Programa de Teleconsulta Docente: percepciones de profesores y alumnos de una facultad de medicina peruana / Teaching Teleconsultation Program: perceptions of professors and students of a peruvian medical school

RESUMEN Introducción: La llegada de la pandemia de COVID-19 al Perú requirió una respuesta inmediata y múltiples cambios tanto en la atención sanitaria como en el entrenamiento de los profesionales de la salud. La Facultad de Medicina de la Universidad Peruana Cayetano Heredia implementó el Programa de Teleconsulta Docente (PTD), para continuar con la formación de estudiantes de medicina en un entorno virtual, sin embargo, se desconoce la aceptación de los involucrados respecto a una educación virtual, condición que puede reflejar lo ocurrido en otras escuelas de medicina del país. Objetivo: nuestro estudio buscó evaluar la percepción de alumnos y docentes respecto al PTD. Métodos: estudio observacional, descriptivo y transversal. Se elaboró un cuestionario para explorar las percepciones de la telemedicina en el escenario de la enseñanza. Resultados: más del 80 % de los profesores y el 60 % de los alumnos consideraron que la PTD podía utilizarse como herramienta de enseñanza. Más del 90 % de los profesores y los estudiantes consideran que realizar la telemedicina no fue más difícil que hacer una consulta presencial. El 60 % de los estudiantes y el 80 % de los profesores perciben que los estudiantes deben desarrollar habilidades en telemedicina; el 80 % de los profesores y estudiantes consideran que la PTD constituye un servicio de responsabilidad social. Profesores y alumnos consideran que el éxito en la implantación de un PTD está influenciado por el nivel de aceptación de la población (20,2 %), el uso de la historia clínica electrónica (19,4 %) y la formación en competencias digitales (18,6 %). Conclusión: los profesores y los estudiantes del PTD perciben la telemedicina como una herramienta útil para evaluar los problemas de salud de la población. Ambos perciben que a través de las sesiones de telemedicina se podrían adquirir las habilidades necesarias para completar el perfil de egresado de la carrera de medicina.

ABSTRACT Introduction : The occurrence of the COVID-19 pandemic in Peru required an immediate response and multiple changes in both healthcare and health professional training. The School of Medicine in Universidad Peruana Cayetano Heredia implemented the Teleconsultation Faculty Program (FTP), aiming to continue with training medicine students in a virtual environment. However, the acceptance of those involved in virtual education is unknown, a condition that may reflect what has happened in other medical schools in our country. Main : our study sought to assess the perception of students and teachers regarding FTP. Methods : observational, descriptive, cross-sectional study. A questionnaire was developed to explore perceptions of telemedicine in a teaching scenario. Results : More than 80% of teachers and 60% of students considered that the FTP could be used as a teaching tool. More than 90% of teachers and students consider that performing telemedicine was not more difficult than doing a face-to-face consultation. Sixty percent of students and 80% of teachers perceive that students must develop skills in telemedicine; 80% of teachers and students consider that FTP constitutes a service with social responsibility. Teachers and students consider that the success in the implementation of an FTP is influenced by the level of acceptance of the population (20.2%), the use of electronic medical records (19.4%), and training in digital skills (18.6%). Conclusion : Teachers and students using FTP perceive telemedicine as a useful tool for assessing health problems. Both perceive that through telemedicine sessions, skills required to complete the medical school graduate profile could be acquired.

Penetrating gastric ulcer as a manifestation of multisystemic tuberculosis.

We present the case of a 30-year old female with a history of abdominal pain, fever, poor oral tolerance and weight loss for 6 months. An abdominal CT scan showed marked gastric dilatation due to extrinsic compression from lymphadenopathies around the second portion of the duodenum. The upper endoscopy revealed the presence of a penetrating gastric ulcer in the greater curvature. Biopsies of the lesions showed hystiocytes with granulomatous features and Acid Fast Bacilli (AFB) positive, and the cultures grew Mycobacterium tuberculosis sensitive to Isonazid and Rifampin. Subsequently anti-TB regimen was initiated achieving great clinical and endoscopic improvement.

