Infecciones intrahospitalarias en el estudiante de medicina.: Intrahospital infections in the medical student

The diseases associated with care in the health sector is a problem that not only involves patients who enter the service, but also the staff and students who carry out their practices in the different institutions. In-hospital infections are defined as: "Localized or systemic diseases resulting from an adverse reaction resulting from exposure to an infectious agent or its toxins, with no evidence that the infection was present or in the incubation period at the time of care." The lack of knowledge on the part of the personnel and students of the health sciences that are in contact with the patients, in addition to the realization of sanitary practices without taking into account the pertinent biosecurity measures are the main reasons for contracting a nosocomial infection.Las enfermedades asociadas a la atención en el sector salud es una problemática que no solo implica a los pacientes que ingresan al servicio, si no al personal y a los estudiantes que llevan a cabo sus prácticas en las diferentes instituciones. Las infecciones intrahospitalarias están definidas como: “Enfermedades localizadas o sistémicas que resultan de una reacción adversa consecuente a la exposición a un agente infeccioso o a sus toxinas, sin evidencia que la infección estuviera presente o en periodo de incubación en el momento de la atención” . La falta de conocimientos por parte del personal y estudiantes de las ciencias de la salud que están en contacto con los pacientes, además de la realización de prácticas sanitarias sin tomar en cuenta las medidas de bioseguridad pertinentes son los principales motivos para contraer una infección nosocomial

Time to disease diagnosis in patients with diabetes and arterial hypertension with symptoms of depression in a sample of Peruvian residents.

Introducción: La prevalencia de HTA se encuentra entre 11,9 % y 49 %, la prevalencia de DM2 es de 10,5 %. La prevalencia de trastornos depresivos en diabéticos va en el rango de 10 % a 15 %. Objetivo: determinar la asociación entre el tiempo de enfermedad de los pacientes con HTA y DM2 con los síntomas de depresión. Metodología: Estudio analítico transversal. La base secundaria analizada fue la Encuesta Demográfica y de Salud del Perú (ENDES) de los años 2019, 2020 y 2021. Se utilizó el Cuestionario de Salud del Paciente-9 (PHQ-9). Se utilizó la prueba del chi cuadrado para cada posible factor asociado a la depresión y las asociaciones de interés se evaluaron con una distribución de Poisson. Resultados: El 21,59 % tenían síntomas de depresión al momento del estudio. El 51,40 % eran del sexo femenino. El 16,58 % presentaba mayor a 60 años. La HTA estuvo presente en el 5.9%, mientras que la DM2 en el 2,09 %. En el análisis bivariado, todas las variables se asociaron con la presencia de síntomas depresivos, excepto la variable que fuma a diario (p=0.275). Discusión: Los resultados señalan una asociación entre el tiempo de enfermedad desde el diagnóstico de HTA y DM2 con los síntomas depresivos. En el caso de ambas patologías el tener menos de un año de diagnóstico aumentaban en 51 % y 44 % respectivamente la probabilidad de presentar síntomas depresivos.Introduction: The prevalence of AHT is between 11.9 % and 49 %, and that of DM2 is 10.5 %. The prevalence of depressive disorders in patients with diabetes ranges from 10 to 15%. Objective: To determine the association between the time of illness in patients with hypertension and DM2 with depressive symptoms. Methodology: This was a cross-sectional analytical study. The secondary base analyzed was the Demographic and Health Survey of Peru (ENDES) for 2019, 2020, and 2021. The Patient Health Questionnaire-9 (PHQ-9) was used. The chi-square test was used for each possible factor associated with depression, and the associations of interest were evaluated using Poisson distribution. Results: At the time of the study, 21.59% of patients had symptoms of depression. Of these patients, 51.40 % were female. A total of 16.58 % of the participants were older than 60 years of age. Hypertension was present in 5.9% of the patients, while DM2 was present in 2.09%. In the bivariate analysis, all variables were associated with the presence of depressive symptoms, except for daily smoking (p=0.275). Discussion: The results showed an association between the time of illness since the diagnosis of HT and DM2 and depressive symptoms. In the case of both pathologies, having less than one year since diagnosis increased the probability of depressive symptoms by 51% and 44%, respectively

