Usability and perceptions of a one-on-one telementoring program for young physicians in rural settings of Peru: a mixed method study.

BACKGROUND: Telementoring seems to be a promising strategy to deliver training and counselling to physicians in remote areas. In Peru, early graduated physicians must work for the Rural and Urban-Edge Health Service Program where they face important training needs. The aim of this study was to describe the usage of a one-on-one telementoring program for rural physicians and evaluate the aspects related to the perceptions of acceptability and usability. METHODS: Mixed methods study on recently graduated physicians who work in rural areas and participate in the telementoring program. The program used a mobile application to connect these young doctors with specialized mentors to answer queries about real-life problems raised by working in a rural area. We summarize administrative data to assess participant characteristics and their participation in the program. Additionally, we conducted in-depth interviews to explore the perceived usability, ease of use, and reason for non-use of the telementoring program. RESULTS: Of 74 physicians (mean age 25, 51.4% women) enrolled, 12 (16.2%) actively used the program and performed a total of 27 queries, which received response in an average time of 5.4 ± 6.3 h. In the interviews, the main reasons for non-use were connectivity issues, feelings of shame, and self-efficacy. For those who used the telementoring program they referred it was easy to use and solve their inquiries timely. CONCLUSIONS: The implementation of a telementoring program sought to provide guidance to recently graduated physicians working in rural areas. Low use rates show that administrative and process-related deficiencies in the program implementation need to be improved.

Ultrastructural skin alterations of healthy subjects with anti-desmoglein 1 antibodies in endemic areas to pemphigus foliaceus: A case series.

Background: Endemic pemphigus foliaceus and endemic pemphigus vulgaris are autoimmune dermatologic disorders endemic to the Peruvian Amazon. Objective: To determine the ultrastructural skin alterations of three healthy subjects with anti DSG-1 antibodies in areas endemic to pemphigus foliaceus and pemphigus vulgaris in the Peruvian Amazon. Patients and methods: Case series carried out from data of three clinically healthy subjects positive to anti DSG-1 antibodies, from Peru. This study consists of a sub-analysis of data gathered in a previous study. Results: Ultrastructural results are presented from the skin biopsies of three clinically healthy patients positive to anti-desmoglein 1 (DSG-1) antibodies. High Resolution Optical Microscopy (HROM) showed the absence of acantholysis. Transmission Electron Microscopy (TEM) showed the widening of intercellular space between keratinocytes, the presence of vacuoles in intercellular space with granular material and cytoplasmic vacuolization, loss of desmosome structure, loss of normal distribution among tonofilaments and lateral separation among cells in the stratum basale. Conclusion: According to our results, healthy subjects that present anti-desmoglein 1 antibodies can develop ultrastructural alterations that are visible through transmission electron microscopy but not through conventional optical microscopy.

Exposure to Atmospheric Ozone Disruption and Altitude Over 3500 m.a.s.l. are Associated with a Higher Prevalence of Photodermatoses in Pediatric Population of High-Altitude in Peru.

Objective: To determine if exposure to atmospheric ozone disruption and other factors are associated with photodermatoses in the high-altitude pediatric population in Peru. Materials and Methods: A cross-sectional study based on data obtained from studies of dermatological diseases among the population exposed to mine tailings in Peru which included children under the age of 18 in 6 population centers located over 2500 meters above sea level (m.a.s.l). We evaluated the presence of photodermatoses and possible associated factors obtaining the adjusted odds ratio (aOR) and confidence intervals (CI). Results: 594 children below the age of 18 participated in this study, 53.0% girls, the average age was 10.4 ± 4.1 years. 51.3% were exposed to a mini hole in the ozone layer, 60.1% resided at an altitude over 3500 m.a.s.l and 51.9% presented cutaneous manifestations of atopy upon physical examination. The prevalence of photodermatoses was 64.8%, of which the most frequent were actinic prurigo (49.3%), pityriasis alba (18.5%) and actinic cheilitis (4.4%). The multivariate analysis found that residing in a region exposed to the mini hole in the ozone layer (aOR = 4.23; CI 95%: 2.32-7.72) and residing at an altitude over 3500 m.a.s.l (aOR = 2.76; CI 95%: 1.57-4.86) were both independent associated factors to photodermatoses. Conclusion: A high prevalence of photodermatoses exists among the pediatric population living at high-altitude in Peru. Residing in a region exposed to a mini hole in the ozone layer and residing over 3500 m.a.s.l constituted associated factors.

Arsenicism by Chronic Exposure to Mine Tailings in Peru: An Analysis of 17 Cases with Lesions on Skin and/or Annexes.

