Deforestation-free land-use change and organic matter-centered management improve the C footprint of oil palm expansion.

In recent decades, mounting evidence has indicated that the expansion of oil palm (OP) plantations at the expense of tropical forest has had a far pernicious effect on ecosystem aspects. While various deforestation-free strategies have been proposed to enhance OP sustainability, field-based evidence still need to be consolidated, in particular with respect to savanna regions where OP expansion has recently occurred and that present large area with potential for OP cultivation. Here we show that the common management practice creating within the plantation the so-called management zones explained nearly five times more variability of soil biogeochemical properties than the savanna land-use change per se. We also found that clayey-soil savanna conversion into OP increased total ecosystem C stocks by 40 ± 13 Mg C ha-1 during a full OP cultivation cycle, which was due to the higher OP-derived C accumulated in the biomass and in the soil as compared to the loss of savanna-derived C. In addition, application of organic residues in specific management zones enhanced the accumulation of soil organic carbon by up to 1.9 Mg ha-1  year-1 over the full cycle. Within plantation, zones subjected to organic amendments sustained similar soil microbial activity as in neighboring savannas. Our findings represent an empirical proof-of-concept that the conversion of non-forested land in parallel with organic matter-oriented management strategies can enhance OP agroecosystems C sink capacity while promoting microbe-mediated soil functioning. Nonetheless, savannas are unique and threatened ecosystems that support a vast biodiversity. Therefore, we suggest to give priority attention to conservation of natural savannas and direct more research toward the impacts of the conversion and subsequent management of degraded savannas.

Impacts of snow-farming on alpine soil and vegetation: A case study from the Swiss Alps.

Snow-farming is one of the adaptive strategies used to face the snow deficit in ski resorts. We studied the impact of a shifting snow-farming technique on a pasture slope in Adelboden, Switzerland. Specifically, we compared plots covered by a compressed snow pile for 1.5, 2.5 or 3.5 years, which then recovered from the snow cover for three, two or one vegetation seasons, respectively, with control plots situated around the snow pile. In plots with >1.5 years of compressed snow pile, plant mortality was high, recovery of vegetation was very slow, and few plant species recolonized the bare surface. Soil biological activity decreased persistently under prolonged snow cover, as indicated by reduced soil respiration. The prolonged absence of fresh plant litter and root exudates led to carbon (C) limitation for soil microbial respiration, which resulted in a significant decrease in the ratio of total organic carbon to total nitrogen (TOC/TN) under the snow pile. Microbial C, nitrogen (N) and phosphorus (P) immobilization decreased, while dissolved N concentration increased with compressed snow cover. Longer snow cover and a subsequent shorter recovery period led to higher microbial C/P and N/P but lower microbial C/N. Nitrate and ammonium were released massively once the biological activity resumed after snow clearance and soil aeration. The soil microbial community composition persistently shifted towards oxygen-limited microbes with prolonged compressed snow cover. This shift reflected declines in the abundance of sensitive microorganisms, such as plant-associated symbionts, due to plant mortality or root die-off. In parallel, resistant taxa that benefit from environmental changes increased, including facultative anaerobic bacteria (Bacteroidota, Chloroflexota), obligate anaerobes (Euryarchaeota), and saprophytic plant degraders. We recommend keeping snow piles in the same spot year after year to minimize the area of the impacted soil surface and plan from the beginning soil and ecosystem restoration measures.

Triple Expressor Lymphoma: Presentation With Acute Paraparesis Due to Spinal Cord Compression.

Diffuse large B-cell lymphoma (DBLCL) is the most common type of non-Hodgkin's lymphoma (NHL). Triple expressor lymphoma is a subgroup of non-Hodgkin's lymphomas that exhibits simultaneous overexpression of the MYC, BCL2, and BCL6 genes. This entity is characterized by its aggressive behavior and its poor response to chemotherapy regimens traditionally used, such as the standard R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen. This neoplasm can have varied clinical manifestations according to its initial location and usually has central nervous system (CNS) involvement. This article presents the case of a triple expressor lymphoma with spinal involvement at the level of the thoracic vertebrae in a previously healthy 34-year-old female patient, which lead to acute paraparesis due to spinal cord compression. Nevertheless, appropriate treatment with the DA-EPOCH-R (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab) regimen resulted in the recovery of the motor and sensory function of the lower extremities.

Carbon neutral expansion of oil palm plantations in the Neotropics.