Penetrating gastric ulcer as a manifestation of multisystemic tuberculosis / Úlcera gástrica penetrante como manifestación de tuberculosis multisistémica

We present the case of a 30-year old female with a history of abdominal pain, fever, poor oral tolerance and weight loss for 6 months. An abdominal CT scan showed marked gastric dilatation due to extrinsic compression from lymphadenopathies around the second portion of the duodenum. The upper endoscopy revealed the presence of a penetrating gastric ulcer in the greater curvature. Biopsies of the lesions showed hystiocytes with granulomatous features and Acid Fast Bacilli (AFB) positive, and the cultures grew Mycobacterium tuberculosis sensitive to Isonazid and Rifampin. Subsequently anti-TB regimen was initiated achieving great clinical and endoscopic improvement.

Se presenta un caso de una mujer de 30 años de edad con historia de dolor abdominal, fiebre, poca tolerancia oral y pérdida de peso por 6 meses. Un CT scan abdominal muestra dilatación marcada gástrica debido a una compresión extrínseca por adenopatías alrededor de la segunda porción del duodeno. Una endoscopía alta revela la presencia de una úlcera gástrica penetrante en la curvatura mayor. Las biopsias mostraron histiocitos con granulomatosis y bacilos acid fast positivos y en los cultivos crecieron micobacterium tuberculosis sensibles a isoniacidad y rifampicina. Subsecuentemente se inició el régimen anti TBC lográndose una mejoría clínica y endoscópica evidente.

[Venous tromboembolism in a patient with Crohn disease with ileal stenosis]. / Trombosis venosa profunda en un paciente con enfermedad de Crohnilealestenosante.

Inflammatory bowel disease is associated with extraintestinal manifestations. Among these manifestations is the venous tromboembolism which presents a risk three times more than that presented in general population. We report the case of a 61-year-old male with a history of abdominal pain, chronic diarrhea and fever, with leukocytosis, and fecal samples containing leukocytes, partial ileal stenosis with multiple ulcers in the enteroscopy, with histologic findings compatible with Crohn's disease. The patient has a good outcome with prednisone and maintenence azathioprine, presenting at the fifth month deep venous thrombosis of both lower extremities that resolvewith anticoagulation treatment.

[Actinic enteritis as a cause of digestive bleeding of obscure origin]. / Enteritis actínica como causa de hemorragia digestiva de origen oscuro.

Chronic actinic enteritis is a malfunction of the small bowel, occurring in the 6 months post-radiotherapy, and it can be manifestated as malabsortion, stenosis, fistula formation, local abscesses, perforation and bleeding, We report a case of an elderly patient who presents an episode of obscure gastrointestinal bleeding (OGIB) secondary to actinic enteritis. She is a 64-year- old female patient with the past medical history of cervical cancer who received radiotherapy and brachytherapy. One year after the treatment, the patient presents a chronic episode of melena and symptomatic anemia and 1 week before the admission she had hematochezia. At admission she has hemodynamic instability with a hemoglobin value of 2.7 gr/dl. We did an upper endoscopy, a colonoscopy and abdomino-pelvic tomography without any findings of the bleeding’s source. Reason why an endoscopic capsule was done, showing bleeding areas in the medial and distal small bowel. The patient had another gastrointestinal bleeding requiring a surgery where they decide to do a resection of the small bowel and a right hemicholectomy. The pathology was compatible with actinic enteritis. The patient after the surgery had a torpid evolution, and finally dies. We describe this case and do a review of all the existent data around the world, because is the first case reported in Peru of an actinic enteritis as a cause of OGIB.

Enteritis actínica como causa de hemorragia digestiva de origen oscuro / Actinic enteritis as a cause of digestive bleeding of obscure origin