Adaptación y validación de un cuestionario para medir burnout académico en estudiantes de medicina de la universidad Ricardo Palma: Adaptation and validation of a questionnaire to measure academic burnout in medical university students

Introduction: Evaluate the validity and reliability of an instrument adapted to Peru to measure pre-presenceof Burnout Syndrome in university students of the career of Human Medicine at the UniversityRicardo Palma, taking as a starting point the Burnout Inventory of Maslach - Student Survey (MBISS). Methods: Cross-sectional analytical study, with level of application research. Validity was evaluated byanalysis of factorial structure with the principal components method, Kaiser-Meyer Olkin tests and Varimax rotation were applied; the reliability by the Cronbach alpha value. Results: 223 students from the Faculty of Human Medicine of the Ricardo Palma University were included, from November to December 2016. The prevalence of academic Burnout found was 28.25% (63); The Kaiser-Meyer Olkin fitness test had a result of 0.813 and Barlett's sphericity test of 1007.5 (p <0.000). The cumulative variance explained by 3 factors was calculated to be 55.4%. The instrument obtained a Cronbach's Alpha coefficient = 0.794, with correlations between the items, Emotional Exhaustion (α =, 855), Cynicism (α = 0.623) and Academic Efficiency (α = 0.744). Conclusion: The adapted and validated instrument gathers the psychometric properties to be considered a useful and reliable instrument initially in human medicine students of the Ricardo Palma University, presenting an adequate factorial structure and internal consistency to determine the level of Burnout Syndrome Academic.   DOI 10.25176/RFMH.v19.n1.1794Introducción: Evaluar lLa validez y fiabilidad de un instrumento adaptado al Perú para medir la pre-senciadel Síndrome de Burnout en estudiantes universitarios de la carrera de Medicina Humana en la UniversidadRicardo Palma, tomando como punto de partida el Inventa-rio de Burnout de Maslach - Student Survey (MBISS). Métodos: Estudio transversal analítico, con nivel de investigación aplicativo. Se evaluó la validez poranálisis de estructura factorial con el método de componentes principales, se apli-caron las pruebas de Kaiser- Meyer Olkin y la rotación Varimax; la confiabilidad por el valor alfa de Cronbach. Resultados: Fueron incluidos 223 estudiantes de la Facultad de Medicina Humana de la Universidad Ricardo Palma, en el periodo noviembre a diciembre del año 2016. La prevalencia de Burnout académico encontrada fue 28,25% (63); La prueba de adecuación de Kaiser-Meyer Olkin tuvo un resultado de 0.813 y la prueba de esfericidad de Barlett de 1007.5 (p<0.000). Se calculó la varianza acumulada explicada por 3 factores fue de 55.4%. El instrumento obtuvo un coeficiente Alfa de Cronbach= 0,794, con correlaciones entre los ítems, Agotamiento Emocional (α= ,855), Cinismo (α=0,623) y Eficacia Académica (α= 0,744). Conclusión: El instrumento adaptado y validado reúne las propiedades psicométricas para ser con-siderado un instrumento útil y fiable inicialmente en estudiantes de medicina humana de la Universidad Ricardo Palma, presentando una adecuada estructura factorial y consistencia interna para la determinación del nivel de Síndrome de Burnout Académico.   DOI 10.25176/RFMH.v19.n1.179

Evaluación del perfil transcriptómico inmunológico y variantes genéticas del SARS-COV-2 como predictores de severidad de la enfermedad COVID-19

