ACTA MEDICA PERUANA 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. en-US (Acta Medica Peruana) (Asistencia Tecnica - AMP) Tue, 18 Aug 2020 00:00:00 -0500 OJS 60 The use of drugs without demonstrated effect as a therapeutic strategy in COVID-19 in Peru <p>-</p> Alonso Soto Copyright (c) 2020 ACTA MEDICA PERUANA Thu, 10 Sep 2020 14:06:46 -0500 Epidemiological transition in Peru: analysis of mortality records from 2003 to 2016 <p><strong>Objective:</strong> to describe the existing patterns of mortality in Peru, at the national and regional level. <strong>Materials and methods:</strong> a secondary analysis using national death records from 2003 to 2016 was conducted. The Global Burden of Disease 20017 approach was utilized to group underlying causes of death into five groups: non-communicable diseases, infectious diseases, maternal and neonatal, nutritional, and injury deaths. The Mann-Kendall tau test was used to assess trends and changes of causes of death over time. <strong>Results:</strong> between 2003 and 2016, a total of 1′295,290 deaths at the national level were recorded, but only 698,037 records were analyzed. For 2003, 63.9% of deaths were attributed to non-communicable diseases, whereas 16.9% were due to infectious diseases, and 8.8% for injuries. For 2016, 83.6% of deaths were attributed to non-communicable diseases (p-value for trends &lt; 0.001), whilst 8.6% of deaths were due to infectious diseases (p-value for trends &lt; 0.001), and 5.4% were due to injuries (p-value for trends &lt; 0.001). Similar results were obtained when analyses were conducted by sex and by regions. <strong>Conclusions:</strong> from 2003 to 2016, the proportion of deaths attributable to non-communicable disease have increased in Peru. These findings were similar for both, males and females, and for the 25 regions in the country, where the non-communicable diseases are the first cause of death.</p> Antonio Bernabe-Ortiz, Rodrigo M. Carrillo-Larco Copyright (c) 2020 ACTA MEDICA PERUANA Wed, 07 Oct 2020 18:44:26 -0500 Prices of essential drugs for management and treatment of COVID-19 in public and private Peruvian pharmacies <p><strong>Objective:</strong> to compare the sale price of essential drugs used in the management and therapy of COVID-19 in public and private pharmacies in Peru. Also, to assess the cost per person of drug therapy for both mild and severe cases. <strong>Materials and methods:</strong> this is a cross-sectional study using data reported by public and private pharmacies in Peru. Drug prices are presented as median values and they were compared using the non-parametric Kruskal-Wallis test. Also, costs per person and drug accessibility for treating mild and moderate cases were estimated. <strong>Results:</strong> drugs used when treating mild cases of COVID-19, such as azythromycin, hydroxichloroquine, ivermectin, and paracetamol had median prices between S/ 0.04 (US$ 0.011) and S/ 23.81 (US$ 6.71) in public pharmacies, while the same compounds cost between S/ 1.00 (US$ 0.28) and S/ 36.00 (US$ 10.15) in private pharmacies. On average, drug prices in private pharmacies are 11 times higher compared to those in public pharmacies. Costs for (COVID-19) therapy in public pharmacies are more accessible compared to those found in private pharmacies, particularly for drugs used for more severely affected patients. Therapy regimens for mild cases require spending 1 to 4 days of the minimum daily wages, while therapy for severe cases (of COVID-19) may require up to 64 days of the minimum daily wages in private pharmacies. <strong>Conclusions:</strong> pharmacological treatment for COVID-19 represents an important expense for the public health system and for families through out-of-pocket expenses. It is urgent to design and implement regulatory measures aiming to improve the access to drug therapy (for Covid-19) in order to have drugs sold at accessible prices.</p> Janeth Tenorio-Mucha, María Lazo-Porras, Alexander Monroy-Hidalgo, German Malaga, Maria Kathia Cardenas Copyright (c) 2020 ACTA MEDICA PERUANA Tue, 29 Sep 2020 10:23:13 -0500 Malnutrition-associated factors in patients hospitalized in an emergency surgical ward in a Peruvian social security hospital <p><strong>Objective:</strong> to identify malnutrition-associated factors in patients hospitalized in the emergency surgical ward in Guillermo Almenara-Irigoyen National Hospital. <strong>Materials and methods:</strong> this is an analytical study in which an initial nutritional evaluation was performed using the 2002 Nutritional Risk Screening. Afterwards, a nutritional assessment was