Alternatives to ecologically devastating deforestation land use change trajectories are needed to reduce the carbon footprint of oil palm (OP) plantations in the tropics. Although various land use change options have been proposed, so far, there are no empirical data on their long-term ecosystem carbon pools effects. Our results demonstrate that pasture-to-OP conversion in savanna regions does not change ecosystem carbon storage, after 56 years in Colombia. Compared to rainforest conversion, this alternative land use change reduces net ecosystem carbon losses by 99.7 ± 9.6%. Soil organic carbon (SOC) decreased until 36 years after conversion, due to a fast decomposition of pasture-derived carbon, counterbalancing the carbon gains in OP biomass. The recovery of topsoil carbon content, suggests that SOC stocks might partly recover during a third plantation cycle. Hence, greater OP sustainability can be achieved if its expansion is oriented toward pasture land.

Epidemiological-clinical characteristics and results of appendiceal plastron management in adult patients from a reference hospital in Peru / Características epidemiológico-clínicas y resultados del manejo de plastrón apendicular en pacientes adultos de un hospital de referencia del Perú

Introduction: Appendicular plastron is considered a progressive form of acute appendicitis, with a national prevalence of 2-10%. Currently management is often controversial. It is that from this context, it seeks to promote studies that can elucidate the variables associated with the management of this condition. Objective: to determine the epidemiological-clinical characteristics associated with the results of the management of the appendiceal plastron in adult patients in a reference hospital in Peru. Methods: Non-experimental study, with a quantitative approach, observational, analytical and cross-sectional design, whose sample consisted of 100 patients with a diagnosis of appendicular plastron. The data collection sheet was applied as an instrument. Likewise, a Poisson regression model was used to respond to the objectives. Results: The multivariate analysis showed that alcohol consumption (p<0.05 RPa=1.12), nausea and vomiting (p<0.05, RPa=1.48), diarrhea (p<0.05; RPa=1.08), duration of symptoms before admission between 3 and 5 days (p<0.05; RPa=1.09), appendiceal mass (p<0.05, RPa=1.18) and bandemia (p<0.05, RPa=1.12) were significantly associated with unsuccessful management results of the appendiceal plastron. Conclusion: There are epidemiological and clinical characteristics associated with the results of the management of the appendicular plastron.

Introducción: El plastrón apendicular se considera una forma progresiva de apendicitis aguda, teniendo una prevalencia a nivel nacional de 2-10%. Actualmente el manejo suele ser controversial. Ante lo expuesto, se busca promover estudios que puedan dilucidar las variables asociadas al manejo de esta condición. Objetivo: determinar las características epidemiológico-clínicas asociadas a los resultados del manejo del plastrón apendicular en pacientes adultos en un hospital de referencia del Perú. Métodos: Estudio no experimental, de enfoque cuantitativo, diseño observacional, analítico y transversal, cuya muestra estuvo conformada por 100 pacientes con diagnóstico de plastrón apendicular. Se aplicó como instrumento la ficha de recolección de datos. Asimismo, se utilizo un modelo de regresión de Poisson para responder a los objetivos. Resultados: El análisis multivariado evidenció que el consumo de alcohol (p<0.05 RPa=1.12), las náuseas y vómitos (p<0.05, RPa=1.48), diarrea (p<0.05; RPa=1.08), duración de síntomas antes del ingreso entre 3 y 5 días (p<0.05; RPa=1.09), masa apendicular (p<0.05, RPa=1.18) y bandemia (p<0.05, RPa=1.12) se asociaron significativamente a resultados de manejo no exitosos de plastrón apendicular. Conclusión: Existe características epidemiológicas y clínicas asociadas a resultados del manejo de plastrón apendicular.

Factores asociados a la mala adherencia al tratamiento antirretroviral en pacientes VIH positivo

Introducción: La infección por el virus de inmunodeficiencia humana representa un problema de salud pública en el mundo. La adherencia a la terapia antirretroviral es necesaria para alcanzar un estado de supresión viral máxima y disminuir la tasa de infecciones oportunistas. Sin embargo, diversos son los factores que pueden influir en la adherencia terapéutica. Objetivo: Identificar los factores de riesgo asociados a la mala adherencia a la terapia antirretroviral en pacientes con el virus de inmunodeficiencia humana. Métodos: Se empleó un estudio con diseño observacional, analítico, de tipo casos y controles. El tamaño muestral fue de 276, a partir del cual 138 fueron casos y 138 controles. Los datos recolectados fueron analizados utilizando métodos de estadística descriptiva y estadística inferencial. Resultados: El análisis multivariado determinó una asociación estadísticamente significativa entre la variable adherencia al tratamiento antirretroviral y las variables depresión (odds ratio OR ajustado= 2,15), esquema de terapia antirretroviral alternativo (OR ajustado= 2,40), efectos secundarios (OR ajustado= 4,24) y cambio en la adherencia durante el estado de emergencia (OR ajustado= 5,67), independientemente de las otras variables intervinientes. Conclusiones: La depresión, el uso del esquema de terapia antirretroviral alternativo, la presencia de efectos secundarios a terapia antirretroviral y el cambio en la adherencia durante el estado de emergencia aumentan el riesgo de mala adherencia a la terapia antirretroviral.

