Epidemiología y nuevos métodos de estimación del riesgo, en casos de pandemias: COVID-19 / Epidemiology and new methods of risk estimation in pandemic cases: COVID-19

RESUMEN Durante el periodo de la pandemia por la COVID-19 se han realizado importantes intervenciones conductuales, clínicas y estatales en busca de mitigar y prevenir la persistencia del virus en la población humana. No obstante, aún no existe claridad de cómo estas intervenciones sin precedentes, incluidas las restricciones de viaje, afectaron la propagación de la COVID-19 en China y en otros países. Por ello, el objetivo de la presente investigación fue describir las principales características epidemiológicas de la COVID-19, a través del análisis de las principales medidas establecidas. Se utilizaron datos de 40 artículos científicos referentes a la pandemia y al virus, considerando información de relevancia respecto a este, como su comportamiento, sintomatología, epidemiología, tratamiento y métodos de mitigación a nivel mundial, así como un plan de medidas de control que se propuso en Perú para mitigar la propagación comunitaria de la enfermedad por coronavirus 2019 y poder estar preparado para futuras enfermedades de igual o mayor proporción que la actual.

ABSTRACT During the COVID-19 pandemic, there have been important behavioral, clinical and government interventions to mitigate and prevent the spread of the virus in the population. However, there is no evidence of how these interventions, including the travel restrictions, affect the spread of COVID-19 in China and other countries. The objective of this research is to describe the main epidemiological characteristics of COVID-19 through the analysis of the main measures established. The sample included 40 scientific articles related to the pandemic and virus, considering relevant information regarding the behavior, symptomatology, epidemiology, treatment and methods of mitigation globally as well as a plan of control measures proposed in Peru to mitigate the spread of COVID-19 and to be prepared for future pandemics.

Utility of follow-up cervical length screening in low-risk women with a cervical length of 26 to 29 mm.

BACKGROUND: In women with a previous preterm birth, a protocol for serial cervical length screening has been studied and recommended for the identification and treatment of a short cervix. Cervical length screening along with vaginal progesterone has been suggested for low-risk women with singleton pregnancies to treat a short cervix and reduce preterm birth. However, specific protocols for single vs serial ultrasound measuring cervical length in this population are not established. Cost-effectiveness of universal cervical length screening depends on the cost of screening; follow-up of borderline measurements can contribute to increased costs with uncertain benefit. OBJECTIVE: This study aimed to determine the utility of follow-up cervical length screening in otherwise low-risk women with singleton pregnancies with a midtrimester cervical length measurement of 26 to 29 mm through the assessment of the rate of short cervix (≤25 mm) on follow-up ultrasound and subsequent delivery outcomes. STUDY DESIGN: This was a 2-year retrospective cohort study at a single urban institution of women with singleton pregnancies with no previous spontaneous preterm birth and an initial transvaginal ultrasound cervical length measurement of 26 to 29 mm identified during universal cervical length screening at time of anatomy ultrasound (18 0/7 to 22 6/7 weeks' gestation). The primary outcome was the rate of short cervix (defined as ≤25 mm on transvaginal ultrasound) on follow-up ultrasound at <24 weeks' gestation. Secondary outcomes included the rate of spontaneous preterm birth (<37 and <34 weeks' gestation). RESULTS: During the study period, there were 2801 women with singleton pregnancies at 18 0/7 to 22 6/7 weeks' gestation with transvaginal ultrasound cervical length screening at time of anatomy scan. Among those women, 201 had a cervical length of 26 of 29 mm, and 184 (7%) had no previous spontaneous preterm birth and were included in the study. Furthermore, 144 women (78%) had a follow-up cervical length completed before 24 weeks' gestation. The mean follow-up interval was 1.5±0.6 weeks. Overall, the percentage of short cervix (≤25 mm) on follow-up was 15% (n=21). Baseline characteristics were similar, but the initial cervical length measurement was shorter in women who subsequently developed a short cervix (26.7±0.8 vs 27.8±1.0; P<.01). Delivery outcomes were available for 126 patients. The rate of spontaneous preterm birth at <37 weeks' gestation in women with an initial cervical length 26 to 29 mm and subsequent short cervix was significantly higher than the rate of spontaneous preterm birth in a historical cohort of low risk women with an initial cervical length >25 mm (16% vs 3%; P=.03). The rate of spontaneous preterm birth at <34 weeks' gestation in women with a subsequent short cervix was 11% (2 of 19). CONCLUSION: Here, approximately 15% of low-risk women with singleton pregnancies with a midtrimester cervical length measurement of 26 to 29 mm will experience cervical shortening of ≤25 mm before 24 weeks' gestation. Compared to women with singleton pregnancies without a history of preterm birth, the rate of spontaneous preterm birth (16%) in women with an initial cervical length of 26 to 29 mm and a subsequent cervical shortening of ≤25 mm is significantly higher. A total of 111 follow-up ultrasounds measuring cervical length would be required to prevent 1 early preterm birth at <34 weeks' gestation.