performed on admission and at discharge using a subjective overall assessment in 206 adult and elderly subjects. Clinical variables were analyzed using logistic regression and p&lt;0.05 was considered as significant. <strong>Results:</strong> sixteen per cent of all patients worsened their nutritional status during hospitalization. Associated factors were some comorbidity (odds ratio [OR] 2.32; 95% confidence interval [CI]: 1.07-5.01); neoplasms (OR: 2.83; 95% CI: 1.21-6.63), nervous system diseases (OR: 5.66; 95% CI: 1.24-25.82); absence of weight and height recording (OR: 4.18; 95% CI: 1.29-13.41); abdominal surgery (OR: 6.67; 95% CI: 3.08-14.89); acute appendicitis decreased 85%; acute cholecystitis decreased 91%; surgical reintervention (OR: 13.91; 95% CI: 4.82-40.06); regular consumption of the indicated diet (OR: 8.78; 95% CI: 3.01-25.63); not consuming the indicated diet (OR: 39.97; 95% CI: 11.39-140.23); use of nutritional support decreased exposure by 83%. Malnutrition increased the risk of mortality 6 times. The number of days of fasting, (OR: 1.73; 95% CI: 1.31-2.27). Mortality was 8.7%. <strong>Conclusions:</strong> there are some factors associated to malnutrition during hospitalization, so it is necessary to perform screening for early detection of malnutrition when patients are admitted, and also, nutritional assessments of those found to be at risk are necessary.</p> Paola A. Zena-Huancas, Denissa Pajuelo-Garcia, Cristian Diaz-Velez Copyright (c) 2020 ACTA MEDICA PERUANA Wed, 07 Oct 2020 19:14:12 -0500 Production, impact and collaboration in Peruvian research in psychiatry and mental health <p><strong>Objective:</strong> to measure production, impact, and collaboration in Peruvian research on mental health as reported in Scopus, from 1992 until 2018. <strong>Materials and methods:</strong> this is a bibliometric review that analyzed publications featured in Scopus and dealing with psychiatry and mental health that had been produced by researchers affiliated to Peruvian institutions. Scientific production analysis reviewed the number of papers published per year, the impact analysis assessed the number of times these papers were referenced in Scopus, and the collaboration analysis assessed institutions and country networks participating in the aforementioned pieces of research. <strong>Results:</strong> research dealing with psychiatry and mental health showed an increasing trend for the number of published papers, as well as with respect to the times such papers were referenced and also considering inter-institutional collaboration during the 1992-2018 time period. Nonetheless, the number of published papers is low, since only 12 papers per year have been published. Research is carried out by few institutions in Lima, it only partially deals with psychiatry and mental health issues, and it shows moderate leadership from Peruvian institutions. <strong>Conclusion:</strong> a larger number of national institutions is required for participating in research dealing with psychiatry and mental health. A collaborative effort is needed.</p> Ruben Valle, María T. Rivera-Encinas, Santiago Stucchi-Portocarrero Copyright (c) 2020 ACTA MEDICA PERUANA Wed, 07 Oct 2020 19:48:49 -0500 Reasons for the election and preferences of the medical specialty in general practitioners of Peru <p><strong>Objective:</strong> to describe the reasons that influence the choice of medical specialty in general physicians in Peru, and to calculate the applicants and vacancies in the national medical residency exam in 2018. <strong>Materials and methods:</strong> descriptive cross-sectional study in general physicians who attended an event that aimed to inform about medical specialties, carried out by the Peruvian Medical College. During this event, a self-applied questionnaire was distributed to collect the variables of interest. The statistical analyzes were performed with the Stata v.14 program. <strong>Results:</strong> surveys of 298 participants were<br>analyzed, of which 54.4% were women, 46.3% had less than 28 years old, 59.8% studied their undergraduate studies in Lima, and 52.3% completed their career between 2014-2016. 