Objective: To characterize the epidemiology and clinical manifestations of arsenicism from chronic exposure to mine tailings in people with lesions on their skin and/or annexes in two mining districts in the highlands of Peru. Materials and Methods: In this case series study, we included 17 people that presented arsenical lesions in skin and annexes which were identified in two prior studies. We evaluated age, occupation, place of exposure, time of exposure, time of disease, manifestations on skin and annexes, location of lesions, severity, and 24-hour urine clearance of arsenic. Results: The average time of exposure was 16.5 ± 14.7 years, and the average length of disease was 9.8 ± 8.1 years. In this study, 70.6% were men, 41.2% were farmers and 17.6% were underage. The most frequent main manifestations in skin and annexes were plantar keratosis (23.5%), palmar (11.8%), palmoplantar (11.8%) and thoracic keratosis (5.9%). Other manifestations were palmoplantar keratosis with thoracic hyperpigmentation (17.6%), Mees' lines (17.6%) and hyper/hypopigmentation in thorax and back (11.8%). With relation to the severity of lesions, 35.3% were grade 1 (mild), 29.4 % were grade 0 (asymptomatic), 29.4 % were grade 2 (moderate), and 5.9% were grade 3 (severe). The median of 24-hour urine clearance of arsenic was 55 µg/L/24 hours. No cases of skin cancer were presented. Conclusion: The studied cases of arsenicism with lesions on skin and/or annexes by exposure to mine tailings present with differential characteristics in comparison to other forms of arsenicism such as less severity, lower urine clearance of arsenic, and absence of skin cancer cases.

Productivity Characteristics of the Thesis Rate of PhD Students in Biomedical Areas of the Different Doctoral Programs in Lima, Peru: A 20-year Retrospective Study.

OBJECTIVE: The aim of this study was to determine the productivity characteristics related to the thesis rate of biomedical students of the PhD program in Health Sciences in Lima, Peru through a 20-year retrospective study. MATERIALS AND METHODS: This was a retrospective, comparative, cross-sectional study. The evaluation period consisted of two time periods, 1999-2014 and 2015-2019, to differentiate thesis defense production both before and after the promulgation of the new University Law 30220 in Peru. The student population included graduates from different professional areas (Dentistry, Medicine, etc.). An electronic search for all the data was carried out by using the Universidad Nacional Mayor de San Marcos (UNMSM) SUM (Unique Registration System) software. RESULTS: It was found that the highest prevalence of students who entered in the doctoral programs of the UNMSM Faculty of Medicine was 26.6% in 2013, whereas the highest prevalence of graduates was 24.4% in 2016. Finally, the highest prevalence of graduates who engaged in thesis defense was 41.4% in 2017. There has been a constant increase in thesis production, with the cutoff point being from 2014 onward. The Pearson's chi-square test showed a significant association between the type of PhD program and thesis defense (P = 0.008). CONCLUSION: The greatest production of thesis defense was carried out from 2014 to 2019. In addition, there was a significant association between thesis defense according to the PhD program and the professional career of the PhD student; however, none of the factors associated with the influence of obtaining a PhD degree in any of the programs evaluated was statistically significant.

Facial porokeratosis: A series of six patients.

Porokeratosis is a disorder of epidermal keratinization characterized by annular plaques with an atrophic centre and hyperkeratotic edges, and includes a heterogeneous group of disorders that are mostly inherited in an autosomal dominant fashion. Facial porokeratosis is rare and is not well documented. We present six cases of facial porokeratosis seen over a period of 15 years in a hospital in Lima, Peru. In most of the cases, porokeratosis was found in younger women without any significant past medical history. Oral isotretinoin showed moderate improvement in two of our patients.

Antidesmoglein 1 and 3 antibodies in healthy subjects of a population in the Peruvian high amazon.

BACKGROUND: The objective of this study was to determine the presence of anti-Dsg1 and Dsg3 antibodies in healthy subjects of the high Peruvian Amazon (Tuemal, Rodriguez de Mendoza province, department of Amazonas) to establish the theoretical presence of environmental factors or triggers in the area. MATERIALS AND METHODS: Cross-sectional study. The study population included persons of any age or gender, clinically healthy, who were evaluated by a dermatologist to confirm the absence of blistering diseases. Blood samples were analyzed by indirect immunofluorescence (IIF), immunoprecipitation (IP), anti-Dsg1 IgM antibody (Ab) enzyme-linked immunosorbent assay (ELISA), as well as anti-Dsg1 and anti-Dsg3 IgG Ab ELISA. RESULTS: Participants included 21 healthy subjects comprised of 61.9% males and 38.1% females; 47.6% had a positive anti-Dsg1 Ab ELISA for total IgG (or any subclasses). IIF detected antibodies against intercellular spaces in one subject. Anti-Dsg1 Ab IP was mildly positive in 33.3% of the subjects. Anti-Dsg1 IgG subclasses found positive were: IgG1 (19.0%), IgG2 (33.3%), and IgG3 (28.6%); none of the samples were positive for anti-Dsg1 Ab IgM ELISA, and 23.8% of the subjects were positive for anti-Dsg3 Ab ELISA. The age distribution was similar for subjects positive for anti-Dsg1 and anti-Dsg3 Ab ELISA, with higher frequencies found among the 20-29 and 40-49 year-old age groups. CONCLUSION: A fraction of healthy subjects of the high Peruvian Amazon developed anti-Dsg1 and anti-Dsg3 antibodies, demonstrating the possible presence of environmental factors for endemic pemphigus (EP) at a higher altitude than previously described.