La enteritis actínica crónica es un trastorno del intestino delgado que ocurre a partir de los 6 meses post radioterapia y se puede manifestar como malabsorción, estenosis, formación de fístulas, abscesos locales, perforación y sangrado. Se reporta el caso de una paciente adulta mayor la cual presentó un cuadro de hemorragia digestiva de origen oscuro (HDO) secundario a enteritis actínica. Es una paciente mujer de 64 años con antecedente de neoplasia maligna de cérvix quien recibió sesiones de radioterapia y braquiterapia, La paciente un año después de dicho tratamiento presenta un cuadro crónico de melena y anemia, presentando hematoquezia en la última semana previa a la hospitalización. Al ingreso presenta inestabilidad hemodinámica con valores de hemoglobina en 2,7gr/dL. Se realiza una endoscopia, colonoscopia y tomografía abdomino pélvica, las cuales no mostraron la causa del sangrado, motivo por el cual se realiza una cápsula endoscópica evidenciando áreas de sangrado en intestino delgado medio y distal. La paciente vuelve a presentar un episodio de sangrado agudo siendo sometida a una cirugía de emergencia en donde se decide realizar resección de intestino más hemicolectomia derecha. En la biopsia de la pieza quirúrgica se encuentran hallazgos compatibles con enteropatía actínica. La paciente posterior a la cirugía evoluciona tórpidamente, llegando a fallecer. Describimos el presente caso y hacemos una recolección de la data existente debido a que es el primer caso en el Perú en el que se reporta a una enteritis actínica como causante de HDO...

Chronic actinic enteritis is a malfunction of the small bowel, occurring in the 6 months post-radiotherapy, and it can be manifestated as malabsortion, stenosis, fistula formation, local abscesses, perforation and bleeding, We report a case of an elderly patient who presents an episode of obscure gastrointestinal bleeding (OGIB) secondary to actinic enteritis. She is a 64-year-old female patient with the past medical history of cervical cancer who received radiotherapy and brachytherapy. One year after the treatment, the patient presents a chronic episode of melena and symptomatic anemia and 1 week before the admission she had hematochezia. At admission she has hemodynamic instability with a hemoglobin value of 2.7 gr/dl. We did an upper endoscopy, a colonoscopy and abdomino-pelvic tomography without any findings of the bleedingÆs source. Reason why an endoscopic capsule was done, showing bleeding areas in the medial and distal small bowel. The patient had another gastrointestinal bleeding requiring a surgery where they decide to do a resection of the small bowel and a right hemicholectomy. The pathology was compatible with actinic enteritis. The patient after the surgery had a torpid evolution, and finally dies. We describe this case and do a review of all the existent data around the world, because is the first case reported in Peru of an actinic enteritis as a cause of OGIB...

Comparación del valor pronóstico de mortalidad del Score Child Pugh y los modelos de pronóstico de enfermedad hepática crónica en pacientes con cirrosis hepática descompensada del Hospital Nacional Cayetano Heredia, Lima-Perú / Comparison of the prognostic value of mortality Child Pugh Score and forecasting models of chronic liver disease in patients with decompensated cirrhosis of the Hospital Nacional Cayetano Heredia, Lima-Peru

La valoración del pronóstico es una parte esencial en la evaluación de todo paciente con cirrosis hepática. En la actualidad se sigue desarrollando nuevos modelos para optimizar la precisión del pronóstico de mortalidad que se calcula mediante el score Child-Turcotte-Pugh (CTP) y el modelo para la enfermedad hepática en etapa terminal (MELD). Objetivo: Comparar la precisión pronóstica de mortalidad hospitalaria y mortalidad a corto plazo del CTP, MELD y demás modelos en pacientes con cirrosis hepática descompensada. Material y Métodos: Estudio descriptivo prospectivo, el cual incluyó 84 pacientes. El score CTP, MELD y demás modelos fueron calculados en el primer día de hospitalización. La precisión pronóstica de mortalidad se evaluó mediante el área bajo la curva ROC (AUROCs) del score CTP, MELD y los demás modelos. Resultados: La mortalidad hospitalaria y la mortalidad en el seguimiento a corto plazo fue de 20 (23,8%) y 44 (52,4%), respectivamente. Los AUROCs del CTP, MELD, MELD Na, MESO, iMELD, RefitMELD y RefitMELD Na para predecir mortalidad hospitalaria fue de 0,4488, 0,5645, 0,5426, 0,5578, 0,5719, 0,5598 y 0,5754; y para predecir mortalidad a corto plazo fue de 0,5386, 0,5747, 0,5770, 0,5781, 0,5631, 0,5881 y 0,5693, respectivamente. Al comparar entre si los AUROCs del score CTP, MELD y demás modelos ninguno mostró ser mejor que el otro (p>0,05). Conclusiones: El presente estudio no ha demostrado la utilidad predictiva del score CTP, MELD y los otros modelos (MELD Na, MESO, iMELD, Refit MELD y Refit MELD Na) para la evaluar la mortalidad hospitalaria o mortalidad a corto plazo en una muestra de pacientes con cirrosis hepática descompensada del Hospital Cayetano Heredia...

