Nutcracker syndrome as an explanation for intermittent macroscopic hematuria: Review of a case report

Nutcracker syndrome is a rare pathology characterized by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery, generating an increase in vascular pressure in the left renal vein. Theclinical presentation in its typical or renal form usually presents with hematuria, left flank pain and varicocele, however, does not usually have specific clinical presentation, which can occur from infancy to the seventh decade of life. Adequate follow-up in the pediatric population, and surgical treatment in certain patients is important to avoid renal vein thrombosis or renal injury. We present the case of a 7-year-old male patient who came to our institution with episodes of intermittent macroscopic hematuria apparently not associated with other symptoms and which resolved spontaneously. During the hospitalization period, a diagnosis of Nutcracker Syndrome was made and an adequate follow-up was established. We made a review of the literature on this pathology. El Síndrome del Cascanueces es una patología poco frecuente que se caracteriza por la compresión de la vena renal izquierda entre la aorta abdominal y la arteria mesentérica superior, generando un aumento de presión vascular enla vena renal izquierda. La presentación clínica en su forma típica o renal suele presentarse con hematuria, dolor en flanco izquierdo y varicocele, sin embargo, no suele tener clínica específica, la cual puede presentarse desde la infancia hasta la séptima década de vida. Un adecuado seguimiento en población pediátrica, y tratamiento quirúrgico en ciertos pacientes es importante para evitar trombosis de vena renal o injuria renal. Presentamos el caso de un paciente masculino de 7 años que acude a nuestra institución por presentar episodios de hematuriamacroscópica intermitente aparentemente no asociada a otra sintomatología y que resuelve espontáneamente. En el periodo de hospitalización se realiza el diagnóstico de Síndrome del Cascanueces, pudiendo establecer un seguimiento adecuado. Realizamos una revisión de la literatura al respecto de esta patología

Biochemical failure and toxicity in treatment with brachytherapy and external beam radiotherapy compared with radical prostatectomy in localized prostate cancer

Antecedentes: El cáncer de próstata localizado (T1-3N0M0) tiene opciones terapéuticas como la prostatectomía radical (PR), la radioterapia de haz externo (EBRT) y la braquiterapia (BT). Sin embargo, la evidencia de los resultados de estos tratamientos es limitada y no se han realizado estudios que comparen el Falla Bioquímica (FB) y la toxicidad asociada al tratamiento quirúrgico y a la EBRT + Braquiterapia de alta dosis (HDBT) en la región. Material y Métodos: Estudio de cohorte retrospectivo, se revisaron las historias clínicas de los pacientes diagnosticados con cáncer de próstata localizado entre 2014 y 2018 en uno de los principales centros privados de neoplasias de Lima, Perú; se utilizó la regresión de Cox tanto para el resultado de BF como para el resultado de toxicidad grado 2, calculando el HR con IC 95%. Resultados: De 549 pacientes, el 76,3% (419) recibió RP como tratamiento primario, y el 72% tenía entre 50 y 70 años en el momento del diagnóstico. Los pacientes tratados con EBRT + HDBT presentaron peores características. El grupo de EBRT + HDBT tuvo un 40% menos de riesgo de presentar FB (HR 0,6; IC 95% 0,4 - 0,9), y también un 50% más de riesgo de presentar toxicidad mayor o igual a grado 2 (HR 1,5; IC 95% 1,0 - 2,0) que el grupo tratado con RP. Conclusión: Nuestros resultados muestran que al comparar los pacientes tratados con EBRT + HDBT y RP, el BF fue mayor en RP, y la toxicidad post-tratamiento fue mayor en EBRT + HDBT. Sin embargo, ambos grupos de comparacion no son homogéneos por lo que la comparacion no puede ser objetiva.Background: Localized prostate cancer (T1-3N0M0) has therapeutic options such as Radical Prostatectomy (RP), external beam radiation therapy (EBRT) and Brachytherapy (BT). However, the evidence of the outcome of these treatments is limited and no studies have been conducted comparing Biochemical Failure (BF) and toxicity associated with surgical treatment and EBRT + High-Dose Brachytherapy (HDBT) in the region. Methods and Materials: Retrospective cohort study, clinical records of patients diagnosed with localized prostate cancer between 2014 and 2018 were reviewed at one of the main private neoplasm centers in Lima, Peru; Cox regression was used for both the BF outcome and the grade 2 toxicity outcome, calculating the HR with 95% CI. Results: Of 549 patients, 76.3% (419) received RP as primary treatment, and 72% were between 50 and 70 years old at the time of diagnosis. The patients treated with EBRT + HDBT presented worse characteristics. The EBRT + HDBT group had a 40% lower risk of presenting BF (HR 0.6; 95% CI 0.4 - 0.9), and also a 50% greater risk of presenting toxicity greater than or equal to grade 2 (HR 1.5; CI 95% 1.0 - 2.0) than the group treated with RP. Conclusion: Our results show that when comparing patients treated with EBRT + HDBT and RP, BF was greater in RP, and post-treatment toxicity was greater in EBRT + HDBT. However, both comparison groups are not homogeneous, so the comparison cannot be objective.Tesi