Resumen del Proyecto: Introduccion: La variabilidad genetica del SARS-CoV-2 ha sido reportada por varios autores. La respuesta del huesped frente al virus es clave para determinar su evolucion. El objetivo es identificar genes o vías de señalización de respuesta antiviral o pro inflamatoria en el huésped asociadas a variantes genéticas de SARSCoV-2 que permitan predecir la progresión de COVID-19 moderado a Severo. Métodos: Estudio observacional, exploratorio de identificacion pronóstica, en pacientes hospitalizados con COVID-19 comparando aquellos con evolucion favorable con los afectados severamente. Del hisopado nasal se extraera RNA viral, Según procedimiento se extraerá RNA y se convertirá a DNA. De muestras sanguíneas de los días 1, 5 y 10 de hospitalización se extraerá RNA/DNA. Las muestras serán centrifugadas para la obtención de plasma y preservadas a -80 0C. Se procederá a preparar manualmente las librerías genéticas a partir del cDNA de sangre y del virus. El análisis de la data primaria se realizará con el software Torrent Suite. Se determinará los genes diferencialmente expresados y el análisis de enriquecimiento de genes entre pacientes. Adicionalmente se realizará una RTPCR para evaluar polimorfismos de genes específicos: ACE2, VEGFA. Se correlacionará el perfil inmunológico del huésped con las variantes genéticas de SARS-CoV-2. Se utilizará un modelo estadístico predictivo para establecer un perfil inflamatorio/viral que determine la progresión a COVID-19 severo. Resultados Esperados: Validacion de resultados previos que demuestran la presencia de un incremento en la expresión de citoquinas proinflamatorias como IL6 y TNF. Se espera encontrar una respuesta antiviral disminuida en aquellos pacientes que presentan una evolución desfavorable. Ademas se evaluaran otros genes de la inmunidad innata y adaptativa que puedan estar asociados a la progresión a un cuadro de COVID-19 severo, así como evaluar genes de predisposición genética para enfermedad grave, que serán complementados con la evaluación de los polimorfismos ACE-2 y VEGFA. El estudio permitirá identificar la cepa prevalente en pacientes con COVID-19 moderado en Perú y variantes asociadas a una evolución desfavorable o a un perfil inmunológico especifico, además de evaluar predisposición genética basal. Finalmente, este estudio puede potencialmente permitirnos identificar pacientes con un perfil inmunológico que respondan mejor a una terapia específica.Trabajo academic

Trend, Associated Factors and Concordance of Obesity by Body Mass Index, Waist Circumference and Waist-Height Ratio in Adolescents. An Analysis of a 4-Year National Survey

Introduction: Regarding diagnosis, identifying reliable anthropometric measures to detect adolescent obesity is fundamental. However, in this age group has different definitions, either according to the body mass index (BMI), the waist circunference (WC) and the waist-height ratio (WHtR), making the measurement of this inaccurate. Objective: This study analyzed the prevalence, trends, and factors associated with obesity in Peruvian adolescents using data from the Demographic and Health Survey (ENDES) for 2019-2022. Methods: A secondary data analysis was conducted on 14,330 adolescents aged 15 to 19. The response variable was obesity, defined in three different ways. General obesity was assessed using the BMI was ≥ 2 standard deviations. 2) Abdominal obesity was defined through WC, with cutoff points ≥ 80.5 cm in men and ≥ 81 cm in women. 3) The relevant indicator for obesity was the WHtR, with a cutoff point ≥ 0.5. The associated factors to be evaluated were sex, age, natural region, marital status, education level, wealth, area of residence, alcohol consumption, and physical disability. Results: The study found that based on BMI, WC, and WHtR respectively, approximately 12.80%, 29.72%, and 24.27% of participants were considered obese. Significant associations were found between obesity and variables such as gender, natural region, marital status, wealth index, area of residence, education level, alcohol consumption, and physical disability. Conclusion: This research uncovered an alarmingly prevalence occurrence of obesity among adolescents in Peru with fluctuating patterns over time, emphasizing the need to tackle the interconnected issues contributing to this health concern. These findings can help inform and guide obesity prevention and control strategies in this population