49.7%, 46.6%, and 3.7% preferred choosing a surgical specialty, clinic, and some other, respectively. The reasons considered important or very important to choose a specialty were: the high probability of getting a job (98.7%), having intellectual challenges (94.9%), see interesting cases (93.2%), and have good economic income (90.8%). Plastic surgery and dermatology were the specialties with greatest number of applicants for each vacant, while family medicine and internal medicine had less applicants than vacancies. <strong>Conclusions:</strong> Peruvian physicians consider economic and academic reasons as the most important ones, when choosing a specialty, in a context where primary care specialties had few applicants. This allows us to better understand the process behind choosing and specialty, adequately inform to the physicians about the specialties available, and promote strategies to increase the interest of doctors in specialties needed in the country.</p> Christoper A. Alarcon-Ruiz, Paula Heredia, Jessica H. Zafra-Tanaka, Alvaro Taype-Rondan Copyright (c) 2020 ACTA MEDICA PERUANA Wed, 07 Oct 2020 20:02:57 -0500 Factors associated to the occurrence of cleft lip and palate in newborns in a tertiary care Peruvian hospital. A case-control study <p><strong>Objective:</strong> to identify factors associated to the occurrence of cleft lip and/or palate in newborns in Edgardo Rebagliati-Martins National Hospital in Lima, Peru, during the time period from November 2012 until December 2016. <strong>Materials and methods:</strong> this is an analytical observational paired case-control study, with data from the Collaborative Latin-American Study of Congenital Malformations. Sixty-one cases and sixty-one controls were analyzed. The dependent variable was the presence of cleft lip and/or palate. Clinical, epidemiological, obstetric, and prenatal variables were also analyzed. <strong>Results:</strong> cleft lip/palate with complete extension predominantly in males was the most frequent form, and it was present in 36 neonates (59%), 44 of all children in the sample (75.9%) had normal karyotype, and 40 did not have a prenatal diagnosis (65.6%). Associated malformations most frequently observed were 27 facial cases (44.2%), followed by cardiac malformations (29.6%). A statistical model using multivariate analysis was built on, and this comprised three variables: chronic disease during pregnancy (odds ratio [OR]: 3.8; 95% confidence interval [CI]: 1.11–13.8), maternal age more than 35 years (OR: 6.85; 95% CI: 2.69–17.43), and family history (OR: 14.5; 95% CI: 1.68–125.56). <strong>Conclusions:</strong> chronic diseases during pregnancy, advanced maternal age, and family history were factors that increased the frequency of cleft lip and/or palate.</p> Esteban A. Plasencia-Duenas, Cristian Diaz-Velez, Milagros M. Dueñas-Roque Copyright (c) 2020 ACTA MEDICA PERUANA Wed, 07 Oct 2020 20:38:40 -0500 Presence of thyroid nodes in patients with metabolic syndrome in a Peruvian tertiary care hospital <p><strong>Objective:</strong> To compare the frequency of thyroid node disease (TND) in patients with metabolic syndrome (MS) and in patients without metabolic syndrome in an area with good iodine supply. <strong>Materials and methods:</strong> This is an analytical comparative casecontrol study performed in paired groups. There were 40 patients with MS and 40 controls attending the Endocrinology service in Cayetano Heredia Hospital in Lima, Peru, who were paired according to age and sex. Weight, height, and blood pressure measurements were taken from clinical records. Abdominal circumference was measured, and the presence of acanthosis nigricans was determined. Lipid profile, baseline blood glucose and TSH were determined. Thyroid ultrasonography was performed in all participants. Thyroid volume values were recorded and thyroid nodes measuring &gt;5-mm were considered as clinically significant. <strong>Results:</strong> Eighty per cent of the studied population in both groups was women. There were significant differences in tobacco use, acanthosis nigricans, TSH levels, thyroid volume, weight, body mass index, abdominal circumference, diastolic blood pressure, baseline blood glucose, HDL-cholesterol and triglyceride levels between both groups. TND was more frequent in those patients with MS compared to patients with no MS (40% vs. 12.5%, respectively; p= 0.015). The odds ratio (OR) for having thyroid nodes in the presence of MS was 4.66 (95% confidence interval: 1.34–16.24). There were significant differences in thyroid volume for both groups (p= 0.039). <strong>Conclusion:</strong> In an area with good iodine supply, MS was associated to TND to with an increased thyroid volume.