-Peptide in persons with type 2 diabetes mellitus

Carmen Palomino — 2023-05-08

Objetivo: To determine the correlation between salivary glucose levels with fasting blood glucose, HbA1c, and C-peptide in patients with type 2 diabetes mellitus (T2DM). Materials and methods: This is a cross-sectional study performed at the Centro de Investigación en Diabetes, Obesidad y Nutrición (CIDON) in Lima, Peru, during 2021. Patients were categorized as those with good metabolic control (HbA1c<7 %), and poor metabolic control (HbA1c≥7 %). Baseline fasting blood glucose, as well as blood HbA1c and C-peptide values were measured. Salivary glucose was measured using the glucose oxidase method. Spearman’s correlation was used for determining an association between salivary glucose levels and fasting blood glucose, HbA1c, and C-peptide. Results: One-hundred and forty-two subjects with T2DM participated in the study. Salivary glucose was significantly higher in T2DM subjects with poor metabolic control (p<0.01). A weak positive correlation between salivary glucose and fasting blood glucose (r= 0.23, p= 0.04) and HbA1c (r= 0.26, p= 0.02) was observed in subjects with T2DM and poor metabolic control, and also a non-significant negative correlation (r=-0.08; p= 0.47) with C-peptide. Conclusions: Salivary glucose levels show significant and positive association with fasting blood glucose and HbA1c, but not with C-peptide in persons with T2DM and poor metabolic control. However, there are many factors that should be considered and analyzed in detail aiming to determine its potential use.

Effectiveness of the vaccine against SARS-CoV-2 upon hospitalizations during the fourth epidemic wave in Queretaro, Mexico

Enrique Villarreal Ríos — 2023-05-08

Objective. To assess the protective effect of the vaccine against SARS-CoV-2 upon hospitalizations due to COVID-19 during the fourth epidemic wave in Queretaro, Mexico.

Methods. This investigation was designed as a retrospective cohort study in patients with COVID-19 during the fourth wave of the epidemic (December 19th, 2021, to January 9^th, 2022). The exposed group consisted in those subjects who had received a vaccine against COVID-19 (genetically modified adenovirus vaccine and messenger ribonucleic acid vaccine); and the non-exposed group consisted in those people who were not vaccinated. Diagnosis of COVID-19 was made with a rapid antigenic test in oropharyngeal exudate, and the test was performed between the first and fifth day after the onset of symptoms. All patients who came to healthcare facilities because of symptoms, with a positive test and having received two doses of the vaccine. Statistical analysis included chi-square, relative risk, and confidence intervals (CI) for the relative risk.

Results. Fifty-two patients who received a genetically modified vaccine, 119 who received a messenger ribonucleic acid vaccine, and 336 non vaccinated subjects were included in the study. The frequency of hospitalization was 62,2% in non-vaccinated persons, this rate was 23,1% (p= 0.000), and relative risk was 0,37 (95% CI; 0,22-0,61) in those who received a genetically modified adenovirus vaccine, and it was 1.7% (p= 0.000), and relative risk was 0,03 (95% CI; 0,006-0,10) in those who received the messenger ribonucleic acid vaccine.

Conclusions. From a population point of view, the vaccine against COVID-19 was effective for preventing hospitalization in patients with acute COVID-19 disease during the fourth epidemic wave.

Follow-up of the aortic valve replacement surgery in a national reference hospital in Lima, Peru, period 2016-2019

Carlos Figueroa-Alfaro — 2023-05-08

Objective: To describe the perioperative characteristics of patients undergoing aortic valve replacement; as well as complications, mortality, follow-up and survival.

Materials and methods: A retrospective study of patients operated between 2016 and 2019 was carried out. Pre, intra, and postoperative characteristics were determined, as well as clinical and echocardiographic follow-up. Student's t test was used to compare means. Overall survival and cardiovascular event-free survival were analyzed using the Kaplan-Meier method.