Oxidative stress in patients with endemic pemphigus foliaceus and healthy subjects with anti-desmoglein 1 antibodies.

BACKGROUND: Previous studies have shown oxidative stress in pemphigus vulgaris and pemphigus foliaceus, nevertheless, it remains unknown whether a similar response is characteristic of endemic pemphigus foliaceus in Peru. OBJECTIVES: To determine the oxidative stress response in endemic pemphigus foliaceus patients and subjects with positive for anti-desmoglein1 antibodies (anti-dsg1) from endemic areas of Peru. SUBJECTS AND METHODS: This is a cross-sectional study. The study population included 21 patients with Endemic Pemphigus foliaceus and 12 healthy subjects with anti-dsg1 antibodies from the Peruvian Amazon (Ucayali), as well as 30 healthy control subjects. Malondialdehyde, an indicator of lipid peroxidation by free radicals, was measured in serum. RESULTS: We collected 21 cases of endemic pemphigus foliaceus, 15 of them with active chronic disease and 6 in clinical remission. Serum malondialdehyde values in patients with chronic active evolution and healthy subjects with anti-dsg1 antibodies were statistically higher than those of healthy controls (p<0.001). There was no significant difference between serum values of localized and generalized clinical forms. STUDY LIMITATIONS: The main limitation of this present study is the small number of patients with endemic pemphigus and healthy subjects positive for desmoglein 1 antibodies. CONCLUSIONS: The increased serum levels of malondialdehyde in patients with chronic active endemic pemphigus foliaceus and healthy subjects from endemic areas with anti-dsg1 antibodies may suggest a contribution of systemic lipid peroxidation in the pathogenesis of endemic pemphigus foliaceus.

Importancia de la biopsia de hueso en el diagnóstico de las enfermedades metabólicas óseas / Importance of bone biopsy in the diagnose on the bone metabolic diseases

RESUMEN Objetivo. Evaluar la importancia de las biopsias óseas en el diagnóstico de las enfermedades óseas metabólicas, su relación con la densitometría ósea (DMO) y los biomarcadores. Métodos. Estudio transversal, descriptivo. Se efectuaron biopsias de la cresta pelviana a 38 personas, 36 mujeres (34 menopáusicas y 2 premenopáusicas) y 2 varones. DMO en columna vertebral, cadera y/o antebrazo por absorciometría dual de rayos X. Se determinó calcio, fósforo, osteocalcina, fosfatasa alcalina, vitamina D, parathormona, hemoglobina, transaminasas, proteínas totales y fracciones en sangre y en orina, N-telopéptido de enlaces de colágeno tipo I, calcio y fósforo por métodos convencionales. Resultados. La edad promedio de 34 mujeres postmenopáusicas fue 58 ± 7,79 y el tiempo de la menopausia 11,48 ± 8,76 años; la DMO promedio en columna, cadera y antebrazo fue de -2,88 ± 1,16, -2,13 ± 0,82, y -5,14 ± 1,76, respectivamente; la biopsia demostró osteoporosis en 33 y enfermedad de Paget en 1. Dos varones de 48 y 63 años, con DMO en antebrazo de -3,2 y -4,9, y osteoporosis en la biopsia. Mujer de 34 años con DMO -3 y osteoporosis en biopsia; y una mujer de 29 años con DMO -3 y osteomalacia en biopsia. Hubo correlación negativa entre la edad y duración de la menopausia con la disminución de la DMO. Conclusiones. Hubo correlación entre la edad y tiempo de menopausia con la disminución de la DMO. Una DMO baja no siempre es osteoporosis, puede tratarse de otra enfermedad ósea metabólica como osteomalacia o enfermedad de Paget. La biopsia ósea es el procedimiento más confiable para el diagnóstico de estas enfermedades.