Introduction: The assessment of prognosis is an essential part of the evaluation of all patients with liver cirrhosis. Currently continues to develop new models to optimize forecast accuracy mortality score is calculated by the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD). Objective: Compare the prognostic accuracy of hospital mortality and short-term mortality CTP, MELD and other models in patients with decompensated liver cirrhosis. Material and Methods: Prospective descriptive study, comparison type of diagnostic test that included 84 patients. The score CTP, MELD and other models were calculated on the first day of hospitalization. The prognostic accuracy of mortality was assessed by the area under the ROC curve (AUROCs) of score CTP, MELD and other models. Results: Hospital mortality and mortality in the short-term monitoring was 20 (23.8%) and 44 (52.4%), respectively. The AUROCs CTP, MELD, MELD Na, MESO, iMELD, RefitMELD and RefitMELD Na to predict hospital mortality was 0.4488, 0.5645, 0.5426, 0.5578, 0.5719, 0.5598 and 0.5754; and to predict short-term mortality was 0.5386, 0.5747, 0.5770, 0.5781, 0.5631, 0.5881 and 0.5693, respectively. By comparing each AUROCs of the CTP score, MELD and other models proved to be no better than the other (p>0.05). Conclusion: This study has not shown the predictive utility of the CTP score, MELD and other models (MELD Na, MESO, iMELD, Refit Refit MELD and MELD Na) to evaluate hospital mortality or short-term mortality in a sample of patients with decompensated cirrhosis of the Hospital Cayetano Heredia...

[Comparison of the prognostic value of mortality Child Pugh Score and forecasting models of chronic liver disease in patients with decompensated cirrhosis of the Hospital Nacional Cayetano Heredia, Lima-Peru]. / Comparación del valor pronóstico de mortalidad del Score Child Pugh y los modelos de pronóstico de enfermedad hepática crónica en pacientes con cirrosis hepática descompensada del Hospital Nacional Cayetano Heredia, Lima-Perú.

INTRODUCTION: The assessment of prognosis is an essential part of the evaluation of all patients with liver cirrhosis. Currently continues to develop new models to optimize forecast accuracy mortality score is calculated by the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD). OBJECTIVE: Compare the prognostic accuracy of hospital mortality and short-term mortality CTP, MELD and other models in patients with decompensated liver cirrhosis. MATERIAL AND METHODS: Prospective descriptive study, comparison type of diagnostic test that included 84 patients. The score CTP, MELD and other models were calculated on the first day of hospitalization. The prognostic accuracy of mortality was assessed by the area under the ROC curve (AUROCs) of score CTP, MELD and other models. RESULTS: Hospital mortality and mortality in the short-term monitoring was 20 (23.8%) and 44 (52.4%), respectively. The AUROCs CTP, MELD, MELD Na, MESO, iMELD, RefitMELD and RefitMELD Na to predict hospital mortality was 0.4488, 0.5645, 0.5426, 0.5578, 0.5719, 0.5598 and 0.5754; and to predict short-term mortality was 0.5386, 0.5747, 0.5770, 0.5781, 0.5631, 0.5881 and 0.5693, respectively. By comparing each AUROCs of the CTP score, MELD and other models proved to be no better than the other (p>0.05). CONCLUSION: This study has not shown the predictive utility of the CTP score, MELD and other models (MELD Na, MESO, iMELD, Refit Refit MELD and MELD Na) to evaluate hospital mortality or short-term mortality in a sample of patients with decompensated cirrhosis of the Hospital Cayetano Heredia.

[Surveillance cultures after high-level disinfection of flexible endoscopes in a general hospital]. / Evaluación microbiológica de la desinfección de alto nivel de los endoscopios flexibles en un hospital general.