Rol de la biopsia por aspiración con aguja fina (BAAF) en el abordaje diagnóstico de tumoraciones mamarias palpables en el Instituto Nacional de Enfermedades Neoplásicas, Lima-Perú / Role of fine-needle aspiration biopsy (FNAB) in the diagnostic approach of palpable breast tumors at the Instituto Nacional de Enfermedades Neoplásicas, Lima-Peru

Objetivo: El objetivo del estudio fue determinar si la Biopsia Core por aspiración con aguja fina es un método seguro para realizar diagnóstico de cáncer de mama en mujeres con tumoración mamaria palpable. Materiales y métodos: Se realizó un estudio prospectivo, analítico y de corte transversal en el área de Prevención del cáncer, constituida por 105 mujeres con tumor palpable en mama que acudieron al Departamento de Prevención y diagnóstico de cáncer del Instituto Nacional de Enfermedades Neoplásicas (INEN) durante el periodo del 01 de julio del 2014 hasta el 30 de abril del 2015. La muestra en estudio fue seleccionada mediante el muestreo no probabilístico y en base a criterios de inclusión y exclusión. Resultados: La edad promedio fue significativamente mayor en el grupo con resultado patológico maligno (51.21 años), se observa que a medida que la edad aumenta, las patologías benignas van disminuyendo en frecuencia en comparación con las patologías malignas que aumentan en frecuencia. Se observa del total de 105 mujeres con tumor palpable; el 35.2 % fueron patología maligna y 64.8 % correspondieron a patología benigna. La sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo se estiman en 94 %, 96 %, 94 % y 96 % respectivamente; la seguridad diagnostica de la BAAF fue de 90.3 %. Conclusiones: La biopsia por aspiración con aguja fina es un método de diagnóstico seguro para detección de cáncer de mama en mujeres con tumoración mamaria palpable.

Objective: The objective of the study was to determine if fine-needle aspiration biopsy is a safe method to diagnose breast cancer in women with a palpable breast tumor. Materials and methods: A prospective, analytical and cross-sectional study on cancer prevention conducted in 105 women with a palpable breast tumor who went to the Department of Cancer Prevention and Diagnosis of the Instituto Nacional de Enfermedades Neoplásicas (INEN) from July 1, 2014 to April 30, 2015. The study sample was selected through non-probabilistic sampling, and based on inclusion and exclusion criteria. Results: The average age was significantly higher in the group with a malignant pathological result (51.21 years). It was observed that, as age increases, benign pathologies decrease in frequency in comparison with malignant pathologies that increase in frequency. It was also observed that out of the total of 105 women with a palpable tumor, 35.2% had a malignant pathology and 64.8% had a benign pathology. Sensitivity, specificity, positive predictive value, and negative predictive value were estimated at 94%, 96%, 94% and 96%, respectively. The diagnostic safety of the FNAB was 90.3% Conclusions: Fine-needle aspiration biopsy is a safe diagnostic method for the detection of breast cancer in women with palpable breast tumors.