ABSTRACT Objective. To evaluate the importance of bone biopsy in the diagnose of the bone metabolic diseases, its relationship with bone densitometry (BMD) and biomarkers. Methods. In a descriptive, transversal study, 38 biopsies of pelvic bone were made, 36 in female (34 postmenopausal and 2 premenopausal) and 2 in male. All had BMD in spine, hip and/or forearm measured by dual x-ray absorptiometry. Calcium, phosphorus, parathormone, vitamin D, alkaline phosphatase, osteocalcin, hemoglobin, transaminases, total protein and fractions were measured in blood and N-telopeptide of collagen type I, calcium and phosphorus in urine by conventional methods. Results. The mean age of 34 menopausal women was 58 ± 7,79 and menopause time was 11,48 ± 8,76 years; mean BMD in spine, hip and forearm were -2,88 ± 1,16, -2,13 ± 0,82, y - 5,14 ± 1,76, respectively; bone biopsy demonstrated osteoporosis in 33 y Paget´s disease in one. Male persons 48 and 63 years old had BMD in forearm -3,2 and -4,9, and osteoporosis in biopsy. A woman 34 years old had a BMD of -3 and osteoporosis en bone biopsy, a woman 29 years old with BMD -3 presented osteomalacia in biopsy. There was a negative correlatión between age and time of menopause with BMD decrease. Conclusions. A negative correlation between the age and time of menopause with BMD decrease was found. A low BMD not always is osteoporosis, it might be other bone metabolic disease like osteomalacia or Paget´s disease. Bone biopsy is a more trustworthy procedure for the diagnose of these diseases.

Factores de riesgo cardiovascular en mujeres obesas menopáusicas y premenopáusicas de Lima Metropolitana / Cardiovascular risk factors in obese menopausal and premenopausal women from Metropolitan Lima, Peru

Objective: To determine the frequency of cardiovascular risk factors (CVRF) in obese menopausal and premenopausal women aged 30 to 75 from Metropolitan Lima, Peru. Methods: We conducted a descriptive, analytical, transversal study in 95 obese women aged 30 to 75 from Metropolitan Lima from 2015 to 2017, where 48 were menopausal (MENO) and 47, premenopausal (PREMENO). Obesity grade was determined using the World Health Organization criteria. Conventional methods were used for anthropometry, blood pressure (BP), fasting blood glucose (G), total cholesterol (TC), triglycerides, HDL cholesterol, insulin (I) and transaminases values; VLDL, LDL and non-HDL (cNoHDL), and HOMA coefficient were calculated. We used the program SPSS v. 23 for statistical analysis. We considered obesity, dyslipoproteinemia, high blood pressure, insulin resistance and high transaminases values as CVRF. Results: From a total of 95 obese women, 45.3% had grade I obesity, 28.4% had grade II, and 26.3% had grade III. Compared to premenopausal women, menopausal women were older and had a greater height and higher BP, cNoHDL, insulin and HOMA values. Conclusion: Obese menopausal women presented a higher cardiovascular risk than obese premenopausal women.

Objetivos. Establecer la frecuencia de factores de riesgo cardiovascular (FRCV) en mujeres obesas menopáusicas y premenopáusicas de 30 a 70 años de Lima Metropolitana. Métodos. Estudio analítico, observacional, transversal en 95 pacientes obesas de 30 a 75 años de edad, de Lima Metropolitana, cuyo grado de obesidad se catalogó de acuerdo a los criterios del Organización Mundial de la Salud; 48 fueron menopáusicas (MENO) y un grupo control de 47 premenopáusicas (PREMENO). Se determinó las medidas antropométricas, presión arterial (PA) y, en una muestra de sangre en ayunas, glucosa (G), colesterol total (CT), triglicéridos (Tg), colesterol HDL, insulina (I), y transaminasas; se calculó las fracciones VLDL, LDL, No-HDL (cNoHDL) e índice HOMA, los cálculos estadísticos mediante el programa SPSS v.23. Se consideró FRCV a la obesidad, dislipoproteinemia, hipertensión arterial (HTA), resistencia a la insulina (RI), transaminasas elevadas. Resultados. De las 95 mujeres, 45,3% tenía obesidad grado I, 28,4% grado II y 26,3% grado III. Las MENO tuvieron mayor edad, talla, PA, cNoHDL, I y HOMA que las PREMENO. Conclusiones. Las mujeres obesas menopáusicas tienen mayor riesgo cardiovascular que las mujeres premenopáusicas obesas.

Características del metabolismo óseo en mujeres con osteoporosis posmenopáusica de un hospital de Lima / Characteristics of bone metabolism in women with post-menopausal osteoporosis in a hospital from Lima

