Latin America and the Caribbean Code Against cancer 1st edition: Environment, occupation, and cancer.

Within the framework of the Latin America and Caribbean region (LAC) Code Against Cancer 1st edition, the current work presents recommendations to reduce exposure to environmental and occupational carcinogenic agents relevant for LAC. Using the methodology established by the International Agency for Research on Cancer (IARC) in the World Code Against Cancer Framework and experience from developing the European Code Against Cancer 4th edition, a working group of LAC cancer-prevention experts reviewed the list of Group I IARC carcinogenic agents, identified prevalent environmental and occupational exposures in the region, and proposed evidence-based cancer prevention recommendations suited to the epidemiological, socioeconomic, and cultural conditions of LAC countries. Two sets of recommendations were drafted: those targeting the general public and a second set for policymakers. Outdoor and indoor air pollution, ultra-violet radiation and occupational exposures to silica dust, asbestos, benzene, diesel, and welding fumes were identified as prevalent carcinogens in LAC and as agents that could be reduced or eliminated to prevent cancers. Recommendations for additional risk factors were not included due to insufficient data of their attributable burden in LAC (sunbeds, radon, aflatoxin), or lack of a clear preventive action to be taken by the individual (arsenic in drinking water, medical radiation), or lack of evidence of carcinogenicity effect (bisphenol A, phthalates, and pesticides). A broad consensus was reached on environmental and occupational carcinogenic exposures present throughout the LAC region and on individual-level and public policy-level recommendations to reduce or eliminate these exposures. Key educational content for the dissemination of these recommendations was also developed as part of LAC Code Against Cancer 1st Edition.

Producción científica en insuficiencia cardiaca en Perú: un estudio bibliométrico / Scientific production in heart failure in Peru: a bibliometric study

Resumen Objetivo: Analizar la producción científica peruana sobre insuficiencia cardiaca (IC) en el periodo 2000-2020. Material y métodos: Se realizó un estudio observacional bibliométrico en la base de datos de Scopus y Scielo de documentos publicados sobre IC por algún autor con filiación peruana entre los años 2000 y 2020. Se analizaron de manera descriptiva las variables de producción científica, número de publicaciones anuales, documentos, características de las publicaciones e instituciones. Se analizaron las redes colaborativas, construyéndose una red de nodos utilizando el software VOSViewer v1.6.5. Resultados: Se encontró 236 publicaciones en Scopus y 55 en Scielo. El mayor número de documentos fueron artículos originales seguido de artículos de revisión. The Lancet y la Revista Peruana de Medicina Experimental y Salud Pública fueron las que tuvieron el mayor número de publicaciones. Se registraron 31 países que tuvieron al menos cinco documentos publicados con un autor del Perú. La colaboración científica fue principalmente con EE.UU. y a nivel regional con Argentina. Se publicaron 55 documentos con solo autores peruanos. Conclusiones: La producción científica en IC de autores peruanos se encuentra en crecimiento exponencial. Y es la Universidad Peruana Cayetano Heredia/Crónicas la institución peruana con más publicaciones sobre esta.

Abstract Objective: To analyze the Peruvian scientific production on Heart Failure (HF) in the period 2000-2020. Methods: We performed an observational bibliometric study, in the Scopus and Scielo database, of documents published on heart failure by an author with Peruvian affiliation, between the years 2000 and 2020. We describe variables of scientific production, number of annual publications, documents, characteristics of the publications, and institutions. The collaborative networks were analyzed by building a network of nodes using the VOSViewer v1.6.5 software. Results: A 236 publications were found in Scopus and 55 in Scielo. The largest number of documents were original articles followed by review articles. The journal "The Lancet" and "Revista Peruana de Medicina Experimental y Salud Pública" were those that had the highest number of publications. Thirty-one countries were registered that had at least 5 documents published with an author from Peru. Scientific collaboration was mainly with the United States and at the regional level with Argentina. 55 documents were published with only Peruvian authors. Conclusion: The scientific production in HF by Peruvian authors is in exponential growth. And the Universidad Peruana Cayetano Heredia/CRÓNICAS is the Peruvian institution with the most publications on it.

Methodological appraisal of the evidence about efficacy of metabolic surgery in adults with non-morbid obesity and hypertension: An overview of systematic reviews.