Does the route of administration matter? Systematic review and meta-analysis of randomized clinical trials between vaginal versus intramuscular progesterone administration in the prevention of preterm birth

Objective. To determine the effectiveness of intramuscular progesterone compared to vaginal application in the prevention of asymptomatic preterm birth (PTB) in randomized clinical trials. Materials and Methods. A systematic search of electronic databases (Embase, PubMed and Scopus) was performed. Randomized clinical trials comparing vaginal and Intramuscular progesterone (17-OHPC) in pregnant women at high risk of PTB. Additionally, bias and certainty assessment were performed. Results. Six clinical trials with a total of 1,408 randomized patients were included. The reported incidence of PTB < 37 weeks ranged from 10.9% to 43.9% for vaginal progesterone, and 14.0% to 38% for 17-OHPC. At the time of meta-analysis, patients receiving 17-OHPC was associated with a lower incidence of PTB < 28 weeks than vaginal use (Risk Difference 0.14; CI 0.01-0.29; I2 = 83.9%; T2 = 0.02) with no significant difference in differences in PTB < 37 and < 34 weeks. Additionally, on neonatal outcomes, the most common was admission to the neonatal ICU independent of the method of administration (6.1% and 7.7%), followed by APGAR < 7 (4.1% and 5.2%), with no significant differences in neonatal outcomes. Conclusions. Both the use of vaginal progesterone and 17-OHPC in the prevention of PTB in singleton high-risk gestations are reasonable options, with similar incidence of PTB and no additional impact on short-term neonatal complications. Thus, costs, resource availability and patient preferences should be considered when choosing a route of administration.Revisión por pare

Multiplex PCR panel as a method of identification of respiratory viral agents in pediatric patients: experience in a private heath center

Objective: To determine the incidence of respiratory viruses in the pediatric population hospitalized in a private health center during the period 2022-2023. Methodology: Retrospective cross-sectional analytical study. The database of the Clínica Internacional laboratory was obtained with all the patients who underwent the Pneumovir test from May 2022 to April 2023. Results: 94% of the viral PCR tests were positive and 20% of these correspond to a viral coinfection; 52.1% were women and 64.7% of the population was under 5 years of age. Among the results obtained, Influenza A, influenza A and B and influenza B correspond to a total of 58.5% of all the samples studied and respiratory syncytial virus is present in 31% of the samples obtained alone or associated with other viruses. Among the coinfections, the most common was Influenza A and RSV, which represents 11.1%. 94% of the cancer population was positive for respiratory virus and 100% of patients with a history of childhood cerebral palsy were positive and with viral coinfection. Discussion: Using the MultiplexPCR panel, a high percentage of viral infections and coinfections was found, this is due to the high sensitivity of the test, the immunological debt and the low vaccination rate in the pediatric population. Conclusion: It is important to continuecarrying out studies of viral etiology through tests with greater sensitivity, which allows us to make decisions and establish public health measures to reduce morbidity and mortality in the pediatric population due to these agents.Objetivo: Determinar la incidencia de virus respiratorios en la población pediátrica hospitalizada en un centro privadode salud durante el periodo 2022-2023. Metodología: Estudio transversal analítico retrospectivo. Se utilizó la base dedatos del laboratorio de la Clínica Internacional con todos los pacientes a quienes se les realizó la prueba Pneumovir desde mayo del 2022 hasta abril del 2023. Resultados: El 94% de las pruebas de PCR viral fueron positivas y el 20% deestas corresponden a coinfección viral; 52.1% fueron mujeres y el 64.7% de la población fue menor de 5 años. Dentro de los resultados obtenidos, Influenza A, influenza A y B e influenza B corresponden en total al 58.5% de todas las muestras estudiadas y virus sincitial respiratorio está presente en el 31 % de las muestras obtenidas solo o asociado a otros virus.Dentro de las coinfecciones, la más común fue Influenza A y VSR, la cual representa el 11.1%. El 94% de la población oncológica resultó positiva a virus respiratorio y el 100% de pacientes con antecedente de parálisis cerebral infantil resultópositiva y con coinfección viral. Discusión: Mediante el panel Multiplex PCR se halló un alto porcentaje de infecciones y coinfecciones virales, esto es por la alta sensibilidad de la prueba, la deuda inmunológica y la tasa baja de vacunación en la población pediátrica. Conclusión: Es importante seguir realizando estudios de etiología viral mediante pruebas con mayorsensibilidad lo que nos permite tomar decisiones y establecer medidas de salud pública para disminuir la morbimortalidaden la población pediátrica a causa de estos agentes