Introducción: En nuestro medio no existen estudios que evaluen los diversos marcadores de recambio óseo en mujeres con osteoporosis posmenopáusica, considerando la alta tasa de morbimortalidad asociada a las fracturas por fragilidad. Objetivo: Conocer las características bioquímicas del metabolismo óseo en mujeres posmenopáusicas con osteoporosis. Métodos: Estudio transversal. Se incluyeron a 49 mujeres posmenopáusicas con osteoporosis, a quienes se midió la densidad mineral ósea por absorciometría dual de rayos X en columna lumbar, cadera y antebrazo. Se determinó calcio, fósforo, osteocalcina, fosfatasa alcalina, vitamina D y paratohormona en sangre y en orina, N-telopéptido de enlaces de colágeno tipo I, calcio y fósforo por métodos convencionales. Resultados: La edad promedio fue 59,1 ± 7,5 años. El tiempo medio de menopausia fue 12,0±7,9 años. Todas tuvieron osteoporosis en antebrazo, 55,1%, en columna lumbar y 18,4%, en cadera total. Valores insuficientes de vitamina D tuvo el 46,9% y 8,2, valores deficientes. La osteocalcina fue normal en 73,5%, disminuida en 20,1% y alta en 6,4%. Se encontró correlación positiva entre la edad y la concentración de paratohormona, y negativa con la vitamina D. La fosfatasa alcalina tuvo correlación positiva con la duración de la menopausia. Conclusión: La mayor extensión de osteoporosis tuvo correlación con la edad y tiempo de menopausia. Más de la mitad de mujeres tuvieron niveles bajos de vitamina D.

Introduction: In our context, there are no studies which had evaluated the markers of bone turnover in post menopausal women with osteoporosis, considering the high rate of morbidity and mortality associated with fragility fractures. Objective: To know the biochemical features of bone metabolism in women with postmenopausal osteoporosis. Methods: A cross-sectional study. 49 women with postmenopausal osteoporosis were included. Bone mineral density in spine, hip and forearm was measured by dual x-ray absorptiometry. Calcium, phosphorus, osteocalcin, alkaline phosphatase, vitamin D and paratohormone were measured in blood. N-telopeptide of collagen type I, calcium and phosphorus were measured in urine by conventional methods. Results: The average age of the participants was 59,1± 7,5 years. The average time since menopause was 12,0 ± 7,9 years. All had osteoporosis in forearm; 46,9% had insufficient levels of vitamin D and 8,2% had deficient values. The osteocalcin was normal in 73,5%, decreased in 20,1% and increased in 6,4% participants. Age showed statistically significant correlation with serum parathyroid hormone and was negatively correlated with vitamin D. The time of menopause had a positive and statistically significant correlation with alkaline phosphatase. Conclusion: The extension of osteoporosis had a positive correlation with older age and longer menopause. The bone turnover markers provide complementary information to bone densitometry.

Frecuencia y características de obesos con y sin riesgo cardiometabólico / Frecuency and characteristics of obese subjects with and without cardiometabolic risk

Objetivo. Determinar la frecuencia y características de una población de pacientes obesos con y sin riesgo cardiometabólico (RCM) y revisar el concepto de obeso cardiometabólico normal (OCMN). Materiales y Métodos. Estudio analítico, transversal, de 105 pacientes obesos, de 30 a 75 años, de ambos géneros. Recolectados de un programa preventivo promocional de mayo de 2015 a abril del año 2016. Previo consentimiento informado, se registró la edad, género, medidas antropométricas, presión arterial (PA), antecedentes personales y familiares de factores de riesgo cardiovascular (FRCV). En ayunas, se determinó en sangre glucosa (G), colesterol total (CT), colesterol HDL, triglicéridos (Tg), creatinina, proteínas plasmáticas, bilirrubinas, transaminasas (AST,ALT), fosfatasa alcalina (FA) y gamaglutamiltranspeptidasa (GGTP), por métodos convencionales; las fracciones VLDL, LDL y NoHDL fueron calculados. Se empleó el programa SPSS.23 para el análisis estadístico Resultados. El 77,4% fueron mujeres, edad promedio 51±0,86 años. El 45,7% tuvo obesidad grado I, 24,7% grado II y 29,5% grado III. Las mujeres tuvieron menor talla, peso y circunferencia abdominal (CA) y cifras más altas de HDL que los varones, no hubo diferencias en otros parámetros. El 89,2 % de mujeres y 87% de varones tuvieron dislipoproteinemia; hipertensión arterial (HTA): mujeres 20,7% y varones 21,4%; tabaquismo: mujeres 5,5% y varones 42,3%; hiperglicemia: mujeres 14,2% y varones 14,2%; macrosomía/bajo peso al nacer: mujeres 6,9%, varones 0; enzimas hepáticas elevadas: mujeres 29,8%, varones 32,1%. El 9,5% fueron OCMN por tener PA, G, cHDL, Tg, cLDL cNoHDL normales. Conclusiones: La mayoría de los pacientes obesos tuvieron RCM, solo 10 (9,5%) fueron OCMN.