BACKGROUND: Nowadays, the high morbimortality of obesity is mainly related to diabetes, cancer, and hypertension. It is reported that obesity in patients with hypertension can lead to resistance to pressure reduction through pharmacological therapy and lifestyle changes, so bariatric surgery emerges as a proposed treatment for obesity. METHODS: We performed an umbrella review that included systematic reviews of clinical trials that evaluated patients with hypertension and non-morbid obesity. The quality and certainty of the evidence was evaluated with the AMSTAR-II and GRADE tools. RESULTS: 677 systematic reviews were identified, of which only three were included for analysis. We considered the outcomes addressed by the reviews on hypertension, identifying that 5 RCTs evaluated pressure reduction at 1 year of follow-up and 5 RCTs at more than 1 year, 5 RCTs evaluated hypertension rate, 6 RCTs analyzed changes in systolic pressure and 5 RCTs changes in diastolic pressure. Likewise, when assessing the methodological quality, it was concluded that the three reviews have critically low quality. CONCLUSIONS: We found only three systematic reviews that evaluated the topic with critically low methodological quality. They reported results in favor of metabolic surgery, but with very low certainty of evidence.

Vitamin E supplementation improves testosterone, glucose- and lipid-related metabolism in women with polycystic ovary syndrome: a meta-analysis of randomized clinical trials.

AIM: This systematic review and meta-analysis assessed the effect of vitamin E supplementation on testosterone, glucose, lipid profile, pregnancy rate, hirsutism, and body mass index (BMI) in women with polycystic ovary syndrome (PCOS). METHODS: A multi-database search was performed from inception to January 2022 for randomized controlled trials (RCTs) reporting the effects of vitamin E supplementation with or without another nutritional supplement on women with PCOS. A random-effects model was used to obtain mean differences (MDs) and its 95% confidence intervals (95%CI). Evidence certainty was assessed with GRADE methodology. RESULTS: We meta-analyzed eight RCTs reporting vitamin E supplementation alone or combined with other individual substances like omega-3, vitamin D3, or magnesium oxide in adult women ≤40 years old with PCOS. Vitamin E supplementation reduced fasting glucose (MD: -1.92 mg/dL, 95%CI: -3.80 to -0.05), fasting insulin (MD: -2.24 µIU/mL, 95%CI: -3.34 to -1.14), HOMA-IR (MD: -0.42, 95%CI: -0.65 to -0.19), total cholesterol (MD: -18.12 mg/dL, 95%CI: -34.37 to -1.86), LDL-cholesterol (MD: -15.92 mg/dL, 95%CI: -29.93 to -1.90), triglycerides (MD: -20.95 mg/dL, 95%CI: -37.31 to -4.58), total testosterone (MD: -0.42 ng/mL, 95%CI: -0.55 to -0.29), and increased sex hormone-binding globulin (MD: 7.44 nmol/L, 95%CI: 2.68 to 12.20). However, it had no impact on female sex hormones, HDL-cholesterol, BMI, and hirsutism. Two RCTs assessed pregnancy and implantation rates with inconsistent results. The certainty of the evidence was very low to moderate. CONCLUSION: Vitamin E supplementation improves glucose, lipid, and androgenic-related biomarkers in women with PCOS.

Guía de práctica clínica para el tratamiento de infecciones odontogénicas en el Seguro Social de Salud del Perú (EsSalud) / Clinical practice guidelines for the treatment of odontogenic infection of the Peruvian Health Social Security (EsSalud)

Introducción. El presente artículo resume las recomendaciones basadas en evidencias de la guía de práctica clínica (GPC) para el tratamiento de los pacientes con infecciones odontogénicas (absceso dentoalveolar, celulitis facial y absceso cervicofacial) en el Seguro Social de Salud del Perú (EsSalud). Objetivo. Brindar recomendaciones clínicas basadas en evidencia para el tratamiento de pacientes con infecciones odontogénicas en EsSalud. Métodos. Se conformó un grupo elaborador de la guía (GEG) que incluyó cirujanos dentistas, especialistas y metodólogos. El GEG formuló cuatro preguntas clínicas a ser respondidas en la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y cuando fue considerado pertinente­ estudios primarios en PubMed y CENTRAL durante el año 2019. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buena práctica clínica y el flujo- grama de tratamiento. Finalmente, la GPC fue aprobada con Resolución N° 067­IET- SI-ESSALUD-2020. Resultados. La presente GPC abordó cuatro preguntas clínicas, divididas en dos temas: manejo farmacológico y manejo quirúrgico de las infecciones odontogénicas. En base a dichas preguntas se formularon seis recomendaciones fuertes, dos recomendaciones condicionales, 11 puntos de buena práctica clínica, y un flujograma. Conclusión. El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para tratamiento de las infecciones odontogénicas (absceso dentoalveolar, celulitis facial y absceso cervicofacial) en EsSalud.