Effects of the COVID-19 pandemic on the prevalence of obsessive-compulsive symptoms among young adults in Peru

The COVID-19 pandemic has exposed the general population to constant stressful and traumatic situations. This, added to the necessary and constant dissemination of preventive measures for COVID-19 infection, can generate an increase in the prevalence of Obsessive-Compulsive (OC) symptoms. Thus, this research aimed to evaluate the prevalence of OC symptoms and explore associated factors in young adults in Peru, the country with the highest COVID-19 death rate in the world. In this analytical cross-sectional study, an online survey distributed through social networks was used. OC symptomatology during the last week was measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Possible Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD) were evaluated with the General Anxiety Disorder 7-items (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), respectively. 1243 young adults were evaluated. Of these, the mean age was 24.1 years, 54.3% were women, and the prevalence of OC symptoms was 50%. Participants who had experienced a traumatic event during COVID-19 pandemic had higher prevalence of OC symptoms (PR 1.54; CI 95% 1.27 – 1.85), when compared to those did not experience such events. In the same way, participants diagnosed with depression (PR 2.37; CI 95% 1.96 – 2.86) and anxiety (PR 1.11; CI 95% 1.02 – 1.21) also had a higher prevalence of OC symptoms, compared with those without depression and anxiety. In conclusion, obsessive-compulsive symptomatology has a high prevalence in young adults, and is associated with the death of a family member or close friend from the COVID-19 disease. The prevalence of possible depression and anxiety are high and are associated with higher prevalence of obsessive-compulsive symptoms. This highlights the importance of including mental health programs during the pandemic for the population who has suffered traumatic events, to be able to give them adequate follow-up and support.Revisión por pare

Retrospective analysis of the incidence and time to care of acute appendicitis in the context of the COVID-19 pandemic: A descriptive cross-sectional study

Introduction: The COVID-19 pandemic generated a major change in emergency department attendance. The aim of this article was to evaluate the incidence of acute appendicitis, the most frequent surgical emergency, between 2019 and2020, as well as to compare the time of emergency department attendance, the stage of appendicitis and the need for admission to critical units. Material and Methods: Retrospective descriptive cross-sectional study. Patients operated on foracute appendicitis between 2019 and 2020 in a private health institution in Lima, Peru were included. Data were obtained by review of medical records. Percentages were used for categorical variables, and chi-square was used for comparison effect. Results: 490 patients were included. In 2019 there were 290 patients operated for acute appendicitis, while in2020 there were 200. In both cases the laparoscopic approach was the most frequent. Significantly longer delays were reported in emergency department attendance, with more patients attending 37 - 48 hours (4.5% vs 9.0%) and more than 61 hours (1.4% vs 9.0%) after the onset of the clinical picture. No significant differences were found in the stage ofappendicitis reported by pathology but there was a non-significant increase in appendicitis complicated by peritonitis (4.1% vs 7.0%). Conclusions: During the COVID-19 pandemic, a decrease in the incidence of acute appendicitis was observed, associated with a longer delay in emergency department attendance and a non-significant increase in peritonitis due toacute appendicitis.Introducción: La pandemia por COVID-19 generó un gran cambio en la asistencia al departamento de emergencias. El objetivo de este artículo fue evaluar la incidencia de apendicitis aguda entre los años 2019 y 2020, además de comparar el tiempo de asistencia a emergencia, la etapa de apendicitis y la necesidad de internamiento en unidades críticas. Material y Métodos: Estudio transversal descriptivo retrospectivo. Se incluyó a los pacientes operados por apendicitis aguda entre los años 2019 y 2020 en un centro de salud privado en Lima, Perú. Se obtuvieron los datos mediante revisión de historias clínicas. Se usaron porcentajes para variables categóricas, y se usó chi cuadrado para efecto de comparación. Resultados: Se incluyeron 490 pacientes. El año 2019 hubo 290 pacientes operados por apendicitis aguda, mientras que el año 2020 hubieron 200. En ambos casos, el abordaje laparoscópico fue el más frecuente. Se reportó una mayor demora significativa en la asistencia al departamento de emergencias, con más pacientes que acuden a las 37 – 48 horas de haber iniciado el cuadro clínico (4.5% vs 9.0%) y más de 61 horas (1.4% vs 9.0%). No se encontró diferencias significativas en la etapa de apendicitis reportada por resultados de patología, pero si un aumento no significativo de cuadros de apendicitis complicada por peritonitis (4.1% vs 7.0%). Conclusiones: Durante la pandemia por COVID-19, se observa una disminución de la incidencia de apendicitis aguda, asociada a una mayor demora en la asistencia al departamento de emergencias e incremento no significativo de peritonitis por apendicitis aguda