Relación de violencia familiar y funcionalidad familiar en gestantes en el primer nivel de atención - Lima - 2015 / Relationship between the family violence and the family functionality in the pregnant women in the first level of care - Lima - 2015

Introducción: Siendo la Violencia Familiar un problema de Salud Pública a nivel mundial, el Perú no ajeno a esto incorporó y continua fortaleciendo con medidas políticas y sociales para aplacar este azote a nuestra sociedad. El presente trabajo incorporó conocimientos de la relación de Violencia familiar y funcionalidad familiar según instrumentos validados como el APGAR familiar y FACES III en un Establecimiento de Salud-(ES) del Primer Nivel de Atención-(PNA) en Lima. Método: Se realizó un muestreo sistemático en el periodo de un año mediante una encuesta anónima con ánfora cerrada en el área de consultorios externos de un centro de salud del primer nivel de atención. El equipo conformado por médico, obstetra y técnicos sistemáticamente recogió la información de 120 gestantes. Resultados: La muestra tiene estadísticamente una distribución normal y el 87.18 por ciento, de las gestantes pertenecían al distrito de estudio, la media de edad 24.17 años con rango (16 y 40 años), se halló que el estado civil conviviente fue predominante 71.2 por ciento, estando casadas del total solo en un 11.7 por ciento, del total viven junto a su pareja en un 78.4 por ciento. La edad de inicio de vida sexual tiene una media de 17.83 años con rango (12-38 años). Nivel educativo aprobado de secundaria completa 44.5 por ciento, y secundaria incompleta en un 25.3 por ciento. Las gestantes refieren haber sufrido algún tipo de violencia en la niñez en un 70.3 por ciento, en la etapa adolescente en un 45 por ciento, en las adultas en un 56 por ciento, y en la gestación actual 46.47 por ciento, provocado este último en los últimos 6 meses por la pareja en un 75.5 por ciento. El test APGAR Familiar mostró que las gestantes al momento de la encuesta presentaron disfunción familiar severa en un 13 por ciento, moderada 16.7 por ciento, leve en un 32.4 por ciento y buena función familiar en un 38 por ciento. El Test de FACES III mostró que las gestantes al momento de la encuesta...

Introduction: As the Family Violence Public Health problem worldwide, Peru is not oblivious to this up and continues to strengthen social policies and measures to quell this scourge to our society. This work incorporated knowledge of the relationship between family violence and family functioning with validated as the family APGAR and FACES III to one primary care system in Lima. Method: A systematic sampling was conducted in the period of one year through an anonymous survey with amphora closed in the area of outpatient on primary care system. The team of doctor, obstetrician and technical got information systematically collected 120 pregnant women. Results: The sample has a normal distribution statistically and 87.18 per cent of pregnant women belonged to the district of study, the mean age 24.17 years, range (16 and 40 years), it was found that the common law marriage was predominant 71.2 per cent, being married only 11.7 per cent of the total living with his partner in 78.4 per cent. The age of onset of sexual life has an average of 17.83 years with range (12-38 years). Approved educational level completed secondary education 44.5 per cent and incomplete secondary at 25.3 per cent. Pregnant women report experiencing some form of violence to her children life in 70.3 per cent, in the adolescent stage by 45 per cent in adults and 56 per cent in the current pregnancy caused the latter 46.47 per cent in the last six months by the couple in a 75.5 per cent. The Family APGAR test showed that pregnant at the time of the survey had severe family dysfunction in 13 per cent, moderate 16.7 per cent, mild in 32.4 per cent and good family function by 38 per cent. The FACES III test showed that pregnant at the time of the survey had severe family dysfunction in 23.8 per cent, mild family dysfunction in 57 per cent, and good family function by 19 per cent. With the Chi-square statistic found statistically significant relationship p<0.05 between family APGAR and some...

Relación de tipo y ciclo vital familiar con la presencia de problemas psicosomáticos en un consultorio docente de medicina familiar / Association of kind and family life cycle with the presence of psychosomatic problems in an academic family practice outpatient setting