Introduction. This article summarizes the evidence-based recommendations of the clinical practice guide (CPG) for the treatment of patients with odontogenic infections (dentoalveolar abscess, facial cellulitis and cervicofacial abscess) in the Social Security of Health of Peru (EsSalud). Objective. To provide evidence-based clinical recommendations for the treatment of patients with odontogenic infections in EsSalud. Methods. A guideline development group (GEG) was formed that included dental surgeons, specialists, and methodologists. The GEG formulated four clinical questions to be answered in this CPG. We conducted systematic searches for systematic reviews and when deemed relevant - primary studies in PubMed and CENTRAL during 2019. The evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice and the treatment flow chart. Finally, the CPG was approved with Resolution No. 067 ­ IETSI-ESSALUD-2020. Results. This CPG addressed four clinical questions, divided into two topics: pharmacological management and surgical management of odontogenic infections. Based on these questions, six strong recommen- dations were formulated, two conditional recommendations, 11 points of good clinical practice, and a flow chart. Conclusion. This article summarizes the methodology and evidence-based conclusions of the CPG for the treatment of odontogenic infections (dentoalveolar abscess, facial cellulitis and cervicofacial abscess) in EsSalud.

Guía de práctica clínica para el manejo quirúrgico de la obesidad en adultos en el Seguro Social del Perú (EsSalud) / Clinical practice guideline for the surgical management of obese adults in the Peruvian Social Security (EsSalud)

Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el manejo quirúrgico de la obesidad en adultos en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para el manejo quirúrgico de la obesidad en adultos en EsSalud. Material y Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 7 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y ­cuando fue considerado pertinente­ estudios primarios en Medline y CENTRAL durante el 2019. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas. El flujograma fue diseñado en la fase final o última reunión en base a las recomendaciones formuladas previamente. Finalmente, la GPC fue aprobada con Resolución N° 115 ­ IETSI ­ ESSALUD ­ 2020. Resultados: La presente GPC abordó 7 preguntas clínicas, divididas en a temas de manejo quirúrgico de pacientes con obesidad. En base a dichas preguntas se formularon 6 recomendaciones (3 fuertes y 3 condicionales), 18 BPC, y 2 flujogramas. Conclusión: El presente artículo resume la metodología, las recomendaciones basadas en evidencias, y los puntos de buena práctica clínica de la GPC para manejo quirúrgico de la obesidad en adultos en EsSalud.

Introduction: This article summarizes the clinical practice guideline (CPG) for the surgical management of obesity in adults in the Social Security of Peru (EsSalud). Objective: To provide evidence-based clinical recommendations for the surgical management of obesity in adults in EsSalud. Material and Methods: A guideline development group (GEG) was formed that included medical specialists and methodologists. The GEG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when considered relevant- primary studies were performed in Medline and CENTRAL during 2019. Evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic working meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice. The flowchart was designed in the final phase or last meeting based on the previously formulated recommendations. Finally, the CPG was approved with Resolution No. 115 - IETSI - ESSALUD - 2020. Results: The present CPG addressed 7 clinical questions, divided into topics of surgical management of patients with obesity. Based on these questions, 6 recommendations (3 strong and 3 conditional), 18 GCP, and 2 flowcharts were formulated. Conclusion: This article summarizes the methodology, evidence-based recommendations, and good clinical practice points of the CPG for the surgical management of obesity in adults in EsSalud.

Prácticas de prevención y control frente a la infección por Sars-Cov2 en la población peruana / Prevention and control practices against Sars-Cov2 infection in the peruvian population

Objetivo: Describir las prácticas de prevención y control para la infección por SARS-CoV2 en la población peruana. Material y Métodos: Estudio observacional de tipo descriptivo. Se evaluó una muestra no probabilística de adultos residentes en algún departamento de Perú. Las prácticas preventivas fueron evaluadas en personas sin antecedente de COVID-19 y las prácticas de control en personas que lo habían padecido. Resultados: Se evaluó un total de 3630 peruanos (edad media 25,4 ± 9,5) de los cuales el 3231 no indicaban el antecedente de COVID-19 y 399 refirieron haberlo padecido. Las medidas de prevención y control que se realizaron a menudo o siempre con mayor frecuencia fueron el utilizar mascarilla al salir de casa (97,9% vs 87,7), cubrirse su nariz y boca al estornudar o toser (95,4% vs 89,9%), guardar distancia de los demás en la calle (91,4% vs 74,7%), realizar el lavado de manos con agua y jabón al volver a casa (92,5% vs 88,7%), y desinfectar las superficies de objetos y lugares personales (82,6% vs 77,4%). El 22,1% y 83,7%, el 59,7% y 80,2, y el 8,0% y 16,8% consumieron algún tipo de medicamento, planta medicinal y dióxido de cloro para la prevención y control de la infección de COVID-19, respectivamente. Conclusiones: En general, menos del 50% de los participantes realizaron prácticas de prevención y control frente a la COVID-19 a menudo o siempre.