Results:110 patients were included (59.1% male), the mean age was 65.2 ± 11.3 years, the majority with arterial hypertension (47.3%). The most frequent etiology was degenerative (47.3%). A mechanical prosthesis was implanted in 59.1%. In the postoperative period, a median mechanical ventilation time of 8 hours was observed, with an average stay in the ICU of 5.8 ± 6.7 days. The most frequent complications were atelectasis (21.8%), atrial fibrillation (19.1%), low output syndrome, pneumonia, and acute kidney injury (7.3% each). Hospital mortality was 5.5% (cardiogenic shock as the frequent cause). During follow-up at one year, there was an improvement from NYHA II-III functional class (pre-surgical) to NYHA I-II (p <0.001), prosthesis dysfunction was found in 13.3% (the majority due to paravalvular leak). Overall survival at 1, 3, and 5 years was 88,2 ± 3,1, 83.4 ± 3.6% y 74.3 ± 5.0%, respectively.

Conclusions: Aortic valve replacement surgery in our setting implies an improvement in quality of life with good functional results, complication rate, and morbidity and mortality comparable with the world literature.

Achieving early metabolic control in adults with type diabetes mellitus in Peru

Jesus Rocca Nación — 2023-05-08

Objective: To estimate the rate of subjects with type 2 diabetes mellitus (T2DM) who reach the therapy goal for HbA1C one year after diagnosis (early metabolic control).

Methods: This was a retrospective study reviewing clinical records of adults who came to sixteen health centers distributed in nine Peruvian cities. Patients who received an initial T2DM diagnosis and who had at least one-year follow-up were included. Metabolic goals set in ADA 29018 standards were considered.

Results: Four hundred and fifty-seven subjects (53,03% female) were included. When diagnosed, their mean age was 55,75 years (standard deviation [SD]: ± 12,92), and mean HbA1C value was 9,10% (SD: ± 2,28). Concomitant diagnosis including high blood pressure or dyslipidemia were found in 27,13% and 52,40% of all subjects, respectively. After one-year follow-up, 57,76% of all subjects achieved the HbA1C goal (<7,0%). Goal achievement for other parameters were 39,66% for LDL-C (<100 mg/dl), 55,56% for HDL-C in males (>40 mg/dL), 24,31% for HDL-C in females (>50 mg/dL), 48,24% for triglycerides (<150 mg/dL), and 89,23 for blood pressure (<140/90 mm Hg).

Conclusions: In this real-life study performed in T2DM adults and with one year follow-up, reaching an appropriate goal for HbA1c (<7%) was achieved by 58% of all subjects. Although these results are compatible with reports from nearby regions, an opportunity is evidenced for improving early goal achievement with the objective of obtaining better results in the short term.

Experience in upper cervical pathology in Guillermo Almenara-Irigoyen Hospital in Lima, Peru: 2016 – 2021

John F. Vargas Urbina — 2023-05-08

Introduction: The C0-C1-C2 complex is responsible of axial load transition, and its biomechanical function is unique, it is affected by multiple pathological conditions; and generally speaking, the literature does not consider these conditions as a single item, it describes them according to etiology. For our study we considered five groups: trauma-related, congenital, rheumatic-inflammatory, neoplastic, and degenerative. Objective: To determine epidemiological, clinical, and therapy-related characteristics in upper cervical pathological conditions. Materials and methods: All patients with a clinical-radiological diagnosis of any upper cervical pathological condition that had undergone surgery between 2016 and 2021 in Guillermo Almenara Hospital were included. Student’s t test and chi square methods were used. Patients were divided into five groups: congenital, trauma-related, rheumatic inflammatory, degenerative, and neoplastic. Results: Thirty-one patients were included in the study; their mean age was 51.16 years. The most frequent upper cervical pathological condition was trauma-related, with 35.48%. Motor deficit occurred in 51.61% of all patients, and sensitive deficit occurred in 54.84%. The most frequently surgical procedure performed was upper cervical fixation, in 43.89% of all patients. Complication rate was 16.13%, and mortality was 0%. Conclusions: Upper cervical pathological conditions are rare, trauma-related conditions are most frequent, but timely and adequate management allow us to achieve better functional prognosis for these patients.