Objetivos: Determinar la relación entre el tipo de familia y el ciclo vital familiar con el desarrollo de problemas psicosomáticos en pacientes que acudieron al consultorio de medicina familiar. Material y métodos: Estudio observacional de corte transversal, en el que se revisaron las historias clínicas de un consultorio docente de medicina familiar y se buscó asociación entre el tipo de familia y ciclo vital familiar con el desarrollo de problemas psicosomáticos. Resultados: Se encontró un mayor porcentaje de familias nucleares según el tipo familiar y en plataforma de despegue según el ciclo vital familiar, se encontró en un 41% del total de la muestra con al menos un problema psicosomático en la historia clínica. No se encontró asociación entre el tipo de familia y el ciclo vital familiar con el desarrollo de problemas psicosomáticos. Conclusiones: El desarrollo de problemas psicosomáticos en un consultorio docente de medicina familiar no está asociado con el tipo de familia ni con el ciclo vital familiar. (AU)

Objectives: Determine an association of kind of family and family life cycle with the presence of psychosomatic problems in an academic family practice outpatient setting. Methods: Cross-sectional study that involved revision of patient´s charts in an outpatient setting. Results: A higher proportion of nuclear families was found, 41% had at least one psychosomatic problem. No association between kind of family and family life cycle with the development of psychomotor problems was found. Conclusions: Psychosomatic problems are not related with kind of families or family life cycle in an academic family practice outpatient setting. (AU)

Valoración de la impronta transoperatoria en la evaluación del ganglio centinela en mujeres con cáncer de mama en el Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima-Perú / Assessment of intraoperative imprint in sentinel node evaluation in Women with breast Ccncer at the National Institute of Neoplastic Diseases (INEN), Lima-Perú

Objetivo: describir el valor de la impronta transoperatoria como método diagnóstico para la detección de metástasis del ganglio centinela en pacientes con cáncer de mama. Material y Métodos: se revisó las historias clínicas de 226 pacientes con cáncer de mama EC 0, I y II con axila cl¡nicamente negativa, sin quimioterapia neoadyuvante, sometidas a mapeo ganglionar y biopsia de ganglio centinela con sonda gamma y/o azul patente, a quienes se les realizó un examen transoperatorio de impronta citológica del ganglio centinela de abril del 2011 hasta marzo del 2012. Resultados: la edad promedio de las pacientes 54,5 años. Dos (0,9%) EC 0, 38 (16,8%) EC I, 170 (75,2%) EC IIA y 16 (7,1%) EC IIB. El resultado definitivo del ganglio centinela fue positivo en 78 (34,5%) casos y negativo en 148 (65,5%). Los resultados de la impronta transoperatoria mostraron una sensibilidad de 67,9% y una especificidad de 99,3%. El valor predictivo positivo fue 98,1% y el valor predictivo negativo de 85,5%. El índice de concordancia entre los resultados de la impronta y la prueba confirmatoria de metástasis se calculó en 0,72. Hubo 25 falsos negativos, 15 (60,0%) de ellos presentaron células aisladas y micro metástasis. Conclusiones: los resultados apoyan la validez y seguridad del método de impronta transoperatoria como prueba diagnóstica para la evaluación de metástasis del ganglio centinela en pacientes con cáncer de mama. Se observó un alto grado de concordancia entre los resultados de la impronta y la prueba confirmatoria para metástasis ganglionar.

Objetives: to evaluate the value of intraoperative imprint evaluation of the sentinel node as a method of diagnosis for node metastasis in breast cancer patients. Material and Methods: the clinical charts of 226 patients with breast cancer diagnosis in clinical stages 0, I and II were reviewed during April 2011 through March 2012. These patients had clinical negative axilla, none had neoadyuvant chemotherapy. They had a sentinel node biopsy with a prior lynphocintigraphy using Technecio 99 and had imprint citology in the operating room. Results: mean age was 54,5 years. Two (0,9%) were pathological stage 0, 38 (16,8%) I, 170 (75,2%) IIA and 16 (7,1%) IIB. We observed both a positive sentinel node in 78 (34,5%) cases and negative sentinel node in 148 (65,5%) cases. The imprint intraoperative results had a sensitivity of 67,9%, specificity of 99,3%, positive predictive value of 98,1% and negative predictive value of 85,5%. The index of concordance between de results of the imprint citology and the final pathology report was 0,72. There were 25 false negative cases, 15 (60,0%) from this group of patients only had micro metastasis or isolated cells. Conclusions: the results support the value and security of the intraoperative imprint cytology of the sentinel node as a diagnosis of node metastasis. There is a great level of concordance between the imprint results and the final pathology result.