INTRODUCTION: Flexible endoscopes are instruments with a complex structure which are used in invasive gastroenterological procedures, therefore high-level disinfection (HLD) is recommended as an appropriate reprocessing method. However, most hospitals do not perform a quality control to assess the compliance and results of the disinfection process. OBJECTIVES: To evaluate the effectiveness of the flexible endoscopes’ decontamination after high-level disinfection by surveillance cultures and to assess the compliance with the reprocessing guidelines. MATERIAL AND METHODS: Descriptive study conducted in January 2013 in the Gastroenterological Unit of a tertiary hospital. 30 endoscopic procedures were randomly selected. Compliance with guidelines was evaluated and surveillance cultures for common bacteria were performed after the disinfection process. RESULTS: On the observational assessment, compliance with the guidelines was as follows: pre-cleaning 9 (30%), cleaning 5 (16.7%), rinse 3 (10%), first drying 30 (100%), disinfection 30 (100%), final rinse 0 (0%) and final drying 30 (100%), demonstrating that only 3 of 7 stages of the disinfection process were optimally performed. In the microbiological evaluation, 2 (6.7%) of the 30 procedures had a positive culture obtained from the surface of the endoscope. Furthermore, 1 (4.2%) of the 24 biopsy forcepsgave a positive culture. The organisms isolated were different Pseudomonas species. CONCLUSION: High-level disinfection procedures were not optimally performed, finding in 6.7% positive cultures of Pseudomonas species.

[Intestinal disease due to Mycobacterium avium in a patient with HIV/AIDS]. / Compromiso intestinal por Mycobacterium avium en un paciente con VIH/SIDA.

We report the first case of colitis due to Mycobacterium avium in a Peruvian patient with HIV/AIDS.

Evaluación microbiológica de la desinfección de alto nivel de los endoscopios flexibles en un hospital general / Surveillance cultures after high-level disinfection of flexible endoscopes in a general hospital

Introducción: Los endoscopios flexibles son instrumentos de estructura compleja utilizados en procedimientos invasivos de la vía digestiva por lo que se recomienda la desinfección de alto nivel como un método de reprocesamiento apropiado. Sin embargo, en la mayoría de hospitales no se ha realizado un control de calidad que evalúe el cumplimiento y resultado del proceso de desinfección. Objetivos: Comprobar la eficacia del proceso de descontaminación de los endoscopios a nivel microbiológico y evaluar el cumplimiento de las directrices de desinfección de alto nivel. Material y método: Estudio descriptivo realizado en enero del 2013 en el servicio de gastroenterología de un hospital de tercer nivel. Se seleccionaron 30 procedimientos endoscópicos aleatoriamente. Se observó el cumplimiento de las directrices y se realizaron cultivos para gérmenes comunes luego del proceso de desinfección. Resultados: En la evaluación observacional se determinó que el cumplimiento de las directrices fue: pre-limpieza 9 (30%), limpieza 5 (16,7%), enjuague 3 (10%), primer secado 30 (100%), desinfección 30 (100%), enjuague final 0 (0%) y secado final 30 (100%); cumpliéndose de manera óptima sólo 3 de las 7 etapas correspondientes al proceso de desinfección. En la evaluación microbiológica, 2 (6,7%) de los 30 procedimientos analizados tuvieron un cultivo positivo en la superficie del endoscopio. Además, 1 (4,2%) de las 24 pinzas evaluadas dio un cultivo positivo. Los microorganismos aislados fueron diferentes especies de Pseudomonas. Conclusión: Se determinó que los procedimientos de desinfección de alto nivel no se realizaron de manera óptima, hallando en un 6,7% cultivos positivos a Pseudomonas de diferentes especies.