Impacto de la campaña nacional de vacunación contra la COVID-19 en la afluencia de pacientes al servicio de emergencias del Hospital de Emergencias Pediátricas

Objective: To analyze the variation in attendance and diagnoses after the national vaccination campaign against COVID-19 in the pediatric emergency department. The study: Analytical retrospective cross-sectional study. Pediatric emergency department visits were compared between epidemiological weeks 1 and 52 of the years 2020 and 2021, analyzing sociodemographic characteristics, condition and diagnosis. Chi-square was used for bivariate analysis. Findings: A 77.8% increase was found in the number of attentions during the year 2021 compared to 2020. There was a 4% increase in infectious diseases and a 9.2% increase in respiratory diseases. In addition, a decrease of 8.7% was observed in gastrointestinal diseases. Conclusion: The results indicate that after the start of the national vaccination campaign, there was a significant increase in the number of patients compared to 2020, mainly for respiratory and infectious or parasitic diseases.Objetivo: Analizar la variación sobre la asistencia y diagnósticos posterior a la campaña nacional de vacunación contra el COVID-19 en el servicio de emergencias pediátricas. El estudio: Estudio transversal retrospectivo analítico. Se comparó las visitas a emergencias pediátricas entre las semanas epidemiológicas 1 y 52 de los años 2020 y 2021, analizando características sociodemográficas, condición y diagnóstico. Para el análisis bivariado se usó Chi-cuadrado. Hallazgos: Se encontró un incremento del 77.8% en el número de atenciones durante el año 2021 en comparación con el año 2020. Se registró un aumento del 4% en enfermedades infecciosas y del 9.2% en enfermedades respiratorias. Además, se observó una disminución del 8.7% en enfermedades gastrointestinales. Conclusión: Los resultados indican que tras el inicio de la campaña de vacunación nacional; se observa un incremento significativo en la afluencia de pacientes en comparación con el año 2020, principalmente de enfermedades respiratorias e infecciosas o parasitarias

Biochemical failure and toxicity in treatment with brachytherapy and external beam radiotherapy compared with radical prostatectomy in localized prostate cancer

Background: Localized prostate cancer (T1–3N0M0) has therapeutic options such as radical prostatectomy (RP), external beam radiation therapy (EBRT) and brachytherapy (BT). However, the evidence of the outcome of these treatments is limited and no studies have been conducted comparing biochemical failure (BF) and toxicity associated with surgical treatment and EBRT + high-dose brachytherapy (HDBT) in the region. Materials and methods: Retrospective cohort study, clinical records of patients diagnosed with localized prostate cancer between 2014 and 2018 were reviewed at one of the main private neoplasm centers in Lima, Peru; Cox regression was used for both the BF outcome and the grade 2 toxicity outcome, calculating the hazard ratio (HR) with 95% confodence interval (CI). Results: Of 549 patients, 76.3% (419) received RP as primary treatment, and 72% were between 50 and 70 years old at the time of diagnosis. The patients treated with EBRT + HDBT presented worse characteristics. The EBRT + HDBT group had a 40% lower risk of presenting BF (HR = 0.6; 95% CI: 0.4–0.9), and also a 50% greater risk of presenting toxicity greater than or equal to grade 2 (HR = 1.5; 95% CI: 1.0–2.0) than the group treated with RP. Conclusion: Our results show that when comparing patients treated with EBRT + HDBT and RP, BF was greater in RP, and post-treatment toxicity was greater in EBRT + HDBT.