Introduction: Human immunodeficiency virus infection represents a public health public problem in the world. Adherence to antiretroviral therapy is necessary to achieve a state of maximum viral suppression and decrease the rate of opportunistic infections. However, there are several factors that can influence therapeutic adherence. Objective: To identify the risk factors associated with poor adherence to antiretroviral therapy in patients with the human immunodeficiency virus. Methods: A study with an observational, analytical, case-control type design was used. The sample size was 276, from which 138 were cases and 138 controls. The collected data was analyzed using methods of descriptive statistics and inferential statistics. Results: The multivariate analysis determined a statistically significant association between the variable adherence to antiretroviral treatment and the variables depression (adjusted Odds Ratio OR = 2.15), alternative antiretroviral therapy scheme (adjusted OR= 2.40), side effects (adjusted OR= 4.24), and change in adherence during the state of emergency (adjusted OR= 5.67) independently of the other intervening variables. Conclusions: Depression, the use of alternative antiretroviral therapy regimens, the presence of side effects to antiretroviral therapy, and the change in adherence during the state of emergency increase the risk of poor adherence to antiretroviral therapy.

Utilidad de la proteína C-reactiva para determinar la gravedad de infección por SARS-CoV-2 en Perú / Usefulness of C-reactive protein to determine the severity of SARS-CoV-2 infection in Peru

INTRODUCCIÓN: En los últimos años se han estudiado diversos biomarcadores para determinar los casos graves de COVID-19. La proteína C-reactiva (PCR) ha mostrado alta sensibilidad en la identificación de pacientes con enfermedad grave y utilidad comparable a la tomografía. OBJETIVO: Determinar la utilidad de la PCR para predecir gravedad de la infección por SARS-CoV-2 en pacientes hospitalizados en el Centro Médico Naval del Perú durante el periodo enero-septiembre del año 2021. MÉTODOS: Se empleó un diseño de tipo cuantitativo, observacional, analítico, retrospectivo, y de tipo prueba diagnóstica. Se calculó un tamaño muestral de 503 pacientes, quienes fueron divididos en dos grupos de acuerdo a su gravedad. RESULTADOS: Se determinó un punto de corte óptimo de 10,92 mg/L de los valores de PCR para el diagnóstico de enfermedad grave por COVID-19. Se calculó un área bajo la curva (AUC) de 0,762 y se obtuvieron valores de sensibilidad, especificidad, valores predictores positivo, negativo y precisión diagnóstica de 78,88%, 66,4%; 41,42%; 87,01%; y 67,27%, respectivamente. El normograma de Fagan mostró una probabilidad posprueba de 41%. En el modelo ajustado fueron significativas la PCR (ORa = 4,853; IC95% 2,987-7,886; p = 0,001), además de la ferritina (ORa = 1,001; IC 95%: 1,001-1,002; p = 0,001) e hipotiroidismo (OR ajustado = 4,899; IC 95%: 1,272-18,872; p = 0,021). CONCLUSIONES: El presente estudio mostró la asociación entre la PCR y la gravedad de infección por SARS-CoV-2 en un modelo ajustado, mostrando su potencial utilidad y contribuyendo a determinar el punto de corte de la PCR en población peruana y su comparación a nivel internacional.

BACKGROUND: Recently, many biomarkers have been studied to determine severe cases of COVID-19. C-reactive protein (CRP) has shown high sensitivity in identifying patients with severe disease and utility comparable to computed tomography. AIM: To determine the usefulness of CRP to predict the severity of SARS-CoV-2 infection in patients hospitalized at the Naval Medical Center of Peru during the period January-September in the year 2021. METHODS: A quantitative, observational, analytical, retrospective, and diagnostic test type design was used. A sample size of 503 patients was calculated, which were divided into two groups according to their severity. RESULTS: An optimal cut-off point of 10.92 mg/L for CRP levels was determined for the diagnosis of severe COVID-19. An area under the curve (AUC) of 0.762 was calculated and sensitivity, specificity, positive and negative predictive values and diagnostic accuracy values of 78.88%, 66.4%; 41.42%; 87.01%; and 67.27%; respectively. Fagan's normogram showed a post-test probability of 41%. In the adjusted model, CRP (aOR = 4.853; 95% CI 2.987-7.886; p = 0.001), ferritin (aOR = 1.001; 95% CI: 1.001-1.002; p = 0.001) and hypothyroidism (adjusted OR = 4899; 95% CI: 1272-18872; p = 0.021) showed significance. CONCLUSIONS: The present study showed an association between CRP and the severity of SARS-CoV-2 infection in an adjusted model, showing its potential utility and contributing to determine the cut-off point of CRP in the Peruvian population and its international comparison.