Association between obesity and depression symptoms in adolescents in Queretaro, Mexico

Ignacio Martínez Soto — 2023-05-08

Objective: To identify the association between obesity and depression symptoms in adolescents attended in a family health center. Materials and Methods: An observational, cross-sectional, comparative study of Mexican adolescents aged 10 to 19 years integrated two comparison groups, adolescents with obesity and without obesity. The sample size was 97 adolescents per group, non-probabilistic sampling per quota was used. Depression was evaluated with the revised version of the Center for Epidemiological Studies (CESD-R) Depression Scale. The statistical analysis included averages, percentages, standard deviations, chi square test, odds ratio (OR), and confidence intervals for OR. Results: In the group of adolescents with obesity 48,5% presented depressive symptoms and in the group of adolescents without obesity 33% also presented depressive symptoms (p=0,02), RM was 1,90 (95%CI; 1,06-3,41). Conclusions: We found an association between obesity and depression symptoms in adolescents.

Intracranial Rosai-Dorfman disease: an infrequent differential diagnosis for meningioma. Report of a case

Elder Castro-Castillo — 2023-04-30

Rosai-Dorfman Disease is a rare disorder of unknown etiology. Intracranial presentation is even rarer and often mimics the appearance of a meningioma on neuroimaging. Here we present the case of a 38-year-old male patient admitted for an intracranial, extra-axial, supratentorial tumor associated with mild neurological deficit; the presumptive diagnosis was convexity meningioma. After surgery, the definitive histological diagnosis was informed as intracranial Rosai-Dorfman Disease.The differential diagnosis of any extra-axial intracranial lesion suggestive of a meningioma should include intracranial Rosai-Dorfman Disease due to the similarities on clinical presentation and neuroimaging.

Harlequin color change in a newborn who was positive for COVID-19: report of a case

Esther Pinel-Guzmán — 2023-05-08

Harlequin color change is a benign, idiopathic, self-limiting disorder characterized by the appearance of skin divided into two distinctly colored areas. Its etiology is unknown but thought to be caused by immaturity of hypothalamic regulation of peripheral vascular tone. COVID-19 infection in neonates is infrequent and rarely symptomatic, with only a few cases described in the literature. In isolation, both conditions have a low incidence. It is the first case reported in the world literature of harlequin color change in a newborn who tested positive for COVID-19. There isn’t a single publication that links harlequin color change to COVID-19.

Insect bite in the cornea, report of a case

Gioconda Lourdes Armas Herrera — 2023-05-08

Stereotaxic gamma knife radiosurgery in a patient with cerebral cavernoma and Evans syndrome

Hector Mijail Lizarraga Valderrama — 2023-05-08

Cerebral cavernoma is an infrequently diagnosed vascular malformation. It is defined as a malformation at the level of the microcerebral vasculature that, depending on the location and if there is a possibility of rupture, leads to an emergency that can end in the death of the patient. On this occasion, we report a case of a patient with cerebral cavernoma associated with Evans syndrome. Surgical management of the lesion was decided due to increased intensity of headache and oral intolerance. Given the coexistence of Evans Syndrome and the high rate of morbidity and mortality, surgical management was decided by stereotaxic radiosurgery with a gamma knife. The use of low-margin doses for treatment with gamma knife for use in brain cavernomas produces controlled management for seizure symptoms and better quality of life expectancy.