Factors Associated with Knowledge, Attitudes, and Practices about Tuberculosis in Peruvians

Objective: To determine the factors associated with knowledge, attitudes, and practices (KAPs) about tuberculosis (TB) in the Peruvian population. Materials and Methods: A cross-sectional, analytical study was carried out by conducting a virtual survey. The instrument that was used consisted of 4 sections: sociodemographic variables (9 questions), knowledge (23 questions), attitudes (9 questions), and practices (8 questions) about tuberculosis. Univariate and bivariate analyses and the Poisson regression model with robust variance were used to obtain crude and adjusted prevalence ratios (PRa). Results: The sample consisted of 1284 participants. Regarding knowledge, attitudes, and practices about TB, an insufficient level was found in 47.97%, 50.3%, and 54.36% of the cases, respectively. The variables that increased the probability of having sufficient knowledge were sex, grade, area, family history, and history of having TB. While only the area and both antecedents were for attitudes. Finally, the age, degree, and history of TB were for the practices. Conclusion: There are insufficient KAPs in around half of the population studied. In addition, there are differences according to the epidemiological characteristics, such as sex, age, academic degree, area, and family history of TB and having had this disease. Therefore, the importance of research in this field should be emphasized in the face of a disease that is related to the differences in the levels of these variables between different strata of the general population

Utilidad diagnóstica de la prueba de riesgo de la Asociación Americana de Diabetes para prediabetes y diabetes. Una revisión sistemática y metaanálisis

Introducción. Dado el aumento de los casos de prediabetes y diabetes mellitus tipo 2 (DM2) a nivel mundial, y al poco acceso de análisis de laboratorio en varios lugares, es necesario contar con la implementación de un método de detección simple, rápido y sin laboratorio: la prueba de riesgo de la Asociación Americana de Diabetes (ADA): el ADA test risk score (ADATRS). Objetivo. Realizar una revisión sistemática (RS) con metaanálisis sobre la utilidad diagnóstica del ADATRS para prediabetes y DM2. Materiales. RS con metaanálisis de estudios de pruebas diagnósticas. Se realizó la búsqueda en cuatro bases de datos: PubMed/Medline, SCOPUS, Web of Science y EMBASE. Se obtuvieron los verdadero positivos, verdaderos negativos, falsos positivos y falsos negativos de cada estudio. Se construyeron tablas de 2×2 con base en la información del artículo o de los autores. Así, se presentaron diagramas de bosque con un intervalo de confianza al 95% (IC 95%), tanto de la sensibilidad como especificidad en conjunto del ADATRS para ambos eventos de interés. Resultados. Los diagramas de bosque revelaron que la sensibilidad y especificidad para prediabetes fueron 0,91 (IC95%: 0,82–0,96) y 0,52 (IC95%: 0,36–0,67), respectivamente. Mientras que, para DM2, la sensibilidad y especificidad, combinados fueron 0,85 (IC95%: 0,71–0,93) y 0,56 (IC95%: 0,47–0,65), respectivamente. Conclusiones. Nuestra revisión sistemática y metanálisis de la literatura actual sugiere que el ADATRS puede ser útil como método de cribado para prediabetes y DM2, dado su alta sensibilidad. Sin embargo, existe mucha heterogeneidad y pocos estudios aun al respecto; por lo tanto, se necesitan más trabajos de investigación en diferentes poblaciones y con métodos más estandarizados para finalmente determinar la importancia clínica de este cuestionario como herramienta de cribado o diagnóstico para la prediabetes o DM2

Diagnostic Accuracy of Anthropometric Markers of Obesity for Prediabetes: A Systematic Review and Meta-Analysis