Factores asociados a dolor lumbar en trabajadores sanitarios de un hospital de referencia del Perú

Introducción: El dolor lumbar es una condición inevitable en todo el personal del rubro de la salud, con llevando desde malestar físico hasta una incapacidad funcional del individuo. Objetivo: Determinar los factores asociados a dolor lumbar entre los trabajadores sanitarios en un hospital de referencia del Perú. Metodología: El presente estudio es observacional, analítico, de corte transversal, temporalmente prospectivo, con muestreo no probabilístico. La población estuvo conformada por trabajadores sanitarios del Hospital Santa Rosa de Pueblo Libre durante el periodo de junio a diciembre del año 2022. Resultados: El análisis multivariado determinó que el ser hombre (OR: 2.818, p valor: 0.017), tener sobrepeso (OR:1.782, p valor: 0.013), demanda laboral alta (OR: 4.750, p valor: 0.026), realizar actividad física (OR: 3.610, p valor: 0.031) y tener antecedentes de trauma lumbar (OR: 2.423, p valor: 0.034), fueron factores estadísticamente significativos que se asociaron al dolor lumbar. Discusión: Se pudo observar que, los factores asociados a dolor lumbar fueron el sexo masculino, el sobrepeso, la demanda laboral alta, el realizar actividad física y el antecedente de trauma lumbar. Conocer estas variables permitirá realizar esquemas y charlas preventivas para afrontar esta recurrente patología.

Introduction: Low back pain is an unavoidable condition in all health personnel, ranging from physical discomfort to functional disability of the individual. Objective: To determine the factors associated with low back pain among health workers at a reference hospital in Peru. Methods: This study is observational, analytical, cross-sectional, temporally prospective, with non-probabilistic sampling. The population was made up of health workers from the Hospital Santa Rosa de Pueblo Libre during the period from June to December of the year 2022. Results: The multivariate analysis determined that being a man (OR: 2.818, p value: 0.017), being overweight (OR:1.782, p value: 0.013), high labor demand (OR: 4.750, p value: 0.026), performing physical (OR: 3.610, p value: 0.031) and having a history of low back trauma (OR: 2.423, p value: 0.034) were statistically significant factors associated with low back pain. Discussion: It was possible to observe that the factors associated with low back pain were the male sex, being overweight, high work demand, physical activity and a history of low back trauma. Knowing these variables will make it possible to carry out preventive schemes and talks to deal with this recurring pathology.

Estudio de caso control en amenaza de parto pretermino y sus factores de riesgo en gestantes en un hospital de referencia del Peru durante la pandemia COVID-19

RESUMEN El objetivo del presente estudio fue determinar la relación entre la amenaza de parto pretermino y sus factores de riesgo en gestantes atendidas en un hospital de referencia del Perú durante la pandemia covid-19, con énfasis en la infección de tracto urinario. Se realizó un diseño de tipo casos y controles no emparejado, con una muestra representativa, con un tamaño muestral de 92 casos y 92 controles por muestreo probabilístico aleatorio simple, se realizó un modelo de regresión logística para la infección de tracto urinario y la amenaza de parto pretermino para el cálculo del Odds Ratio e intervalos de confianza al 95%. Se reportó una asociación para la amenaza de parto pretermino con las variables gestante añosa 3.159 (IC95% 1.66 - 6.02), menos de seis controles prenatales 3.9 (IC95% 2.084 - 7.298), paridad 0.353 (IC95% 0.180 - 0.691), antecedente de parto pretermino 2.843 (IC95% 1.253 - 5.639) e infección de tracto urinario 2.843 (IC95% 1.253 - 5.639). Se concluye que la infección de tracto urinario se asocia a la amenaza de parto pretermino en gestantes atendidas en un hospital de referencia peruano.

ABSTRACT The objective of the present study was to determine the relationship between the threat of preterm birth and its risk factors in pregnant women treated at a referral hospital in Peru during the covid-19 pandemic, with emphasis on urinary tract infection. An unpaired case-control type design was carried out, with a representative sample including 92 cases and 92 controls selected by simple random probabilistic sampling. A logistic regression model was carried out for urinary tract infection and threat of preterm birth for calculating the Odds Ratio and 95% confidence intervals. An association was reported for the threat of preterm birth with the variables: elderly pregnant woman 3.159 (95% CI 1.66 - 6.02), less than six prenatal controls 3.9 (95% CI 2.084 - 7.298), parity 0.353 (95% CI 0.180 - 0.691), history of preterm birth 2843 (95% CI 1253-5639) and urinary tract infection 2843 (95% CI 1253-5639). It is concluded that urinary tract infection is associated with the threat of preterm birth in pregnant women treated in a Peruvian reference hospital.