Introduction: Flexible endoscopes are instruments with a complex structure which are used in invasive gastroenterological procedures, therefore high-level disinfection (HLD) is recommended as an appropriate reprocessing method. However, most hospitals do not perform a quality control to assess the compliance and results of the disinfection process. Objectives: To evaluate the effectiveness of the flexible endoscopes’ decontamination after high-level disinfection by surveillance cultures and to assess the compliance with the reprocessing guidelines. Material and methods: Descriptive study conducted in January 2013 in the Gastroenterological Unit of a tertiary hospital. 30 endoscopic procedures were randomly selected. Compliance with guidelines was evaluated and surveillance cultures for common bacteria were performed after the disinfection process. Results: On the observational assessment, compliance with the guidelines was as follows: pre-cleaning 9 (30%), cleaning 5 (16.7%), rinse 3 (10%), first drying 30 (100%), disinfection 30 (100%), final rinse 0 (0%) and final drying 30 (100%), demonstrating that only 3 of 7 stages of the disinfection process were optimally performed. In the microbiological evaluation, 2 (6.7%) of the 30 procedures had a positive culture obtained from the surface of the endoscope. Furthermore, 1 (4.2%) of the 24 biopsy forceps gave a positive culture. The organisms isolated were different Pseudomonas species. Conclusion: High-level disinfection procedures were not optimally performed, finding in 6.7% positive cultures of Pseudomonas species.

Compromiso intestinal por Mycobacterium avium en un paciente con VIH/ SIDA / Intestinal disease due to Mycobacterium avium in a patient with HIV/AIDS

amos el primer caso de colitis por Mycobacterium avium en un paciente peruano con infección por VIH /SIDA.

We report the first case of colitis due to Mycobacterium avium in a Peruvian patient with HIV/AIDS.

Tratamiento médico de la pancreatitis aguda / Medical treatment of acute pancreatitis

Se revisan los últimos avances en el manejo médico de la pancreatitis aguda. Estos se basan en los cambios que van desde el mayor conocimiento de la fisiopatología y la clínica y el desarrollo de técnicas para el manejo de las complicaciones. El reconocimiento del mal pronóstico dado por la falla persistente de órganos (mayor a 48 horas) y la evolución lenta pero sin severidad de los pacientes con complicaciones locales, ha hecho redefinir la clasificación de la pancreatitis, estratificándose al paciente con cuadros leves, moderados y severos. De los múltiples scores de severidad disponibles para predecir la severidad, APACHE II y BISAP son los que demuestran mayor valor en los trabajos realizados en el Perú. El uso de hidratación enérgica al inicio del cuadro, para evitar el daño a nivel de la microcirculación pancreática, la nutrición enteral precoz cuando se predice un cuadro severo o prolongado, además de la analgesia con narcóticos, son algunas de las medidas que se preconizan en la actualidad. Se discute además la evidencia de realimentar con sólidos en vez de dieta líquida desde el primer día de inicio de dieta a pacientes con pancreatitis leve. Por último se presenta la evidencia del uso de necrosectomía endoscópica como alternativa a la necrosectomía quirúrgica.

We review recent advances in medical management of acute pancreatitis. These are based on changes ranging from increased knowledge of the pathophysiology and clinical development of techniques for the management of complications. The recognition of poor prognosis given persistent organ failure (more than 48 hours) and the slow evolution without severity of patients with local complications, has redefined the classification of pancreatitis, stratifying the patient with mild, moderate and severe. Of the many available severity scores to predict severity, APACHE II and BISAP are demonstrating greater value on work done in Peru. Using vigorous hydration to avoid damage to the pancreatic microcirculation level, early enteral nutrition when it predicts a severe or prolonged disease in addition to narcotic analgesia, are some of the measures advocated in the present. I also discuss the evidence of refeeding with solid rather than liquid diet to patients with mild pancreatitis. Finally, evidence of safety and good outcomes of endoscopic necrosectomy is presented as an alternative to surgical necrosectomy.

[Validation of a modified version of SODA questionnaire (severity of dyspepsia assessment) adapted to Peru for evaluating evolution of symptoms severity in patients with dyspepsia]. / Modificación y validación del instrumento SODA (severity of dyspepsia assessment) adaptada al Perú para evaluar la evolución de la severidad de los síntomas en pacientes con dispepsia.