Objective: To describe prevention and control practices for SARS-CoV2 infection in the Peruvian population. Material and Methods: Observational descriptive study. A non-probabilistic sample of adults residing in a Peruvian department was evaluated. Preventive practices were evaluated in people with no history of COVID-19 and control practices in people who had had COVID-19. Results: A total of 3630 Peruvians were evaluated (mean age 25.4 ± 9.5) of whom 3231 did not indicate a history of COVID-19 and 399 reported having suffered from it. The prevention and control measures most frequently or always performed were using a mask when leaving home (97.9% vs 87.7%), covering their nose and mouth when sneezing or coughing (95.4% vs 89.9%), keeping their distance from others in the street (91.4% vs 74.7%), washing hands with soap and water when returning home (92.5% vs 88.7%), and disinfecting surfaces of objects and personal places (82.6% vs 77.4%). 22.1% and 83.7%, 59.7% and 80.2, and 8.0% and 16.8% consumed some type of medication, medicinal plant, and chlorine dioxide for prevention and control of COVID-19 infection, respectively. Conclusions: Overall, less than 50% of the participants performed prevention and control practices against COVID-19 often or always.

Sarampión en Latinoamérica: un análisis de tendencia y red de colaboración científica en los últimos 20 años / Measles in Latin America: a trend analysis and scientific collaboration network in the last 20 years

Con el objetivo de analizar la contribución científica de las publicaciones sobre sarampión y representar gráficamente las redes de colaboración entre países durante los últimos 20 años, se realizó un estudio bibliométrico entre 1999 y 2018 de revistas indexadas en Scopus. Se analizaron datos de producción anual y se representó gráficamente un análisis de co-ocurrencia de producción y colaboración entre países utilizando VOSviewer. Se registraron 587 documentos entre los 1999 y 2018, con tendencia estacionaria; el promedio de publicaciones anual fue de 29 documentos (rango 13-44), siendo el 72,4 por ciento artículos originales. Los países Brasil (53,3 por ciento ) y México (17,5 por ciento ) tuvieron mayor productividad y colaboración, principalmente con Estados Unidos y Reino Unido. La investigación sobre sarampión en Latinoamérica presenta una tendencia estacionaria. Brasil y México fueron los países con más publicaciones y tienen mayores redes de colaboración científica con Estados Unidos y Reino Unido(AU)

With the objective of analyzing the scientific contribution of measles publications and graphing the collaboration networks between countries during the last 20 years. A bibliometric study was conducted between 1999 and 2018 of journals indexed in Scopus. Annual production data were analyzed and a co-occurrence analysis of production and collaboration between countries using VOSviewer was plotted. 587 documents were registered between 1999 and 2018, with a steady trend, the average of annual publications was 29 documents (range 1-44), being 72.4 percent were original articles. The countries of Brazil (53.3 percent) and Mexico (17.5 percent) had greater productivity and collaboration mainly with the United States and the United Kingdom. Measles research in Latin America presents a stationary trend. Brazil and Mexico were the countries with more publications and have greater networks of scientific collaboration with the United States and the United Kingdom(AU)

Asociación entre horas laboradas diariamente y presencia de síntomas depresivos en médicos residentes de Perú / Association between daily working hours and depressive symptoms in resident physicians in Peru

RESUMEN Introducción: Los médicos residentes que laboran más horas diarias son propensos a sufrir problemas de salud mental como la depresión, tema que se ha estudiado poco. Por ello, el presente estudio tiene por objetivos determinar la prevalencia de los síntomas depresivos y evaluar la asociación entre el número de horas diarias laboradas y la presencia de síntomas depresivos en residentes del Perú. Métodos: Estudio transversal analítico que usó la base de datos de la Encuesta Nacional para Médicos Residentes-2016, una encuesta voluntaria realizada virtualmente por el Consejo Nacional de Residentado Médico de Perú a médicos que realizaban su residencia en este país. Se consideró presencia de síntomas depresivos una puntuación ≥ 3 con la escala Patient Health Questionnaire-2. Las horas laboradas diariamente se tomaron mediante una pregunta directa. Para evaluar la asociación de interés, se calcularon razones de prevalencia (RP) y sus intervalos de confianza del 95% (IC95%) usando regresiones de Poisson brutas y ajustadas con varianza robusta. Resultados: Se evaluaron las respuestas de 953 residentes (el 41,3% mujeres; media de edad, 32,5 arios), de los que el 14,6% tenía síntomas depresivos. En el análisis ajustado, se encontró que la prevalencia de síntomas depresivos aumentaba por cada hora laborada adicional (RP = 1,11; IC95%, 1,04-1,17). Conclusiones: Uno de cada 7 residentes presentó síntomas depresivos. Por cada hora laborada diariamente extra, la frecuencia de síntomas depresivos aumentó un 11%.