Recaída de linfoma folicular de alto grado en tiroides / Relapse of high grade follicular lymphoma in thyroid

El linfoma folicular de tiroides es una entidad rara que representa menos del 2% de los linfomas extranodales y cuyo principal factor de riesgo es la tiroiditis de Hashimoto. Suele afectar con mayor predisposición a pacientes adultos mayores, en los que con frecuencia se presenta como una masa de crecimiento rápido con compromiso de las estructuras adyacentes en el cuello. Sin embargo, dada su rara incidencia, esta patología debe ser sospechada por el clínico para un diagnóstico temprano oportuno. Aunque en la actualidad no existen guías de manejo estandarizadas para esta entidad, acostumbra tener buena respuesta a radioterapia y quimioterapia. El presente caso describe la historia de un paciente con una recaída de linfoma no Hodgkin de tipo folicular de alto grado localizado en tiroides que se presentó a urgencias con disfonía, parálisis bilateral de cuerdas vocales, cambio en el tono de la voz y disfagia, con el antecedente de un linfoma folicular de alto grado en localización retroperitoneal y en remisión luego de 8 ciclos de quimioterapia con rituximab, ciclofosfamida, doxorubicina, vincristina y prednisona, el cual presentó citorreducción luego del tratamiento con quimioterapia con el protocolo de rituximab, dexametasona, citarabina y cisplatino.

Follicular thyroid lymphoma is a rare entity that represents less than 2% of extranodal lymphomas; and whose main risk factor is Hashimoto's thyroiditis. This tends to affect older adult patients with greater predisposition, where it usually presents as a rapidly growing mass with compromise of the adjacent structures in the neck. However, given its rare incidence, this pathology should be suspected by the clinician for an early diagnosis. Although there are currently no standardized management guidelines for this entity, it usually responds well to radiotherapy and chemotherapy. The present case describes the history of a patient with a relapse of high-grade follicular-type NHL located in the thyroid who presented to the emergency room with dysphonia, bilateral paralysis of the vocal cords, change in tone of voice and dysphagia, with the history of high-grade follicular lymphoma in retroperitoneal location in remission after 8 cycles of chemotherapy with Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone, which presented cytoreduction after treatment with chemotherapy with the protocol Rituximab, Dexamethasone, Cytarabine and Cisplatin.

Factores asociados a bronquiolitis en pacientes menores de 2 años atendidos en un hospital de referencia del Perú

RESUMEN Introducción: La bronquiolitis se considera una patología respiratoria de etiología viral, frecuente a nivel de infantes. Existen diversos determinantes que contribuyen a su desarrollo dentro de esta población. El conocer dichos factores permitirá ejecutar medidas preventivas, así como disminuir el número de casos. Objetivo: Determinar los factores asociados a bronquiolitis en pacientes menores de 2 años atendidos en un hospital de referencia del Perú. Materiales y Métodos: se realizó un diseño de tipo casos y controles no emparejado, con una muestra representativa, con un tamaño muestral de 174 casos y 174 controles por muestreo probabilístico aleatorio simple, se realizó un modelo de regresión logística para los factores asociados al lactante y la madre para el cálculo del Odds Ratio e intervalo de confianza al 95% respecto a la variable dependiente bronquiolitis aguda Resultados: se reportó una asociación para la bronquiolitis aguda con las variables prematuridad 3.02 (IC95% 1.54 - 5.92), bajo peso al nacer 1.85 (IC95% 1.07 - 3.20), género femenino 2.89 (IC95% 1.72 - 4.86), madre adolescente 3.82 (IC95% 2.13 - 6.86) y madre sin grado de instrucción 3.02 (IC95% 1.83 - 11.87). Conclusión: los factores de prematuridad, bajo peso al nacer y género femenino del lactante y el grado de instrucción y condición adolescente de la madre se asocian al bronquiolitis aguda en pacientes menores de 2 años.

ABSTRACT Introduction: Bronchiolitis is considered a respiratory pathology of viral etiology that is frequent in infants. There are several determinants that contribute to its development within this population. Knowledge of these factors will allow preventive measures to be in place, as well as reduce the number of cases. Objective: To determine the factors associated with bronchiolitis in patients under 2 years of age treated at a reference hospital in Peru. Materials and Methods: an unpaired case-control type design was carried out, with a representative sample, with a sample size of 174 cases and 174 controls by simple random probabilistic sampling, a logistic regression model was carried out for the factors associated with the infant. and the mother for the calculation of the Odds Ratio and 95% confidence interval regarding the dependent variable acute bronchiolitis. Results: an association was reported for acute bronchiolitis with the following variables: prematurity 3.02 (95% CI 1.54 - 5.92), low birth weight 1.85 (95% CI 1.07 - 3.20), female gender 2.89 (95% CI 1.72 - 4.86), teenage mother 3.82 (95% CI 2.13 - 6.86) and mother with low educational level 3.02 (95% CI 1.83 - 11.87). Conclusion: prematurity, low birth weight, female gender, birth to an adolescent mother and maternal low educational levels are associated with acute bronchiolitis in patients under 2 years of age.