</p> Victor Noriega-Ruiz, Liliana Torres-Samame, Miluska Huachin-Soto, Jaime Villena, Javier Loza Copyright (c) 2020 ACTA MEDICA PERUANA Wed, 07 Oct 2020 20:54:33 -0500 Association between insulin resistance and acanthosis nigricans in obese children in a tertiary care hospital in Lima, 2018 - 2019 <p><strong>Objective:</strong> to explore whether there is an association between the frequency of insulin resistance and the presence and distribution of acanthosis nigricans in obese children. <strong>Materials and methods:</strong> this is a cross-sectional study in which 42 obese children between 5 and 10 years of age participated. The presence of acanthosis nigricans was characterized (number and distribution of affected areas) as well as other variables, such as age, sex, and Body Mass Index. Four groups were formed, and the frequency of insulin resistance was determined, aiming to explore its association with the other variables. <strong>Results:</strong> mean participants’ age was 8.6 years, and male subjects accounted for 54.8%. Nearly two-thirds of participants (64.3%) had acanthosis nigricans, and 78% of them had insulin resistance. Associated variables with statistical significance were age (p= 0.009), BMI (p= 0.025), and the presence of acanthosis nigricans affecting the neck region. <strong>Conclusions:</strong> there is an association between insulin resistance and the presence of acanthosis nigricans affecting the neck of obese children.</p> Miguel Bardellini Ortiz, Raul E. Canales, Kevin Robles Heredia, Emilio Cabello Morales, Frine Samalvides Cuba Copyright (c) 2020 ACTA MEDICA PERUANA Fri, 04 Sep 2020 17:48:01 -0500 A review on obesity as a risk factor for mortality in COVID-19 disease <p>This review presents evidence available up to June 2020 dealing with the effects from obesity as a possible factor increasing mortality in patients diagnosed with COVID-19 infection. Quality for most of the studies was good according to the Newcastle Ottawa scale (7/9 or higher). Studies reported follow-up periods between February 6th up to May 17th, 2020. In patients with COVID-19, obesity was a risk factor for mortality. Obese persons should be treated as a highrisk population, and preventive measures against transmission of the aforementioned infection must be intensified, and specialized assistance must be given to confirmed COVID-19 cases.</p> Janeth Tenorio-Mucha, Yamilée Hurtado-Roca Copyright (c) 2020 ACTA MEDICA PERUANA Wed, 07 Oct 2020 21:57:51 -0500 Initial CT scanning in patients with COVID-19 pneumonia in the peruvian central air force hospital: a case series <p>We present nine cases of COVID-19 patients that developed pneumonia caused by SARSCov-2 who were seen in the Peruvian Central Air Force Hospital and showed different clinical features, risk factors, and outcomes. Findings of their thorax CT scans are described using a tomographic score that was applied on admission. Points assigned were based on the percentage of involvement on each pulmonary lobe and this allowed us to determine a clinical diagnosis of pneumonia according to its severity, even before having positive results in molecular and serological tests for some of these patients.</p> Ursula Cáceres-Bernaola, Claudia Becerra-Nuñez, Sabina Mendívil-Tuchía de Tai, Jorge Ravelo-Hernandez, Edwin Quispe-Ayuque Copyright (c) 2020 ACTA MEDICA PERUANA Wed, 07 Oct 2020 22:15:34 -0500 Native valve infective endocarditis caused by Staphylococcus hominis in a patient hospitalized with Covid-19. Report of a case <p>Covid-19 disease shows many different manifestations, from common symptoms affecting both the upper and lower respiratory tract, and also sensorial alterations such as anosmia or taste perversion. Heart valve thrombosis and subsequent endocarditis are extremely rare manifestations and they have been scarcely described within the context of Covid-19. We present a case of a patient that was positive for SARS-Cov-2, who developed Staphylococcus hominis bacteremia. Afterwards, he developed persistent fever, and after ruling out some differential diagnoses, a diagnosis of infective endocarditis affecting a native healthy aortic valve was made, using cardiac ultrasonography. This occurrence was considered to be hospital-acquired.</p> Jorge L. Velez-Paez, Edgar F. Lopez-Rondon, Fernando E. Jara-Gonzalez, Evelyn E. Castro-Reyes Copyright (c) 2020 ACTA MEDICA PERUANA Wed, 07 Oct 2020 22:27:40 -0500 Vibrio cholerae bacteremia (non-O1/non-O139): case report <p>Vibrio cholerae (non-O1/non-O139) is an uncommon pathogen that causes infection in humans, it is a free-living microorganism in river and sea waters, where it colonizes fish and shellfish, which are the main transmission sources. We present the case of a 78-year old man with a history of diabetes mellitus and suspected pancreas malignancy; who was brought because of fever disease with abdominal pain, and Vibrio cholerae bacteremia was documented, so antibacterial therapy was started, and his clinical condition resolved. Since this case was related to the ingestion of contaminated water, we notified the authorities so the infectious source may be controlled, and this intervention will prevent the occurrence of infections in persons in contact with this particular water source.