Objetive. To study the frequency and characteristics of an obese population with and without cardiometabolic risk (CMR) and, to revise the concept of cardiometabolically healthy obese CMHO subjects. Material and methods. A total of 105 obese subjects, 30 to 75 years old, were recluted from a preventive-promotional program from may 2015 to april 2016. Previous informed consent, age, gender, anthropometric measures, blood pressure (BP), personal and family history of cardiovascular risk factors (CVRF) were registered. At fasting glucose (G), total cholesterol (TC), HDL cholesterol (cHDL), triglycerides (Tg), creatinine, plasma proteins, bilirrubins, transaminases (AST,ALT), alkaline fosfatase (FA) and gamaglutamyltranspeptidase (GGTP) were measured in blood by conventional methods. VLDL, LDL, Non-HDL fractions were calculated. Statistics were calculated with SPSS.23 program. Results. 77,4% were women, mean age 51±0,86 years. Women had lower height, weight and abdominal circumference than male but higher HDL concentration, other parameters were similar. Obesity grade I was found in 45,7%, grade II in 24,7% and grade III in 29,5%. Dislipoproteinemia had 89,2% of women and 87% of men; high blood pressure (HBP): women 20,7%, men 21,4%; tobaccoism women 5,5%, male 42,3%; hyperglycemia: women 14,2%, men 14,2%; macrosomia/low birthweight: women 6,94%, men 0%; elevated hepatic enzymes: women 29,8%, male 32,1%. 9,52% were CMHO since they had normal BP, G. HDLc, Tg, LDLc and Non-HDL . Conclusions. The majority of obese patients had CMR, only 10 (9,5%) were CMHO.

[Gastroprotective and antisecretory effect of a phytochemical made from matico leaves (Piper aduncum)]. / Efecto gastroprotector y antisecretor de un fitofármaco de hojas de matico (Piper aduncum).

OBJECTIVES: To determine the gastroprotective and antisecretory effect of ethanol extract from matico leaves (Piper aduncum) in animal models. MATERIALS AND METHODS: To evaluate the gastroprotective effect, 220 mice of the Balb C57 strain were used. They were randomized in 22 groups of ten animals each, in which the formation of gastric ulcers was induced with indomethacin. Gastroprotection was determined by evaluating three aspects: inflammation, number of hemorrhagic shocks and number of ulcers. To evaluate the antisecretory effect, 64 white male Holtzman rats were used, which were randomized in eight groups of eight animals, one control and seven groups of treatment with one extract dose level and two phytochemical dose levels. Antisecretion was obtained through the pylorus ligation. RESULTS: Regarding gastroprotection, dichloromethane, chloroform, hexane and methanol extracts decreased inflammation to over 66% (p<0,05). The ethanolic extract shows 100% activity in reducing the number of hemorrhagic bands (p<0,05). The chloroform extract shows antiulcer activity at 75% (p<0,05). In terms of antisecretion, the phytochemical in capsules containing the ethanolic extract achieved 72% reduction of the gastric secretion volume (p<0,01) and 104,3% (p<0,01) PH increase. CONCLUSIONS: In experimental conditions, ethanolic extracts, their fractions and phytochemicals have a gastroprotective effect in mice and antisecretory effect in rats.

Oxidative stress in patients with endemic pemphigus foliaceus and healthy subjects with anti-desmoglein 1 antibodies

Abstract: Background: Previous studies have shown oxidative stress in pemphigus vulgaris and pemphigus foliaceus, nevertheless, it remains unknown whether a similar response is characteristic of endemic pemphigus foliaceus in Peru. Objectives: To determine the oxidative stress response in endemic pemphigus foliaceus patients and subjects with positive for anti-desmoglein1 antibodies (anti-dsg1) from endemic areas of Peru. Subjects and Methods: This is a cross-sectional study. The study population included 21 patients with Endemic Pemphigus foliaceus and 12 healthy subjects with anti-dsg1 antibodies from the Peruvian Amazon (Ucayali), as well as 30 healthy control subjects. Malondialdehyde, an indicator of lipid peroxidation by free radicals, was measured in serum. Results: We collected 21 cases of endemic pemphigus foliaceus, 15 of them with active chronic disease and 6 in clinical remission. Serum malondialdehyde values in patients with chronic active evolution and healthy subjects with anti-dsg1 antibodies were statistically higher than those of healthy controls (p<0.001). There was no significant difference between serum values of localized and generalized clinical forms. Study limitations: The main limitation of this present study is the small number of patients with endemic pemphigus and healthy subjects positive for desmoglein 1 antibodies. Conclusions: The increased serum levels of malondialdehyde in patients with chronic active endemic pemphigus foliaceus and healthy subjects from endemic areas with anti-dsg1 antibodies may suggest a contribution of systemic lipid peroxidation in the pathogenesis of endemic pemphigus foliaceus.

[Effect of sacha inchi oil (plukenetia volúbilis l) on the lipid profile of patients with hyperlipoproteinemia]. / Efecto del aceite de sacha inchi (plukenetia volúbilis l) sobre el perfil lipídico en pacientes con hiperlipoproteinemia.