Índice neutrófilo linfocito un marcador predictivo para el diagnóstico de apendicitis aguda complicada

Objetivo: Determinar la capacidad diagnóstica del índice neutrófilo-linfocito (INL) para establecer el diagnóstico de apendicitis aguda complicada en un hospital de referencia nacional del Perú. Material y Método: Estudio observacional, descriptivo, transversal, retrospectivo, de tipo prueba diagnóstica. El tamaño muestral fue de 333 pacientes con diagnóstico de apendicitis aguda, siendo 207 pacientes con apendicitis aguda complicada y 126 pacientes con apendicitis aguda no complicada. Se utilizó un modelo de regresión logística binario para generar una curva COR y estimar las características operativas del Índice neutrófilo linfocito para la apendicitis aguda complicada, así como la probabilidad posprueba para casos positivos y negativos. Resultados: La curva COR del INL presento un AUC de 64,4% (IC 95% 58,3% - 70,5%) con un P-valor < 0,05. La sensibilidad y especificidad para el diagnóstico de apendicitis aguda complicada fueron de 69,08%, 61,11%, respectivamente, a su vez, la probabilidad posprueba para casos positivos y negativos fue de 63% (58 - 68%) y 33% (27% - 39%) respectivamente. Conclusión: El INL posee precisión adecuada para el diagnóstico de la apendicitis aguda complicada, así como variaciones significativas en la probabilidad posprueba cuando los casos son positivos o negativos.

Objective: To determine the diagnostic capacity of the neutrophil-lymphocyte index (NLR) to establish the diagnosis of complicated acute appendicitis in a national Peruvian hospital. Material and Method: Observational, descriptive, cross-sectional, retrospective study, diagnostic test type. The sample size was 333 patients with a diagnosis of acute appendicitis, being 207 patients with complicated acute appendicitis and 126 patients with uncomplicated acute appendicitis. A binary logistic regression model was used to generate a COR curve and estimate the operating characteristics of the Lymphocyte Neutrophil Index for complicated acute appendicitis, as well as the post-test probability for positive and negative cases. Results: The INL COR curve presented an AUC of 64.4% (95% CI 58.3% - 70.5%) with a P-value < 0.05. The sensitivity and specificity for the diagnosis of complicated acute appendicitis were 69.08%, 61.11%, respectively, in turn, the post-test probability for positive and negative cases was 63% (58 - 68%) and 33% (27%) - 39%) respectively. Conclusion: The INL has adequate precision for the diagnosis of complicated acute appendicitis, as well as significant variations in the post-test probability when the cases are positive or negative.

Factores asociados a bajo conocimiento de bioseguridad en internos de medicina en una universidad del Perú en el contexto de la pandemia COVID-19

Introducción: El derecho a prácticas pre-profesionales amparado bajo la Ley Peruana permite que el estudiante de último año de la carrera de medicina humana comience a participar en procedimientos e intervenciones asistenciales de salud bajo la guía de un médico tutor. Objetivo: determinar los factores asociados a bajo conocimiento en bioseguridad en internos de medicina de una universidad del Perú en el contexto de la pandemia covid-19. Metodología: se realizó un diseño observacional, prolectivo y transversal. La muestra estuvo comprendida por 336 internos de medicina humana, los cuales se seleccionaron por muestreo probabilístico aleatorio simple. Se empleó un instrumento válido y confiable para determinar el nivel de conocimiento en bioseguridad. Se trabajó con un modelo de regresión de binario logarítmico bivariado y múltiple para el cálculo de la razón de prevalencia cruda y ajustada con sus respectivos intervalos de confianza al 95% para los factores asociados al nivel de conocimiento en bioseguridad. Resultados: se encontraron niveles de conocimiento alto, medio y bajo del 44,6%, 26,8% y 28 ,6% respectivamente. El estado civil casado (RPA 0.418, IC95% 0.181 - 0.968), convivir con personas con riesgo para síntomas graves por covid-19 (RPA 0.472, IC95% 0.344-0.647), realizar el internado medico en un hospital y haber sido diagnosticado por covid-19 en los últimos 12 meses (RPA 0.586, IC95% 0.387-0.887) se asociaron a un nivel de conocimiento bajo bioseguridad por modelo de regresión binaria logarítmica múltiple. Discusión: el estado civil casado, el convivir con personas con riesgo para síntomas graves de covid-19, el realizar el internado medico en un centro hospitalario y el haber sido diagnosticado con covid-19 tienen una relación inversamente proporcional con el conocimiento bajo en bioseguridad en internos de medicina en el contexto de la pandemia covid-19.