OBJECTIVES: To validate SODA (severity of dyspepsia assessment) questionnaire in our population for evaluating symptoms severity in patients with dyspepsia. MATERIALS AND METHODS: Content and appearance validity were measured, and then a modified questionnaire was developed. A pilot test was made and reliability, construct validity and responsiveness were measured. RESULTS: An adequate content and appearance validity were obtained. On the pilot test, reliability of the complete questionnaire and by components had Cronbach alpha values over 0,7. Construct validity of SODA was evaluated by correlating modified SODA results with SF-36 scores using Pearson test: -0.72 (p<0.001). When we compared results of modified SODA questionnaire and the score of a question about subjective perception of the disease using Spearman test we obtained similar results: 0.72 (p<0.001). Two means of SODA questionnaire scores, before and after treatment, were compared using Student's T test, and a significant difference was found, (p<0.001) with a drop mean of 5.70 ±5.33. CONCLUSION: Modified SODA questionnaire meets all criteria of validity and it could be used to measure dyspepsia severity and its evolution in a Peruvian population.

Modificación y validación del instrumento SODA (severity of dyspepsia assessment) adaptada al Perú para evaluar la evolución de la severidad de los síntomas en pacientes con dispepsia / Validation of a modified version of SODA questionnaire (severity of dyspepsia assessment) adapted to Peru for evaluating evolution of symptoms severity in patients with dyspepsia

Objetivos: Validación del cuestionario SODA (severity of dyspepsia assessment) para evaluar la severidad de los síntomas en pacientes con dispepsia. Materiales y métodos: Se evaluó la validez de contenido y de apariencia, tras lo cual se elaboró un cuestionario modificado. Posteriormente se evaluó la consistencia interna, la validez de constructo y la sensibilidad al cambio. Resultados: Se obtuvo una validez de contenido y de apariencia adecuadas. Se obtuvo un α-Cronbach del cuestionario y por componentes superiores a 0,7. Al analizar la validez de constructo, la correlaciσn entre los valores del cuestionario SODA modificado y SF-36 fue de -0,72 (p<0,001) a través de la prueba de Pearson. Al evaluar la correlación entre el puntaje del cuestionario SODA modificado y el de percepción subjetiva de los síntomas se obtuvo un valor de 0,72 (p<0,001) mediante la prueba de Spearman. Se comparó las medias de los puntajes del cuestionario SODA modificado pre y post-tratamiento mediante la prueba de T-Student en el que se encontró una diferencia significativa (p<0,001) con un promedio de caída de 5,70±5,33. Conclusiones: El cuestionario SODA modificado cumple con los criterios de validez por lo que sirve para valorar la severidad de la dispepsia y su evolución.

Objectives: To validate SODA (severity of dyspepsia assessment) questionnaire in our population for evaluating symptoms severity in patients with dyspepsia. Materials and methods: Content and appearance validity were measured, and then a modified questionnaire was developed. A pilot test was made and reliability, construct validity and responsiveness were measured. Results: An adequate content and appearance validity were obtained. On the pilot test, reliability of the complete questionnaire and by components had Cronbach alpha values over 0,7. Construct validity of SODA was evaluated by correlating modified SODA results with SF-36 scores using Pearson test: -0.72 (p<0.001). When we compared results of modified SODA questionnaire and the score of a question about subjective perception of the disease using Spearman test we obtained similar results: 0.72 (p<0.001). Two means of SODA questionnaire scores, before and after treatment, were compared using Student’s T test, and a significant difference was found, (p<0.001) with a drop mean of 5.70 5.33. Conclusion: Modified SODA questionnaire meets all criteria of validity and it could be used to measure dyspepsia severity and its evolution in a Peruvian population.

Colonoscopic findings in Peruvian patients with chronic diarrhea.

OBJECTIVE: To report the colonoscopic and pathological findings in patients with chronic diarrhea from a gastroenterology unit during approximately 3 years in a general teaching hospital located in Lima-Peru. MATERIALS AND METHODS: Patients with chronic diarrhea as the motive for colonoscopy from March 2008 to December 2010 were selected from the colonoscopy report computerized database. Colonoscopic findings were registered. Biopsies taken during the procedure were prospectively reviewed. RESULTS: 226 patients were included, of which 162 (71.7%) had a colon biopsy available. The average age of the patients was 53.6±16.36. 85.8% of patients were reported to have a normal colon. 14.8% of patients were found to have a normal colonic mucosa or mucosal edema, 35.8% of patients had lymphocytic colitis and 28.4% had paucicelular colitis. CONCLUSIONS: The majority of colonoscopies were reported with unremarkable macroscopic findings. Lymphocytic colitis was unusually frequent compared to previous reports.

