Enfermedades raras y catastróficas en un Hospital del norte peruano: Características y factores asociados a la mortalidad.

Objetivos: El objetivo fue determinar las características y los factores asociados a la mortalidad en los pacientes atendidos por enfermedades raras (ER) y catastróficas (EC) en un hospital de la seguridad social del norte peruano. Materiales y métodos: Estudio transversal analítico, se usó datos reportados de pacientes atendidos en un hospital del norte del Perú durante el 2013. Se caracterizó a los pacientes, las enfermedades y se obtuvo datos estadísticos de asociación. Resultados: De los 2316 pacientes, 2135 (92%) tuvieron EC y 181 (8%) ER. La enfermedad más común fue la insuficiencia renal crónica inespecífica (43%), pero la deficiencia hereditaria del factor VIII fue la que generó mayor gasto total (más de S/. 3 millones) y por cada paciente (S/. 7719,42). En el análisis multivariado se encontró asociación con la mortalidad al sexo femenino (p<0,001, RPa: 1,76, IC95%:1,67-1,86), la edad (p<0,001, RPa: 1,02, IC95%:1,01-1,03) y la cantidad de días hospitalizados (p<0,001, RPa: 1,08, IC95%:1,07-1,09), ajustando por el tipo de enfermedad. Conclusión: Existen características económicas y factores asociados a la mortalidad en los pacientes atendidos en nuestro medio, por lo que deberían realizarse más investigaciones para conocer mejor sobre este grupo de pacientes, ya que generalmente se encuentran desatendidos

Factors associated with basic scientific-academic capacity in medical students from Latin America

"Introducción: existe evidencia limitada en cuanto al entrenamiento estudiantil en capacidades científicas y académicas esenciales para la formación médica. Objetivo: identificar los factores asociados a la capacidad científica-académica básica en estudiantes de medicina de 11 países de Latinoamérica. Métodos: se hizo un estudio transversal de análisis de datos secundarios a través de un cuestionario autoadministrado en estudiantes de medicina de 11 países latinoamericanos. La variable dependiente fue la presencia de capacidad básica, definida como el autorreporte de capacitación y uso de al menos una de tres bases de datos (PubMed, SCOPUS, UpToDate), capacitación en búsqueda bibliográfica y lectura crítica, uso académico de al menos una de tres tecnologías de información (laptop, smartphone, tablet) y consulta a revistas científicas. Se estimaron razones de prevalencia (RP) utilizando modelos lineales generalizados multinivel de efectos mixtos (MEGLM). Se realizó un modelo anidado para evaluar la inclusión de covariables en el modelo parsimónico utilizando LRTest. Resultados: de 11.587 estudiantes, solo el 1,4 % presentó capacidad básica científica-académica. Los factores asociados de forma positiva fueron la procedencia de universidad privada (RP: 4,85, p < 0,001), estar afiliado a una sociedad científica estudiantil (SOCEM) (RP: 3,20, p < 0,001), pertenecer a grupos de investigación (RP: 2,97, p < 0,001) y ser parte de más de un grupo extracurricular (RP: 4,29, p = 0,012). Los factores asociados de forma negativa fueron proceder de Bolivia (RP: 0,05, p = 0,005), Argentina (RP: 0,06, p = 0,011) y Perú (RP: 0,14, p < 0,001). Conclusión: existe un pobre entrenamiento en capacidades científicas-académicas básicas en estudiantes de medicina. Proceder de universidad privada y estar afiliado a sociedades científicas o grupos afines se asoció a una mayor frecuencia de adquirir dichas herramientas.

Factors Associated with Surgical Site Infection in Post-Cesarean Section: A Case-Control Study in a Peruvian Hospital

BACKGROUND: Surgical site infection is the main cause of morbidity and mortality in post-cesarean section patients. The objective of this study was to determine the preoperative factors associated with the surgical site infection in patients undergoing cesarean emergency section in the Goyeneche Hospital of Arequipa.METHODS: We conducted a cases-control study on women who presented with surgical site infection after cesarean section in a hospital in Arequipa, Peru. We evaluated associated factors to surgical site infection after cesarean section (sociodemographics and clinical variables). For the inferential analysis, we estimated logistic regression using odds ratio.RESULTS: Out of a total of 4346 cesarean sections, only 2.4% developed surgical site infection. The associated factors to surgicalsite infection were mild anemia (OR: 2.80), moderate anemia (OR:2.71), number of vaginal examinations higher than five (OR:2.71) and onset of labor (OR: 1.95).CONCLUSION: Patients with risk factors such as anemia, onset of labor and five or more vaginal examinations should be evaluated after surgery to prevent surgical site infection

Association between Family Dysfunction and Post-Traumatic Stress Disorder in School Students during the Second COVID-19 Epidemic Wave in Peru