ABSTRACT Introduction: Resident physicians who work more hours a day are prone to suffer mental health problems such as depression, a subject that has been little studied. In this regard, the aim of this study was to determine the prevalence of depressive symptoms and to evaluate the association between the number of daily working hours and depressive symptoms in Peruvian residents. Methods: Analytical cross-sectional study that used the database of the National Survey for Resident Physicians-2016, a voluntary survey issued virtually by the National Council of Medical Residency of Peru to physicians who were undertaking their residency in Peru. The presence of depressive symptoms was considered as having obtained a score ≥3 with the Patient Health Questionnaire-2 scale. The number of hours worked each day was collected through a direct question. To assess the association of interest, prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using crude and adjusted Poisson regressions with robust variance. Results : The responses of 953 residents (41.3% women, mean age: 32.5 years) were evaluated, 14.6% of which presented depressive symptoms. In the adjusted analysis, it was found that the prevalence of depressive symptoms increased for each additional hour worked (PR = 1.11; 95% CI, 1.04-1.17). Conclusions: One in seven residents had depressive symptoms. For every extra daily working hour, the frequency of depressive symptoms increased by 11%.

Guía de Práctica Clínica para el manejo de pacientes con Leucemia Linfoblástica Aguda en el Seguro Social del Perú (EsSalud) / Clinical practice guideline for the management of patients with acute lymphoblastic leukemia in Peruvian Social Security (EsSalud)

RESUMEN El presente artículo resume recomendaciones clínicas basadas en evidencia para la evaluación y el manejo de pacientes con Leucemia Linfoblástica Aguda (LLA) en EsSalud. Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos. El GEG formuló 8 preguntas clínicas a ser respondidas por la presente GPC. Se realizó búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en PubMed y CENTRAL durante el 2019. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de evaluación y manejo. La presente GPC abordó 8 preguntas clínicas, divididas en cuatro temas: diagnóstico, medidas generales, manejo quimioterápico de LLA, y trasplante. En base a dichas preguntas se formuló 5 recomendaciones (3 recomendaciones fuertes y 2 recomendaciones condicionales), 20 puntos de buena práctica clínica, y 3 flujogramas.

ABSTRACT This paper summarizes the evidence-based clinical recommendations for the assessment and management of patients with acute lymphoblastic leukemia (ALL) in Peruvian Social Security (EsSalud). A guide writing team (GWT) was convened, which included specialized physicians and methodologists. The GWT asked 8 clinical questions to be responded by the Clinical Practice Guidelines (CPG). Detailed searches of systematic reviews and - when it was considered as pertinent - primary studied featured in PubMed and CENTRAL during 2019 were performed. Evidence for responding each of the proposed clinical questions was selected. Certainty of the evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In scheduled workshops, the GWT used the GRADE methodology for reviewing the evidence and propose recommendations, the points for good clinical practice, and the assessment and management flowcharts. This CPG worked on 8 clinical questions, which were divided in 4 topics: diagnosis, general measures, chemotherapy management for ALL, and transplantation. On the basis of these questions, 5 recommendations were formulated (3 strong recommendations and 2 conditional recommendations), 20 points for good clinical practice, and 3 flow charts.

Perceived discrimination as a barrier for the adequate treatment of chronic diseases in Venezuelan migrants from Peru / Discriminação percebida como barreira para o adequado tratamento de doenças crônicas em migrantes venezuelanos do Peru

ABSTRACT: Objective: To determine the association between perceived discrimination and receiving adequate treatment for chronic diseases in Venezuelan migrants. Methodology: A cross-sectional study was performed. This is a secondary analysis of the ENPOVE national survey from Peru. The association between the perceived discrimination and receiving adequate treatment for chronic diseases was evaluated using a Poisson regression model, considering the adjusted effect of the multistage sampling. Results: A total of 865 migrants were evaluated (age: 36.6 ± 0.7 years and 58.2% women). Of these, 54.8% perceived discrimination, and 89.2% did not receive adequate treatment for chronic diseases. Perceived discrimination was significantly associated with a lower prevalence of receiving adequate treatment for chronic diseases (PRa = 0.49; 95%CI 0.25 - 0.97). Conclusion: This study evidenced that perceived discrimination decreases the prevalence of receiving adequate treatment for chronic diseases by approximately 50% compared with those who did not perceive discrimination.