Short-term outcomes of surgical treatment for colon cancer in a private institution in Lima, Peru

Introduction: Although surgical treatment is the main curative treatment for colon cancer, there are few reports on short-term functional outcomes after surgery. We evaluated these outcomes in patients operated with curative intent in a private institution in Lima, Peru. Material and Methods: Retrospective analytical study, including patients diagnosed with colon cancer between 2018 and 2022 with localized or locally advanced disease. The presence of intraoperative or postoperative complications was considered as an outcome. Results: 75 patients were included, 57.3% were male, 60.0% without comorbidities. The most commonly performed procedures were right (38.7%) and left (45.3%) hemicolectomy. No cases of intraoperative complications were reported, while the most common postoperative complications were reoperation (12/75), hospital readmission (11/75) and urinary retention (7/75). Conclusions: Colon cancer surgery is safe and with few postoperative complications in the population studied, although replication of this study in larger populations is recommended.Introducción: A pesar de que el tratamiento quirúrgico es el principal tratamiento curativo para el cáncer de colon, existen pocos informes sobre desenlaces funcionales a corto plazo postquirúrgicos. Se evaluaron estos desenlaces en pacientes operados con intención curativa en una institución privada de Lima, Perú. Material y Métodos: Estudio analítico retrospectivo, incluyendo pacientes con el diagnóstico de cáncer de colon entre 2018 y 2022 con enfermedad localizada o localmente avanzada. Se consideró como desenlace la presencia de complicaciones intraoperatorias o postoperatorias. Resultados: Se incluyeron 75 pacientes, 57.3% eran hombres, 60.0% sin comorbilidades. Los procedimientos más comúnmente realizados fueron hemicolectomía derecha (38.7%) e izquierda (45.3%). No se reportaron casos de complicaciones intraoperatorias, mientras que las complicaciones postoperatorias más comunes fueron la re-operación (12/75), readmisión hospitalaria (11/75) y retención urinaria (7/75). Conclusiones: La cirugía de cáncer de colon es segura y con pocas complicaciones postoperatorias en la población estudiada, aunque se recomienda replicar este estudio en poblaciones más grandes

Health interventions to reduce the incidence of pneumonia in children under 5 years of age in the A.H Pacífico de Villa, Chorrillos, Lima, in 2020

Introducción: Se identificó las infecciones respiratorias agudas (IRA) como un problema de salud principal según el ASIS Lima Sur 2018. Dentro de las IRA, la neumonía presenta el mayor impacto en menores de 5 años, afectando tanto la salud como el desarrollo de la población. Diversos estudios resaltan la escasez de adecuados conocimientos, actitudes y prácticas para hacer frente a la neumonía. El objetivo del estudio fue identificar el impacto de brindar educación comunitaria acerca de la “Neumonía y signos de alarma” y “Medidas Higiénico dietéticas”. Se ejecutó el proyecto en el A.H Pacifico de Villa - Chorrillos entre agosto y noviembre de 2020. Materiales y métodos: Se realizó un estudio de diseño cuasi experimental descriptivo de corte transversal, y para ello se utilizó la herramienta del marco lógico. La intervención consistió en difundir material educativo impreso en base a conocimientos y actitudes sobre los temas antes mencionados. Se aplicaron cuestionarios antes y después de la intervención. El método de muestreo fue no probabilístico por bola de nieve. Resultados: en el post test sobre conocimientos de "Neumonía y signos de alarma", el 87.5% de los participantes obtuvieron una nota mayor o igual a 12; en el de conocimientos y actitudes de "Medidas Higiénico-dietéticas" el 100%. Conclusiones: La intervención redujo el porcentaje de inadecuado conocimiento y prácticas de la población acerca de la neumonía y las medidas higiénico-dietéticas. Esto destaca la necesidad de impartir educación sanitaria y considerar a la comunidad como agente activo de su salud; así como el trabajo conjunto con los promotores de la salud.Introduction: Acute respiratory infections were identified as a main health problem according to ASIS Lima Sur 2018. Within this group of diseases, pneumonia presents the greatest impact in children under 5 years of age, affecting both health and development of the population. Various studies highlight the lack of knowledge, attitudes and practices regarding pneumonia. The objective of the study was to identify the impact of providing community education about "Pneumonia and warning signs'' and "Dietary Hygienic Measures". The health project was carried out in A.H Pacifico de Villa - Chorrillos between August and November 2020. Methods: A cross-sectional descriptive quasi-experimental study was carried out. The logical framework matrix was used. The intervention was to give out educational material based on knowledge and attitudes on the afore mentioned topics. Questionnaires were applied before and after the intervention. The sampling was non-probabilistic by snowball. Results: In the verification survey for the topic of "Pneumonia and Red Flags", 87.5% of the participants obtained a score greater than or equal to 12; while 100% of the participants had the same result in the survey for "Hygienic-dietetic Recommendations''. Conclusions: The intervention reduced the lack of knowledge and practice of the population about pneumonia and hygienic-dietary recommendations. This highlights the need to provide health education and consider the community as an active agent of their health; as well as the closely work with community health promoters.Tesi