Introduction: Prediabetes is a significant public health concern due to its high risk of progressing to diabetes. Anthropometric measures of obesity, including body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) have been demonstrated as key risk factors in the development of prediabetes. However, there is a lack of clarity on the diagnostic accuracy and cut-off points of these measures. Objective: To determine the diagnostic accuracy of these anthropometric measures for their most effective use in identifying prediabetes. Methodology: A systematic review (SR) with metanalysis of observational studies was carried out. The search was conducted in four databases: Pubmed/Medline, SCOPUS, Web of Science, and EMBASE. For the meta-analysis, sensitivity and specificity, together with their 95% confidence intervals (CI 95%) were calculated. Results: Among all the manuscripts chosen for review, we had four cross-sectional studies, and three were classified as cohort studies. The forest plots showed the combined sensitivity and specificity for both cross-sectional and cohort studies. For cross-sectional studies, the values were as follows: BMI had a sensitivity of 0.63 and specificity of 0.56, WC had a sensitivity of 0.59 and specificity of 0.58, and WHtR had a sensitivity of 0.63 and specificity of 0.73. In the cohort studies, the combined sensitivity and specificity were: BMI at 0.70 and 0.45, WC at 0.68 and 0.56, and WHtR at 0.68 and 0.56, respectively. All values are provided with 95% confidence intervals. Conclusions: This systematic review and meta-analysis evaluated the diagnostic accuracy of BMI, WC, and WHtR in identifying prediabetes. The results showed variations in sensitivity and specificity, with WHtR having the highest specificity in cross-sectional studies and BMI having improved sensitivity in cohort studies

Obstructive Sleep Apnea Syndrome Associated with Atrial Fibrillation in Adult Patients: A Systematic Review and Meta-Analysis

Introduction: Obstructive sleep apnea syndrome (OSAHS) is a common disease. However, its diagnosis and treatment are underestimated. The main reason is that the upper airway completely or partially collapses, leading to repeated sleep apnea episodes. In addition, atrial fibrillation(AF) is the most frequent arrhythmia in the world, these two entities may be related and are important public health problems. Objective: To determine the association between obstructive sleep apnea syndrome and atrial fibrillation in adult patients. Materials and Methods: A systematic review and meta-analysis of observational studies that associate obstructive sleep apnea syndrome and atrial fibrillation was carried out. The search was carried out in 4 databases: PUBMED, Web of Science, Embase, Scopus. Results: Eight studies were included (n=562241). A significant association was found between obstructive sleep apnea and atrial fibrillation (OR: 1.38; 95% CI 1.24 to 1.54). In addition, low heterogeneity was found between studies I2: 13%. Conclusions: It was found that obstructive sleep apnea and atrial fibrillation are significantly associated

Metabolically Obese Normal-Weight Phenotype as a Risk Factor for High Blood Pressure: A Five-Year Cohort

"Background: The metabolically obese normal-weight (MONW) phenotype has been considered a risk factor for different chronic diseases, but its role in high blood pressure (HBP) is still unclear. The aim of the study is to determine if the MONW phenotype constitutes a risk factor for hypertension in Peruvian adults belonging to a 5-year cohort. Methods: This is a retrospective cohort study. A secondary analysis from the database of the PERU MIGRANT study was carried out from the MONW and non-MONW cohorts; after a 5-year follow-up, the appearance of HBP was evaluated in the subjects of both cohorts. To assess the strength and magnitude of the association, a Poisson regression model (crude and adjusted) with robust variance was used. The measure of association was the relative risk (RR). Results: The incidence of HBP was 11.30%. In the multivariable analysis, subjects with the MONW phenotype had a 2.879-fold risk of presenting HBP in 5 years compared with those who were not MONW at the beginning of the study; this was adjusted for categorized age, sex, group, and state of smoker and alcohol drinker (RR: 2.055; 95% confidence interval (CI): 1.118 - 3.777; P = 0.020). Conclusions: The presence of the MONW phenotype doubled the incidence of HBP, even after adjusting for other covariates. However, studies in this field should continue. If these findings are confirmed, it should be considered that presenting an adequate weight for height should not be interpreted as a condition free of metabolic alterations, so screening for hypertension should be carried out regardless of w