RESUMO: Objetivo: Determinar a associação entre a discriminação percebida e o recebimento de tratamento adequado para doenças crônicas em migrantes venezuelanos. Métodos: Foi realizado um estudo transversal. Esta é uma análise secundária da pesquisa nacional Venezuelan Population Residing in the Country Survey do Peru. A associação entre discriminação percebida e receber tratamento adequado para doenças crônicas foi avaliada por meio de um modelo de regressão de Poisson, considerando o efeito ajustado da amostra em múltiplos estágios. Resultados: Foram avaliados 865 migrantes (idade: 36,6 ± 0,7 anos e 58,2% mulheres). Destes, 54,8% perceberam discriminação e 89,2% não receberam tratamento para a doença crônica. A discriminação percebida foi significativamente associada à menor prevalência de receber adequado tratamento para doenças crônicas (razão de prevalência ajustada — RPa = 0,49, intervalo de confiança de 95% — IC95% 0,25 - 0,97). Conclusão: Este estudo mostrou que a discriminação percebida diminui a prevalência de receber adequado tratamento para doenças crônicas em 50%, em comparação com aqueles que não percebem a discriminação.

Guía de práctica clínica para el tamizaje y manejo del episodio depresivo leve en el primer nivel de atención del Seguro Social del Perú (EsSalud) / Clinical practice guideline for the screening and management of the mild depressive episode at the first level of care for the Peruvian Social Security (EsSalud)

El presente artículo resume la guía de práctica clínica (GPC) para el tamizaje y el manejo del episodio depresivo leve en el primer nivel de atención en el Seguro Social del Perú (EsSalud). Para el desarrollo de esta GPC, se conformó un grupo elaborador de la guía (GEG) que incluyó especialistas clínicos y metodólogos, el cual formuló 06 preguntas clínicas. Para responder cada pregunta se realizó búsquedas sistemáticas en PubMed y en repositorios de GPC, y se seleccionó la evidencia pertinente. La certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG usó la metodología GRADE para revisar la evidencia y emitir las recomendaciones. Se emitieron siete recomendaciones (tres fuertes y cuatro condicionales), 28 puntos de buena práctica clínica, y dos flujogramas.

This paper summarizes the clinical practice guide (CPG) for the screening and management of mild depressive episode at the first level of care in the Social Security of Peru (EsSalud). A guideline development group (GDG) was established for develop this CPG, which included clinical and methodology specialists, who formulated 06 clinical questions. Systematic searches were conducted in Pubmed and GPC repositories to answer each question, and relevant evidence was selected. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GDG used the GRADE methodology for reviewing the evidence and for developing recommendations. At the end, this CPG formulated 07 recommendations (03 strong and 04 conditional), 28 points of good clinical practice, and 02 flow charts were formulated.

Atypical lymphangioma and hyperkeratosis in a patient with morbid obesity

Abstract Lymphangioma is a rare and understudied pathology that is usually detected in the first decade of life, and its appearance in adults is rare. This report details a 51-year-old man with morbid obesity who presented, for the last eight months, multiple asymmetric tumor lesions with extension to the scrotal region. The diagnosis of circumscribed lymphangioma with associated infection was confirmed. This case report demonstrates an unusual presentation of the characteristics of the lymphangioma that are seldom described in the literature.

Apendicitis aguda en gestante: Un Reporte de Caso / Acute Appendicitis In Pregnant Women: A Case Report

La apendicitis aguda es una patología de abdomen agudo quirúrgico frecuente en el embarazo, siendo de difícil diagnóstico debido a los cambios fisiológicos del embarazo que ocasionan cuadros clínicos confusos. Reportamos el caso de una gran multigesta de 27 años de 22 semanas 3/7 en el cual se diagnosticó clínicamente apendicitis aguda, siendo intervenida quirúrgicamente sin complicaciones, encontrándose un apéndice necrosado corroborado posteriormente con anatomía patológica. Es importante enfatizar el rol de la anamnesis dirigida aunado al examen clínico orientado por los cambios fisiológicos del embarazo. Un diagnóstico oportuno junto al manejo interdisciplinario permitirá reducir significativamente los riesgos materno y fetales relacionados a esta patología, y tanto la extirpación del apéndice como la continuación del embarazo.

Acute appendicitis is the most common pathology from acute abdomen during pregnancy, which has a difficult diagnosis because of the physiological changes during pregnancy which results in confusing clinical presentations. We reported the case of a multiparous woman of 27 years with 22 3/7 weeks diagnosed with acute appendicitis, undergoing surgery without complications and with a necrosed appendix that was evidenced through pathological examination. It is important to emphasis the role of the anamnesis with the physical examination guided by the physiological pregnancy changes related to the appendix. A timely diagnosis and treatment with an interdisciplinary approach would significantly reduce the maternal-fetal risks related to this pathology, the appendix removal and the continuation of the pregnancy.

Atypical lymphangioma and hyperkeratosis in a patient with morbid obesity.