We performed a pilot, experimental, open study in order to know the effect, effective dosage and secondary effects of sacha inchi´s (Plukenetia Huallabamba) [corrected] oil on the lipid profiles of patients with hypercholesterolemia. We included 24 patients of ages 35 to 75, to whom we measured total cholesterol (TC), HDL, triglycerides (Tg), glucose (G), non-esterified fatty acids (NEFA) and insulin (I) levels in blood, then we randomized them to receive sacha inchi oil orally 5 ml or 10 ml of a suspension of sacha inchi oil (2gr/5ml) for four months. The oil intake produced a decrease in the mean values of TC, and NEFA, and a rise in HDL in both subgroups. The subgroup receiving 10 ml was associated to an increase in the insulin levels. Sacha inchi oil appears to have beneficial effects on the lipid profile of patients with dyslipidemia, but their efficacy and security should be evaluated in randomized clinical trials.

Skin diseases in the Peruvian Amazonia.

BACKGROUND: Dermatologic diseases vary widely as a result of geographic location and may be influenced by environmental factors. Aim To determine the epidemiology of dermatological diseases in the Peruvian Amazonia. METHODS: Transversal and multicentric study, which were carried out during February of 2006, 2007, and 2008 in three regional hospitals in the Peruvian Amazonia. All new patients who were looking for dermatological consultation were included. Univariate/bivariate analysis, chi square, and multinomial logistic regression were used with a confidence level of 95%. RESULTS: A total of 1602 patients were included. The infectious and parasitic dermatoses were the most prevalent (31.5%). There was a statistically significant association between infections of the skin and subcutaneous tissue in children (P < 0.001). The parasitic dermatoses such as scabiosis, pediculosis, and myiasis were associated with an altitude less than 700 meters above sea level (m.a.s.l.) (P = 0.003, OR = 3.1, CI: 1.5-6.7). On the other hand, radiation-related disorders of the skin and subcutaneous tissue were associated with more than 700 m.a.s.l. (P < 0.01, OR = 2.9, CI: 1.7-4.9). CONCLUSIONS: Infectious dermatological diseases were the most common diagnoses in the Peruvian Amazonia. In addition, radiation-related disorders of the skin should be addressed for people living/traveling in the rainforest area. These findings may assist in the training of general doctors in diagnosis and treatment of the most common dermatoses in tropical areas. Moreover, this study would be helpful for physicians from developed countries when giving medical advice/attention to travelers or immigrants of tropical areas.

Formación de placas ateromatosas en pacientes en riesgo cardiovascular / Formation of atheromatosas plaques in patients with cardiovascular risk

Objetivos: Determinar la relación entre la formación de placas ateromatosas arteriales con factores de riesgo cardiovascular (FRCV). Material y métodos: Estudio descriptivo, transversal y correlacional en el que se determinó la relación entre obesidad y diabetes mellitus (DM), hipertensión arterial (HTA) y/o dislipoproteinemia basal y postprandial y la formación de placas ateromatosas en 42 pacientes, 17 varones y 25 mujeres, de 30 a 71 años (promedio 53.2 +- 9.30 años). Se efectuo medidas antropométricas, exámenes clínicos, determinaciones en sangre de colesterol total (CT), triglicéridos (Tg), colesterol HDL (HDL), glucosa (G), ácidos grasos no esterificados (AGNE), insulina (I) en ayunas y durante 6 horas después de administrar una comida mixta y una ultrasonografía bimodal de las arterias carótidas. Resultados: En los 42 pacientes se encontró placas ateromatosas que disminuyen la luz de las carótidas en un rango promedio de 11.1% a 58.2%. Hubo correlación significativa entre el grado de obstrucción con la edad, la circunferencia abdominal, presión arterial diastólica y la glicemia. Conclusiones. Se demuestra la existencia de una relación significativa entre la formación de ateromas con disminución de la luz de las carótidas con la edad de los pacientes, la obesidad central, presión arterial diastólica y la glicemia.

Objectives: To determine the possible relationship between the formation of arterial atheromatous plaques and cardiovascular risk factors (CVRF). Methods: A descriptive, transversal, correlative study to find uot the relationship between obesity, diabetes mellitus (DM), high blood pressure (HBP) and/or dislipoproteinemia and arterial atheromatous plaques formation was conducted. A total of 42 patients, 17 male and 25 female, 30 to 71 years old, mean 53.2 +- 9.30, were included. Antrophometric meassures, clinical examinations, blood determinations of total cholesterol (TC), HDL, triglycerides (Tg), glucose (G), insulin (I) and non-sterified fatty acids (NEFA) were performed both at fasting as well as during 6 hours after a standarized mixed meal, a bimodal ultrasound examination of carotid arteries was done. Results: In all 42 patients atheromatous plaques stenosing the carotid arteries in a mean range of 11.1% to 58.2 were found. A significantly coorrelation between the mean arterial obstruction degree and the patient's age, abdominal circunference, diastolic blood pressure and blood glucose was found. Conclusions: There is a significantly relationship between the atheromatous plaques formation in carotid arteries with the patient's age, abdominalcircunference, diastolic blood pressure and blood glucose.