</p> Juan Camilo Motta, Carolina Forero, Alvaro Arango, Isabel Hernandez-Linares, Magda Sanchez Copyright (c) 2020 ACTA MEDICA PERUANA Tue, 18 Aug 2020 16:36:32 -0500 Leprosy: a suspected diagnosis in a non-endemic area. Case series and literature review <p>Leprosy (Hansen’s disease) is a chronic granulomatous condition caused by Mycobacterium leprae, a microorganism that affects the skin and Schwann’s cells. Making a diagnosis of this condition is difficult in non-endemic areas because of low clinical suspicion. During the 2012-2019 time period, three cases of Hansen’s disease were diagnosed and treated in the ID service of Dos de Mayo Hospital. The average time history of the disease was 4 years. Patients started their condition with the appearance of pruriginous papular lesions affecting specific body regions, progressing to generalized nodular lesions. Paresthesia and tactile, thermal, pain, and vibratory hypoesthesia were found. These manifestations later progressed to anesthesia. Diagnosis was made through bacilloscopy in lymphatic fluid and skin node biopsy. Clinical features for each patient are also described. We emphasize the importance of clinical suspicion for diagnosing this unattended disease in non-endemic areas.</p> Carolina Mendez-Guerra, Juan Jose Montenegro-Idrogo, Cristhian Resurreccion-Delgado, Andres Quevedo-Ramirez, Gonzalo Cornejo-Venegas, Sabja Berrio-Martinez, Jorge Arevalo-Abanto, Alfredo Chiappe-Gonzalez Copyright (c) 2020 ACTA MEDICA PERUANA Fri, 04 Sep 2020 16:07:22 -0500 Distal motor deficit as a variant of Guillain-Barré Syndrome: case report <p>There are some variants of Guillain-Barré syndrome (GBS) that are so unusual, such as distal limb weakness (DL-GBS), which features weakness restricted to the distal area of limbs (wrists, hands, ankles, and toes) with preserved muscle strength in the proximal areas during the course of the disease. We report the case of a 26 year-old woman, who at two weeks before admission showed mild distal motor deficit affecting the arms and afterwards her legs, and this was associated to diarrheal disease. Physical examination showed mild distal quadriparesis, with no hyporeflexia/areflexia, and a positive Lasègue sign. Laboratory studies showed ferropenic anemia, immunological tests for commonly associated viruses, tumor markers and vitamin B12 levels were all normal. Also, CSF examination showed no alterations. Cerebral and cervical spine MRI studies were normal. Electromyography and nerve conduction velocity studies at the 10th day of the disease showed acute motor axonal neuropathy with no denervation. The benign form of presentation and progression led us to think this case is a mild GBS variant (DL-GBS), different from the usual AMAN-GBS variants, which are usually severe and have a poor prognosis.</p> Proel Perez Galdos Copyright (c) 2020 ACTA MEDICA PERUANA Wed, 07 Oct 2020 23:10:24 -0500 Evidence-based clinical decision making during the COVID-19 pandemic <p>The COVID-19 pandemic is a difficult scenario for clinical decision making. Therefore, this paper aims to explain healthcare practitioners some basic concepts about evidence-based decision making with respect on doing or not doing a given intervention. For this, firstly we will discuss in which cases an evidence-based decision making process in necessary. Then, some previous concepts will be clarified (decision making based on pathophysiological plausibility, observations made during clinical practice, clinical evidence, as well as the influence from the pharmaceutical industry). Afterwards steps for evidence-based decision making will be described: Asking a question, looking for references answering this question, critically assess such references, understand the underlying logic for decision making, prepare for decisionmaking, make a balance (benefit, harm, and cost), perform a shared decision making process and reassess the evidence.