"Although the effect of the COVID-19 pandemic on children and adolescents’ mental health has been studied, there is still scarce evidence of the influence of nuclear family on the development of post-traumatic stress disorder (PTSD). This study aimed to determine the association between family dysfunction and PTSD in Peruvian high-school students during the COVID-19 pandemic. A cross-sectional study was conducted using a virtual survey administered to 562 high-school students in three schools in Chiclayo, Peru. The dependent variable was PTSD, which was measured with the Child PTSD Symptom Scale. Family dysfunction was the main independent variable, measured with the Family APGAR Questionnaire. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were estimated with generalized linear models. Most of the students were female (88.3%) and the average age was 14.4 years. We found that 21.4% showed severe family dysfunction and 60.3% had PTSD. Students with mild and moderate family dysfunction had 37% (PR: 1.37; 95% CI: 1.14–1.65) and 26% (PR: 1.26; 95% CI: 1.04–1.54) higher PTSD prevalence, respectively. In conclusion, family dysfunction may influence the development of PTSD in adolescents. This study suggests the importance to develop a healthy family environment to help adolescents face critical situations experienced during the pandemic.

Validez de la prueba de riesgo de la Asociación Americana de Diabetes como cribado para prediabetes en una muestra de trabajadores peruanos: Validity of the American Diabetes association Diabetes risk test as screening for Prediabetes in a sample of peruvian workers.

Objective:&nbsp;To evaluate the validity of the risk test of the American Diabetes Association (ADA Test) as a screening for hyperglycemia in a sample of workers in Lima, Peru.&nbsp;Methods:&nbsp;Cross-sectional study of diagnostic tests. Secondary analysis of the data generated by the electronic health record of an occupational polyclinic, carried out in January and February 2020. The sample was made up of workers from different areas who attended for their occupational medical evaluation. Prediabetes was considered with a fasting glucose ≥ 100 mg / dl but less than 126 mg / dl.&nbsp;Results:&nbsp;397 subjects were evaluated. The prevalence of hyperglycemia was 29% (115/397). With a cutoff ≥ 3 points, the ADA Test presented an area under the curve of 0.868, a sensitivity of 94.8%, and a specificity of 51.8%. The PPV was 44.5% and the NPV was 96.1%. Finally, the positive likelihood coefficient calculated was 1.96, and the negative was 0.101.&nbsp;Conclusion:&nbsp;The ADA test, with a 3-point cutoff, proves to be a simple pragmatic screening tool for undiagnosed cases of prediabetes. If current results are confirmed in future research, due to its simplicity, it can facilitate various initiatives aimed at introducing and expanding early prevention and management strategies based on this trial.Objetivo:&nbsp;Evaluar la validez de la prueba de riesgo de la Asociación Americana de Diabetes (Prueba ADA) como cribado para prediabetes en una muestra de trabajadores peruanos.&nbsp;Métodos:&nbsp;Estudio transversal de pruebas diagnósticas. Análisis secundario de los datos generados por el registro electrónico en salud de un policlínico ocupacional, realizado en los meses enero y febrero del año 2020. La muestra estuvo conformada por trabajadores de diferentes áreas que asistieron para su evaluación médica ocupacional. Se consideró prediabetes con una glucosa en ayunas ≥ 100 mg/dl pero menor a 126 mg/dl.&nbsp;Resultados:&nbsp;Se evaluaron 397 sujetos. La prevalencia de prediabetes fue 29% (115/397). Con un corte ≥ 3 puntos, la Prueba ADA presentó un área bajo la curva de 0.868, una sensibilidad del 94,8% y una especificidad del 51,8%. El valor predictivo positio fue de 44,5% y negativo fue de 96,1%. Por último, el coeficiente de verosimilitud positivo calculado fue de 1,96, y el negativo fue de 0,101.&nbsp;Conclusión:&nbsp;La prueba ADA, con un corte de 3 puntos, demuestra ser una herramienta de detección pragmática simple para casos no diagnosticados de prediabetes. Si los resultados actuales se confirman en investigaciones futuras, debido a su simplicidad, puede facilitar diversas iniciativas orientadas a introducir y ampliar estrategias de gestión y prevención temprana a partir de esta prueba

Prevalence and Factors Associated with Insomnia in Military Personnel: A Retrospective Study during the Second COVID-19 Epidemic Wave in Peru

Studies in military personnel are scarce and have reported increased rates of medical con-sultations and insomnia. The COVID-19 pandemic has been associated with a number of factors thatincrease the prevalence of insomnia, which has established consequences in the military. However,reported data are from different settings. We aimed to identify the prevalence and factors associatedwith insomnia during the second COVID-19 epidemic wave in Lambayeque, Peru. A retrospectivestudy in 566 participants was conducted face-to-face in November 2021. The dependent variable wasinsomnia, measured with the Insomnia Severity Index. The independent variables were socio-laborvariables, physical activity, food insecurity, eating behavior disorder, fear of COVID-19, and resilience.The prevalence of insomnia was 23% (95% CI: 19.6–26.7%). In multivariate analysis, insomnia wasassociated with a personal history of mental health (PR: 1.71, 95% CI: 1.01–2.93), food insecurity(PR: 1.43, 95% CI: 1.05–1.95), fear of COVID-19 (PR: 2.57, 95%CI: 1.87–3.54), and high resilience(PR: 0.60, 95%CI: 0.42–0.86). Overall, the Peruvian military population presents a high prevalenceof insomnia during the pandemic period. Special attention should be paid to factors that influenceinsomnia. Prevention and promotion programs should be established to reverse this negative trendin the military