Introduction: The right to pre-professional practices protected under Peruvian Law allows the student in the last year of the human medicine career to begin to participate in health care procedures and interventions under the guidance of a tutor. Objective: to determine the factors associated with low knowledge of biosafety in medical interns at a university in Peru in the context of the covid-19 pandemic. Methods: an observational, prolective and cross-sectional design was carried out. The sample consisted of 336 human medicine interns, who were selected by simple random probabilistic sampling. A valid and reliable instrument was used to determine the level of knowledge in biosafety. A bivariate and multiple logarithmic binary regression model was used to calculate the crude and adjusted prevalence ratio with their respective 95% confidence intervals for the factors associated with the level of knowledge in biosafety. Results: high, medium and low levels of knowledge of 44.6%, 26.8% and 28.6% respectively were found. Married marital status (RPA 0.418, 95% CI 0.181 - 0.968), living with people at risk for severe symptoms from covid-19 (RPA 0.472, 95% CI 0.344-0.647), undergoing medical internship in a hospital, and having been diagnosed by covid-19 in the last 12 months (RPA 0.586, 95% CI 0.387-0.887) were associated with a level of knowledge under biosafety by multiple logarithmic binary regression model. Discussion: married marital status, living with people at risk for severe symptoms of covid-19, undergoing medical internship in a hospital center and having been diagnosed with covid-19 have an inversely proportional relationship with low knowledge in biosafety. In medical interns in the context of the covid-19 pandemic.

Evaluación de la capacidad discriminativa de los indicadores antropométricos y su relación predictiva de diabetes en trabajadores de salud del Hospital Universitario de Guayaquil - Ecuador / Evaluation of the discriminative capacity of anthropometric indicators and their predictive relationship of diabetes in health workers of the University Hospital of Guayaquil - Ecuador

Objetivo: Evaluar la capacidad discriminativa de predicción de diabetes con indicadores antropométricos, bioquímicos y antecedentes. Métodos: Se utilizaron dos modelos, el análisis de las curvas ROC y regresión logística binaria. Resultados: Mediante el análisis de las curvas ROC, el perímetro abdominal obtuvo mayor poder discriminativo de predicción (AUC=0,747; p<0,001; IC: 0,624-0,870), en comparación a la glicemia (AUC=0,749; p<0,001; IC: 0,645-0,852) y el índice de cintura-talla (AUC=0,737; p=0,001; IC: 0,638-0,836). Los antecedentes patológicos personales se incluyen en la ecuación de regresión logística P(Y=1) = (1+e0,693+1,897APP)-1 para predecir el riesgo de tener diabetes en el futuro. Conclusiones: El perímetro abdominal obtuvo mayor poder discriminativo, seguido de los antecedentes patológicos personales.

Objective: To evaluate the discriminative ability to predict diabetes with anthropometric and biochemical indicators and medical history. Methods: The sampling carried out was census and the sample consisted of 104 workers. A longitudinal study was carried out to evaluate the discriminative ability to predict diabetes with the anthropometric, biochemical, and antecedent indicators, using two models, the analysis of the ROC curves and binary logistic regression. Results: By analyzing the ROC curves, the abdominal circumference obtained greater predictive discriminative power (AUC = 0.747; p <0.001; CI: 0.624-0.870), compared to glycemia (AUC=0.749; p <0.001; CI: 0.645-0.852) and the waist-height index (AUC=0.737; p=0.001; CI: 0.638-0.836). Personal medical history is included in the logistic regression equation P(Y=1)=(1+e0,693+1,897APP)-1 to predict the risk of developing diabetes in the future. Conclusions: The abdominal circumference obtained the highest discriminative power, followed by the pathological history.

Avances en la prevención de cánceres atribuidos a agentes infecciosos / Advances on the prevention of cancers attributed to infectious agents

Actualmente los canceres de origen infeccioso representan un problema de salud pública, especialmente en países subdesarrollados. Esta carta al editor está enfocada en la prevención de estas neoplasias a diversos niveles.

Currently, cancers of infectious origin, represent a public health problem, especially in emergent countries. After its discovery more than 50 years ago, arduous efforts have been made to identify the agents involved, their routes of transmission and their carcinogenesis mechanisms, in order to develop effective prevention measures.

Predicting the settlement of coarse granular materials under vertical loading.

Granular materials are widely used in industrial processes despite their complex and poorly understood mechanical behaviour both in static and dynamic regimes. A prototypical example is the settlement and compaction of a granular bed under vibrational loading. The elementary mechanisms of this process are still unclear and there is presently no established theory or methodology to predict the settlement and its statistical variability. By means of a parametric study, carried out on a full-scale track, and a critical analysis of density relaxation laws, we introduce a novel settlement model in coarse granular materials under cyclic loading. Our extensive experimental data indicate that the settlement process is governed by three independent parameters strongly correlated with the vibration intensity and initial packing fraction. We show that the mean settlement is well predicted by the model with its parameter values extracted from experimental data.