Familial X-chromosome linked hypophosphatemic rickets: Report of a case

Cristian Leon-Rabanal — 2023-04-30

Phosphorus is regulated by the kidney and bone system orchestrated mainly by the action of parathormone (PTH) and a molecule recently described as fibroblast growth factor 23 (FGF-23). We present the cases of two mother-son patients with X-linked hypophosphatemic rickets. Hypophosphatemic rickets is part of a group of tubulopathies characterized by hyperphosphaturia. A genetic study was performed, identifying a mutation in the PHEX gene (pathogenic splicing-type variant in hemizygosis), mutation previously described as HGMD CS126536. Loss-of-function mutation of the PHEX gene leads to increased FGF-23. PHEX degrades FGF-23 into inactive fragments, preventing excessive phosphate excretion and the development of hypophosphatemia. In a patient with hypophosphatemia not dependent on the hormone PTH or vitamin D and of familial presentation, the diagnosis of X-linked hypophosphatemic rickets should be considered.

Rituximab therapy in two pediatric patients with systemic lupus erythematosus

Freddy Liñán Ponce — 2023-05-08

Introduction. Pediatric systemic lupus erythematosus (pSLE) represents 15% of all SLE patients. Renal and neuropsychiatric involvement are more aggressive in pSLE, and single organ involvement is the most commonly found clinical form. Conditions such as cerebral infarction and serositis are unusual manifestation of pSLE. Therapy for pSLE is not different from that for the adult forms, and the therapy armamentarium is the same. Rituximab (RTX) is a worldwide used biological for SLE, with excellent results; however, there is still no consensus with respect to is real efficacy in pSLE. Objectives. Presentation of two pSLE cases with cerebral infarction and serositis as main characteristics, who did not respond to conventional therapy, but who did respond to RTX. Methods. Case report, describing the clinical presentation, diagnostic methods, and therapy approach used. Results. First case: This is a sixteen-year-old girl who was brought because of progressing headache and a tonic-clonic crisis. The brain CT scan showed a left frontoparietal cerebral infarction. Physical examination revealed livedo reticularis in both legs, joint pain, hair loss, and mouth ulcers. Laboratory tests revealed normocytic anemia, thrombocytopenia, reduced complement, 1/320 ANA with a homogeneous pattern, 3.200 mg 24-hour proteinuria, and negative anti-phospholipidic antibodies. A pSLE diagnosis was made, with renal, neurologic, and hematologic involvement, so it was decided to use methylprednisolone, 1 gram IV per day for three days, and then switch to cyclophosphamide 1 g IV per month for 6 months. After three months, proteinuria, fatigue, and arthralgia persisted. For this reason, it was decided to administer rituximab, 375 mg/m2 in days 1 and 15, every six months. After four infusions, proteinuria, joint pain and malaise all disappeared. Nowadays this patient maintains SLEDAI-K scores in remission, and she is also receiving low-dose prednisone. Second case: This is a ten-year-old boy, who presented with abrupt diffuse abdominal pain associated with (abdominal) distention. Other manifestations were tiredness, shortness of breath, and palpitations. A plain abdomen X-ray film did not show hydro-aerial levels, but the chest X-ray film showed bilateral pleural effusion, and enlarged cardiac silhouette. Cardiac ultrasonography and abdominal ultrasonography revealed pericardial effusion and ascites, respectively. Findings in physical examination showed pallor translucid edema of the legs, pericardial throbbing, and reduced respiratory sounds in both pulmonary bases. Laboratory tests revealed leukopenia, lymphopenia, normocytic anemia, elevated acute phase reactants, ANA 1/560, antiDNA 280 U/mL, reduced complement, elevated transaminases, and normal urea and creatinine. pSLE was diagnosed, and therapy instituted was methylprednisolone 30 mg/Kg/dose for 4 days, then it was switched to mycophenolate 600 mg/m2 per day. There was improvement initially, but after two months, serositis reappeared. Then it was decided to start rituximab 375 mg/m2 . After the second infusion, serositis disappeared, and CBC, complement, and transaminase values returned to normal. Nowadays the patient is in remission, and he is receiving low-dose prednisone. Conclusión. Both presented cases featured cerebral infarction and serositis. They also showed high ANA titers and reduced complement. Both patients improved their condition with rituximab after failure with cyclophosphamide and mycophenolate. Informed consent from both parents and patients was obtained.