Lymphangioma is a rare and understudied pathology that is usually detected in the first decade of life, and its appearance in adults is rare. This report details a 51-year-old man with morbid obesity who presented, for the last eight months, multiple asymmetric tumor lesions with extension to the scrotal region. The diagnosis of circumscribed lymphangioma with associated infection was confirmed. This case report demonstrates an unusual presentation of the characteristics of the lymphangioma that are seldom described in the literature.

Prevalencia y factores asociados a sintomatología depresiva en adultos mayores del centro de salud "Micaela Bastidas" Lima-Perú / Prevalence And Factors Associated With Depressive Symptomatology In Older Adults Of The "Micaela Bastidas" Health Center, Lima-Peru

Objetivo: Evaluar los factores asociados a la sintomatología depresiva en adultos mayores residentes del centro de salud asistentes al centro de salud "Micaela Bastidas" de Lima-Perú. Métodos: Estudio transversal analítico en adultos mayores de 60 años residentes de una zona urbano marginal de Lima. Se evaluó la variable dependiente usando la escala de depresión geriátrica de 15 ítems, se consideró la presencia de sintomatología depresiva con un puntaje ≥ 6. Los factores asociados a la sintomatología depresiva, se calcularon usando razones de prevalencia crudas y ajustadas con intervalos de confianza al 95% (IC 95%) mediante regresiones de poisson con varianza robusta. Resultados: De los 142 adultos mayores (edad 70,4 ± 8,14 años), la prevalencia de la presencia de sintomatología depresiva fue 55,6% (mujeres: 39,6% y hombres; 53,4%). El no tener escolaridad (RPa: 1,40; IC 95%: 1,04 ­ 1,88) y no estar trabajando (RPa: 1,50; IC 95%: 1,09 ­ 2,05) fueron factores asociados que aumentaban la prevalencia de sintomatología depresiva. Conclusión: La prevalencia de presencia de sintomatología depresiva en adultos mayores de una zona urbano marginal de Perú fue alta. Los adultos mayores que no completaron su escolaridad y no trabajaban presentaron más probabilidades de presentar sintomatología depresiva.

Objective: To evaluate the factors associated with depression in older adults in a marginal urban area of Peru. Methods: It is a cross-sectional analytical study in adults over 60 years of age in a marginal urban area of Lima. The dependent variable was evaluated using the 15-items geriatric depression scale, considering presence of depression with a score ≥ 6. The factors associated with depression were calculated using raw and adjusted prevalence ratios with 95% confidence intervals (95% CI) using poisson regressions with robust variance. Results: Of the 142 older adults (age: 70.4 ± 8.14 years), the prevalence of the presence of depression was 55.6% (women: 39.6% and men: 53.4%). The education (RPa: 1.40, 95% CI: 1.04 - 1.88) and not currently working status (RPa: 1.50, 95% CI: 1.09 - 2.05) were associated factors that increased the prevalence of depression. Conclusion: The prevalence of depression in older adults in a marginal urban area of Peru was high. Older adults who did not complete their schooling and did not work were more likely to develop depression.

Machismo entre los estudiantes de medicina peruanos: Factores socio-educativos relacionados en 12 universidades peruanas / Male Chauvinism Among Peruvian Medical Students: Related Socio-Educational Factors in 12 Peruvian Universities

RESUMEN Introducción: El machismo está arraigado en ciertas poblaciones, pero no se ha medido esto entre los que se encargarán de la atención de la salud. Objetivo: Determinar los factores asociados con el machismo entre los estudiantes de Medicina de 12 universidades peruanas. Métodos: Estudio transversal analítico de tipo multicéntrico, con datos recogidos previamente, en el que se usaron tests validados para la medición del machismo y la religiosidad; además, se indagaron otras características sociales y educativas y se cruzaron los datos. Se obtuvieron estadísticos descriptivos y analíticos. Resultados: En el análisis multivariable, se encontró asociación entre ser machista y no creyente (RP = 1,88; IC95%, 1,47-2,40), así como ser mujer (RP = 0,35; IC95%, 0,27-0,46). De las 12 universidades evaluadas, la universidad menos machista fue una particular en Lima. Utilizando esta universidad como categoría de comparación, las universidades estadísticamente más machistas fueron una privada de Chiclayo (a=3,63; p < 0,001), seguida de una particular en Huancayo (a=3,20; p = 0,001), la nacional de Huancayo (a = 2,79; p < 0,001) y la pública de Ica (a = 2,32; p = 0,006); los cruces se ajustaron por la edad. Conclusiones: Se encontró que el machismo es mayor entre los no creyentes, los varones y en algunas universidades, con predominio de universidades de la sierra central del Perú o con migrantes de la serranía. Esto es importante, ya que brinda un panorama acerca de este rasgo de los que serán los futuros encargados de velar por la salud de los peruanos.