</p> Alvaro Taype-Rondan, Sergio Goicochea-Lugo Copyright (c) 2020 ACTA MEDICA PERUANA Fri, 02 Oct 2020 07:57:46 -0500 The role of telehealth in the fight against COVID-19 and the evolution of the Peruvian regulatory framework <p>Information and communication technologies (ICT) in health play a fundamental role in the management of COVID-19. This pandemic has rediscovered telehealth and has accelerated the use of digital platforms with health-oriented services. Within the context of the COVID-19 pandemic, the Peruvian Government has issued several regulations aiming to promote its use. The objective of this paper is to discuss the role of telehealth, and the evolution of its regulatory framework in Peru. Likewise, the initiatives developed and implemented by the Peruvian College of Physicians (PCP) regarding ICT use for healthcare within the framework of COVID-19 are described, such as "Observatorio CMP" (PCP Observatory), and the technological platforms: “Alo CMP” (Hello PCP) and “Salud a un Clic” (Health in a Click). Finally, the paper analyzes some current challenges for ICT in healthcare during the COVID-19 pandemic.</p> Walter H. Curioso, Eden Galan-Rodas Copyright (c) 2020 ACTA MEDICA PERUANA Tue, 18 Aug 2020 16:44:01 -0500 Pediatric hospital demand in the COVID-19 pandemic <p>The COVID-19 pandemic in Perú is causing an unusual pressure in our sanitarian and critic care resources. As the pandemics have progressed in the population, an increasing of several cases and intensive care units (ICU) demand will be expected, because of that, the hospitals capacities would be exceeded in a short place. Despite the low severity of COVID-19 cases in children, we expect that the projected number of pediatric cases could overwhelm the available pediatric capacity. Under a 25% cumulative infection rate scenario, there would be approximately 891 critically ill children requiring ICU admission. We propose several strategies to handle the concerns about shortfalls in our ability to provide pediatric ventilation and critical care support during the epidemic in Perú.</p> Emiliana Rizo Patron, Justo Padilla, José A. Tantalean Copyright (c) 2020 ACTA MEDICA PERUANA Wed, 07 Oct 2020 23:27:53 -0500 Suggestions for the management of general surgery patients during the Covid-19 health emergency <p>The objective of this paper is to present suggestions for the preoperative, intraoperative, and postoperative management of general surgery patients during the COVID-19 health emergency, aiming to minimize risks for surgeons and to reduce in-hospital transmission of SARS-CoV-2. We reviewed the literature using the PubMed database and we also reviewed websites from international scientific societies and the Peruvian Ministry of Health website. Suggestions for the management of surgical patients are proposed, based on the experience of countries with larger numbers of COVID-19 cases. We emphasize the importance of the adequate use of personal protective equipment (PPE), and the feasibility of using an open or laparoscopy approach in emergency surgical procedures, taking adequate care in order to avoid viral transmission for both the patient and healthcare personnel. Nonetheless, we must consider that recommendations may vary with time as new knowledge is acquired.</p> Yeray Trujillo-Loli, Alejandro Cabrera-Pastor, Llenner Castañeda Puicon Copyright (c) 2020 ACTA MEDICA PERUANA Tue, 08 Sep 2020 08:02:00 -0500 Seroprevalence of COVID-19 in workers in a hospital in the Peruvian Amazon Ricci Alonso Chafloque-Vasquez, Luis Pampa-Espinoza, Juan Carlos Celis Salinas Copyright (c) 2020 ACTA MEDICA PERUANA Tue, 01 Sep 2020 16:50:25 -0500 Pre-hospitalary medication in COVID-19 patients from a public hospital in Lima-Peru Ernesto Zavala-Flores, Jannin Salcedo-Matienzo Copyright (c) 2020 ACTA MEDICA PERUANA Thu, 03 Sep 2020 17:39:44 -0500 COVID-19 and mental health in Peruvian police officers: preliminary results Tomas Caycho-Rodriguez, Carlos Carbajal-Leon, Lindsey W. Vilca, Jose Heredia-Mongrut, Miguel Gallegos Copyright (c) 2020 ACTA MEDICA PERUANA Thu, 08 Oct 2020 00:12:06 -0500 Surgery based on scarce evidence: a reduction in emergency laparoscopy in the COVID-19 era Yeray Trujillo-Loli, Marcia Olivera-Villanueva, Rodrigo Arroyo-Garate Copyright (c) 2020 ACTA MEDICA PERUANA Thu, 08 Oct 2020 00:19:31 -0500 COVID-19 and potential years of life lost in Colombia Diego Rosselli, Gabriela Rincon, Camila Pantoja-Ruiz Copyright (c) 2020 ACTA MEDICA PERUANA Thu, 08 Oct 2020 00:25:51 -0500 End of lockdown and occurrence of a Kawasaki-like syndrome in children, relationship with COVID-19 Christian Silva-Rengifo, Mariana Velasquez-Sotomayor, Joshuan J. Barboza Copyright (c) 2020 ACTA MEDICA PERUANA Tue, 29 Sep 2020 10:25:08 -0500 COVID-19 and autoimmune diseases: population at high risk of developing severe disease? Ernesto Zavala-Flores, Jannin Salcedo-Matienzo, Alfredo Berrocal-Kasay Copyright (c) 2020 ACTA MEDICA PERUANA Tue, 29 Sep 2020 10:41:02 -0500