Cutaneous acanthamebiasis infection in immunocompetent and immunocompromised patients.

BACKGROUND: Cutaneous acanthamebiasis is a rare infection and few patients have been reported worldwide. METHODS: Observational and descriptive study carried out from March 1996 to February 2006 in patients with diagnosis of cutaneous free-living amebic infection caused by Acanthamoeba spp. The patients were diagnosed at the Dos de Mayo National Hospital (Lima-Peru) where skin biopsies, histopathologic studies and cultures were performed. The clinical and epidemiologic characteristics, diagnosis, treatment and evolution were recorded in a survey. RESULTS: Five patients with cutaneous free-living amebic infection caused by Acanthamoeba spp. were identified. Skin lesions were ulceronecrotic (four patients), an infiltrative bluish plaque (one patient), and a periorbital tumor (one patient). Three patients were positive for human immunodeficiency virus (HIV), had only cutaneous involvement, and died of opportunistic infections. The two immunocompetent patients developed Acanthamoeba granulomatous encephalitis and meningoencephalitis that progressed to intracranial hypertension and death. CONCLUSION: The clinical manifestations of cutaneous free-living amebic infection caused by Acanthamoeba spp. appear to vary according to the underlying immunologic status.

[Endemic pemphigus foliaceus in a pregnant woman. Report of one case]. / Gestante con pénfigo foliáceo endémico y producto libre de enfermedad: Caso clínico.

Endemic pemphigus foliaceus (EPF) in an autoimmune skin disease present in areas of the Amazonia. We report a 36 year-old woman who presented EPF at 17 weeks of pregnancy. At 29 weeks, she started antimicrobial treatment and steroids. At the moment of delivery, the disease was in remission and cutaneous lesions were not seen in the neonate. Indirect immunofluorescence titers of total IgG in the mother and in the neonate were negative. Sixteen months later, IgG titers in the offspring were 1/20 and remained negative in the mother, who was on low doses of oral corticosteroids.

Conocimientos, actitudes y prácticas sobre bioseguridad en unidades de cuidados intensivos de dos hospitales de Lima-Per£ 2008 / Knowledge, attitudes and practices on biosafety in intensive care units in two hospitals from Lima, Peru 2008

Objetivo: Determinar el nivel de conocimientos, actitudes y las prácticas (CAP) sobre bioseguridad del personal de salud de las unidades de cuidados intensivos (UCI) de dos hospitales de Lima, Perú. Métodos: Estudio descriptivo transversal realizado en las UCIs de los hospitales Nacionales Dos de Mayo e Hipólito Unanue. Se desarrolló un instrumento de recolección de datos conformado por 27 ¡tems (KR-20=0.81) el cual se aplicó a médicos, enfermeras y técnicos de enfermer¡a. Resultados: Apreciamos que el 63.3% del personal tuvo un nivel de conocimientos bueno, el 95% actitudes favorables y el 47.5% buenas prácticas, no se encontr¢ personal con un nivel de pr cticas deficiente. No existieron diferencias entre grupos profesionales. Solo se encontró una correlación moderada entre las prácticas y el nivel de conocimientos (r=0,46; p<0,001), no se encontró correlación significativa entre las prácticas y las actitudes. Conclusiones: Encontramos que el nivel de CAP es mayor a lo reportado en la literatura nacional, sin embargo existieron ciertas deficiencias que deben ser resueltas con programas de capacitaci¢n en normas de bioseguridad con el fin de reducir la prevalencia de infecciones intrahospitalarias en UCI.

Objective: To determine the level of knowledge, attitudes and practices (KAP) on biosafety of the health care providers of intensive care units (ICUs) in two hospitals from Lima Peru. Methods: Cross sectional study performed at ICUs from Hospitals Dos de Mayo and Hipolito Unanue - Lima, Peru. An instrument of data collection was developed conformed by 27 items (KR-20 = 0,81), which was applied to physicians, nurses and health technicians. Results: We appreciate that 63,3% of staff had a good knowledge level, 95% of them favorable attitudes and 47,5% had good practices, and there were no staff with a level of poor practices. No differences between professional groups. There was only a moderate correlation between the practices and knowledge level (r=0,46; p <0,001), no correlation was found between the practices and attitudes. Conclusions: We found a higher level of KAP than the one reported in the national literature. However, there were some deficiencies that should be resolved with training programs in biosafety regulations in order to reduce the prevalence of nosocomial infections in ICUs.