ABSTRACT Introduction: Male chauvinism is rooted in certain populations, but it has not been measured among those who will be responsible for healthcare. Objective: To determine the factors associated with male chauvinism among the medical students of 12 Peruvian universities. Methods: Cross-sectional multicentre analytical study, with previously collected data, which used validated tests to measure male chauvinism and strong religious beliefs. In addition, other social and educational factors were analysed and the data was crossed. Descriptive and analytical statistics were obtained. Results: In the multivariate analysis, we found an association between male chauvinism and religious non-believers (RP=1.88; 95% CI, 1.47-2.40), as well as being female (RP=0.35; 95% CI, 0.27-0.46). Of the 12 universities evaluated, the least chauvinistic university was in Lima. Using this university as a comparison category, the statistically more chauvinistic universities were a private university in Chiclayo (a=3.63; p<0.001), followed by a university in Huancayo (a=3.20; p=0.001), Huancayo national university (a=2.79; p<0.001) and the public university of Ica (a=2.32; p=0.006); the crossed data were adjusted for age. Conclusions: It was found that male chauvinism is greater among non-religious believers, men and in some universities, with a predominance of universities in the central highlands of Peru or that had migrants from the mountains. This is important, since it gives us an overview about this trait in those who will be responsible for the future healthcare of Peruvians.

Factores asociados a la homofobia en estudiantes de Medicina de once universidades peruanas / Factors associated with homophobia in medical students from eleven Peruvian universities

RESUMEN Introducción: Las consecuencias de la homofobia pueden afectar a la integridad y la salud mental y física de los individuos homosexuales en la sociedad. En Perú hay escasos estudios que hayan evaluado la homofobia en la población médico-estudiantil. Objetivo: Determinar los factores sociales, educativos y culturales asociados con la homofobia entre estudiantes de Medicina peruanos. Métodos: Se realizó un estudio de tipo transversal analítico en 12 sedes de Medicina humana peruanas. Se definió homofobia según un test validado, que se asoció con otras variables. Se obtuvieron estadísticos de asociación. Resultados: Las 4 universidades de Lima obtuvieron menores porcentajes de alumnos homofóbicos (15-20%) que las universidades del interior del país (22-62%). Al realizar el análisis multivariable, disminuyeron la frecuencia de homofobia: ser mujer (RPa = 0,74; IC95%, 0,610,92; p = 0,005), estudiar en una universidad de Lima (RPa = 0,57; IC95%, 0,43-0,75; p < 0,001), profesar la religión católica (RPa = 0,53; IC95%, 0,37-0,76; p < 0,001), conocer a un homosexual (RPa = 0,73; IC95%, 0,60-0,90; p = 0,003) y haber atendido a un paciente homosexual (RPa = 0,76; IC95%, 0,59-0,98; p = 0,036); en cambio, ser machista aumentó la frecuencia de homofobia (RPa = 1,37; IC95%, 1,09-1,72; p = 0,007), ajustado por 4 variables. Conclusiones: La homofobia fue menos frecuente entre las mujeres, los que estudiaban en la capital, los que profesan el catolicismo y los que conocen/han atendido a un homosexual; por el contrario, los machistas fueron más homofóbicos.

ABSTRACT Background: The consequences of homophobia can affect the integrity, mental and physical health of homosexual individuals in society. There are few studies in Peru that have evaluated homophobia in the medical student population. Objective: To establish the social, educational and cultural factors associated with homophobia among Peruvian medical students. Methods: A cross-sectional analytical study was conducted in 12 medicine schools in Peru. Homophobia was defined according to a validated test, which was associated with other variables. Statistical associations were identified. Results: The lowest percentages of homophobic students (15-20%) were found in the four universities in Lima, while universities in the interior of the country had the highest percentages (22-62%). Performing a multivariate analysis, we found that the frequency of homophobia was lower for the following variables: the female gender (PRa=0.74; 95% CI, 0.61-0.92; p=0.005), studying at a university in Lima (PRa=0.57; 95% CI, 0.43-0.75; p<0.001), professing the Catholic religion (PRa=0.53; 95% CI, 0.37-0.76;p<0.001), knowing a homosexual (PRa=0.73; 95% CI, 0.60-0.90; p=0.003) and having treated a homosexual patient (PRa=0.76; 95% CI, 0.59-0.98; p=0.036). In contrast, the frequency of homophobia increased in male chauvinists (PRa=1.37; 95% CI, 1.09-1.72; p=0.007), adjusted by four variables. Conclusions: Homophobia was less common in women, in those who study in the capital, those who profess Catholicism and those who know/have treated a homosexual. In contrast, male chauvinists were more homophobic.