Factors associated with the perception of inadequate sanitary control in 12 Latin American countries during the COVID-19 pandemic

"Introduction: Sanitary control mechanisms differ greatly from country to country. Therefore, it is important to know citizens' perception of different realities. We aimed to determine the factors associated with the perception of inadequate sanitary control in 12 Latin American countries during the COVID-19 pandemic. Methods: This is an analytical cross-sectional study. We asked about six perceptions in regard to different situations experienced by inhabitants of 12 Latin American countries during the pandemic. Frequencies according to country were described and associations vs. other important variables were obtained. Results: Out of 8,489 participants, 68% stated that there were moments of collective hysteria. Honduras was the country that most perceived inadequate control mechanisms established by the government. Multivariate analysis showed that there were statistically significant differences among many of the countries according to the six evaluated items. The higher the level of education, the greater the perception of poor control in five of the aspects. Additionally, men had a lower perception of inadequate control. The older the age, the lower the perception of inadequate control regarding whether there was collective hysteria and shortages of basic essentials. Those with COVID-19 had a lower perception of medicine shortages. Conclusion: The population of multiple realities in Latin America have perceived a bad management of the pandemic. Citizens' perception is an important indicator of the performance of each government during the COVID-19 pandemic. This study may provide valuable information on the relationship between the effectiveness of government sanitary control and people's mental health, which ultimately helps to create objective prevention programs against post-traumatic stress disorder, depression, fear of contagion, and collective hysteria. In addition, governments could use this information to design effective mitigation plans for future unavoidable pandemic events based on the six criteria discussed here.

Factores asociados al dominio docencia e investigación en facultades de medicina

Introducción: La investigación en pregrado se ha convertido en una parte integral de la formación médica, la cual ha transformado a la educación en salud y ha seguido históricamente un modelo estático con una orientación hospitalaria. Objetivo: Determinar los factores asociados al dominio correspondiente a docencia e investigación, en las mallas curriculares de las facultades de medicina humana de universidades peruanas. Métodos: Estudio de corte transversal en el cual se analizaron las mallas curriculares de las facultades de medicina humana existentes en Perú en el año 2022. Se seleccionaron asignaturas que cumplieron las características correspondientes al dominio Docencia e Investigación según lo establecido en el Documento Técnico del Ministerio de Salud. Asimismo, se evaluaron las variables tipo de universidad, ubicación, año de creación; también se recopilaron variables relacionadas con investigación: Ranking SIR IBER 2022, número de publicaciones generales en Scopus, número de publicaciones en medicina en Scopus, índice H Scopus y número de investigadores. Resultados: De 40 facultades de medicina humana, la media de cursos del dominio Docencia e Investigación fue de 6,5. Se encontró que el tipo de universidad tuvo asociación significativa con la frecuencia de cursos correspondientes al dominio Docencia e Investigación, con una media de cursos en universidades privadas superior a la media reportada en universidades públicas (?= 7,5 vs. ?= 5,5; p= 0,023). Conclusiones: El factor asociado al dominio correspondiente Docencia e Investigación es el tipo de universidad, se encuentra una media de cursos en universidades privadas superior a lo reportado en universidades públicas

Toxoplasma gondii Infection and Threatened Abortion in Women from Northern Peru

Introduction. Toxoplasma gondii infection can cause important complications during pregnancy. Threatened abortion may be a late indicator for infection in settings with high prevalence of toxoplasmosis. We aimed to determine the association between T. gondii infection and threatened abortion in women from northern Peru. Methods. We conducted a secondary analysis of a cross-sectional study in pregnant women from a hospital and a rural community in Lambayeque, Peru. Exposure variable was serological diagnosis of toxoplasmosis, defined as the demonstration of either IgM or IgG antibodies against T. gondii. Outcome variable was threatened abortion, defined as the diagnosis of bloody vaginal discharge or bleeding during the first half of pregnancy. Prevalence ratios were estimated in simple and multiple regression analyses. Results. Of 218 pregnant women, 35.8% presented positive serology for T. gondii and 14.7% had threatened abortion in their current pregnancy. Pregnant women with positive T. gondii infection had 2.45-fold higher frequency of threatened abortion (PR: 2.45, 95% CI: 1.15-5.21). In addition, the frequency of threatened abortion decreased by 9% for each additional year of age (PR: 0.91, 95% CI: 0.86-0.97). A previous history of threatened abortion also showed a higher frequency of threatened abortion (PR: 5.22, 95% CI: 2.45-11.12). Conclusions. T. gondii infection is associated with threatened abortion. An early age of pregnancy and a previous history of abortion are also associated with this condition