Porencefalia, reporte de caso / Porencephaly, report of a case

La porencefalia como lesión cerebral es una entidad que por el gran compromiso encefálico genera déficits motores y conductuales afectando el normal desarrollo de niños, siendo este el grupo poblacional principalmente afectado; quienes desde muy temprana edad presentan manifestaciones clínicas, sin embargo en algunos casos excepcionales tienden a cursan asintomáticos o con mínimas secuelas motoras que pueden retrasar su diagnóstico; campo en que las técnicas de imagen llegan a ser fundamentales. Se presenta aquí el primer caso de porencefalia reportado en Boyacá a la edad adulta sin antecedentes que sugieran su diagnóstico o algún manejo instaurado a la misma, la cual termina complicándose dejando varias secuelas..(AU)

Porencephaly as a brain injury is an entity that due to the great encephalic engagement generates motor deficits and behavioral affections on the normal development of children, being this the population group mainly affected, who from a very early age present clinical manifestations, however some exceptional cases are asymptomatic or has minimal motor sequelae that may delay their diagnosis; a sphere in which imaging techniques become fundamental. Here we present the first case of porencephaly reported in Boyacá to adulthood without a history suggesting its diagnosis or some management established to it, which ends up complicating leaving several sequelae..(AU)

Estudio Descriptivo: Detección del Dolor Músculo - Esquelético y Enfermedades Reumáticas Aplicando el COPCORD en la Población Indígena de Saraguro - Ecuador / Descriptive Research: Pain Muscle ­ Esquelectic Detecction and Copcord Aplication Reumatics Copcord Reumatics Illness in Indigena Population of the Saraguro - Ecuador

INTRODUCCIÓN: El instrumento COPCORD permite identificar el dolor músculoesquelético y enfermedades reumáticas como artrosis, artritis reumatoide, lumbalgia. El objetivo de esta investigación es validar y adaptar transculturalmente el instrumento COPCORD en la población indígena como prueba de tamizaje para la detección de estas enfermedades. MÉTODOS: Se trata de un estudio descriptivo, el universo fue de 210 indígenas mayores de 18 años que residen en Saraguro ­ Loja, Ecuador. Durante el periodo del 1 diciembre de 2016 al 30 de enero de 2017. El COPCORD se ajustó al lenguaje español, se realizó adecuación y validación transcultural al contexto del grupo indígena. La información fue ingresada en el programa estadístico Stata Versión 11, se analizó: alfa de Cronbach, matrices de correlación con la prueba de Spearman. Se correlacionó las variables con el diagnóstico establecido por el reumatólogo. RESULTADOS: La edad promedio fue 46.1 años, 64.7 % del género femenino, la prueba de tamizaje para detectar una enfermedad reumática tiene sensibilidad del 92.3 % y especificidad de 57.9 %. La consistencia interna del cuestionario presentó unidimensionalidad en los apartados de carga biomecánica y capacidad funcional; y multidimensionalidad en la trayectoria del dolor músculo - esquelético y comorbilidades. Se observaron correlaciones significativas del COPCORD comparado con la evaluación del reumatólogo. CONCLUSIONES: Al realizar la validación y adaptación transcultural del cuestionario COPCORD se demostró su utilidad como prueba de tamizaje para la detección del dolor músculo - esquelético y enfermedades reumáticas en la población aplicada

BACKGROUND: The COPCORD instrument allows the identification of musculoskeletal painand rheumatic diseases such as osteoarthritis, rheumatoid arthritis, low back pain. The aim of this research is to validate and cross-culturally adapt the COPCORD instrument in the indigenous population as a screening test for the detection of these diseases. METHODS: It is a descriptive study, the universe of 210 indigenous people over 18 years residing in Saraguro - Loja, Ecuador. During the period from December 1, 2016 to January 30, 2017. The COPCORD was adjusted to the Spanish language, a transcultural adaptation and validation was made to the context of the indigenous group. The information was entered into the statistical program of Stata Version 11, analyzed: Cronbach's alpha, correlation matrixes with the Spearman test. The variables were correlated with the diagnosis established by the rheumatologist. RESULTS: The average age was 46.1 years, 64.7 % of the female gender, the screening test to detect a rheumatic disease has sensitivity of 92.3 % and specificity of 57.9 %. The internal consistency of the questionnaire presented a dimensionality in the biomechanical load and functional capacity sections; and multidimensionality in the path of musculoskeletal pain and comorbidities. Significant correlations of the COPCORD were observed compared with the rheumatologist's evaluation. CONCLUSIONS: By carrying out the cross-cultural validation and adaptation of the COPCORD questionnaire, its usefulness could be demonstrated as a screening test for the detection of musculoskeletal pain and rheumatic diseases in the population of Saraguro.of approach including the laparoscopic approach.