[Stromal tumor of esophagus: case report]. / Tumor estromal de esófago: reporte de caso.

Gastrointestinal stromal cell tumors (GIST) are rare neoplasms of the gastrointestinal tract, although they are the most common mesenchymal neoplasms. The stomach and small intestine are the most frequent site of involvement accounting for approximately 85% of cases. However, esophagus involvement is exceptional (<5%); indeed some large series fail to report it. Surgery resection is the cornerstone of treatment; currently imatinib has demonstrated its utility to reduce local recurrences and tumor mass. We report a 75 years-old male with a medical history of dysphagia who presented upper gastrointestinal bleeding caused by an esophageal GIST. The patient did not undergo surgery because of severe chronic heart failure.

Dimorphic fungal coinfection as a cause of chronic diarrhea and pancolitis.

Histoplasma capsulatum and Paracoccidioides brasiliensis are dimorphic fungi that cause systemic mycosis mostly in tropical South America and some areas of North America. Gastrointestinal involvement is not uncommon among these fungal diseases, but coinfection has not previously been reported. We report a patient with chronic diarrhea and pancolitis caused by paracoccidioidomycosis and histoplasmosis.

Tumor estromal de esófago: reporte de caso / Stromal tumor of esophagus: case report

Los tumores del estroma gastrointestinales (GIST) son neoplasias poco frecuentes del tracto digestivo, sin embargo, son los tumores mesenquimales más frecuentes. El estómago y el intestino delgado son los lugares de presentación más comunes representando aproximadamente el 85 por ciento de los casos. Por otro lado la ubicación esofágica es excepcional (<5 por ciento), inclusive existen grandes series donde su frecuencia no se reporta. El manejo quirúrgico es el tratamiento definitivo, sin embargo actualmente con el uso de imatinib se ha podido disminuir la frecuencia de recurrencias y la masa tumoral. Presentamos un paciente varón de 75 años con antecedente de disfagia que presentó hemorragia digestiva alta debido a un GIST de esófago. El paciente no fue sometido a manejo quirúrgico, debido a una severa insuficiencia cardiaca.

Gastrointestinal stromal cell tumors (GIST) are rare neoplasms of the gastrointestinal tract, although they are the most common mesenchymal neoplasms. The stomach and small intestine are the most frequent site of involvement accounting for approximately 85 percent of cases. However, esophagus involvement is exceptional (<5 percent); indeed some large series fail to report it. Surgery resection is the cornerstone of treatment; currently imatinib has demonstrated its utility to reduce local recurrences and tumor mass. We report a 75 years-old male with a medical history of dysphagia who presented upper gastrointestinal bleeding caused by an esophageal GIST. The patient did not undergo surgery because of severe chronic heart failure.

[Hemoconcentration, Apache II and Ranson as early predictors of severity in patients with acute pancreatitis in a hospital in Lima - Peru]. / Hemoconcentración, Apache II y Ranson como predictores tempranos de severidad en pacientes con diagnóstico de pancreatitis aguda en un Hospital de Lima - Perú

OBJECTIVE: Compare hemoconcetration, APACHE II and Ranson scores as early predictors of severity defined by Atlanta criteria in patients with acute pancreatitis at Hospital Nacional Cayetano Heredia. MATERIALS AND METHODS: Retrospective descriptive study between December 2009 to November 2010 done using a data collection sheet to gather study relevant information. We classified acute pancreatitis into mild or severe according to Atlanta symposium criteria for organ failure and/or local complications. Comparison of hematocrit values was made using a t Student test to detect a significant difference and the area below the ROC curve was analyzed. RESULTS: Counting with 151 patients, 103 women (68.2%), with mean age of 45.5 ± 19.17 years, 112 mild pancreatitis (74.2%) and 39 severe (25.8%). Mean hematocrit in mild cases was 38.40 ± 4.77% and 39.78 ± 7.35% in severe group with p equal to 0.182. Area below the ROC curve of 0.89 y 0.68 for APACHE II and Ranson scores respectively. CONCLUSION: Hemoconcentration and Ranson proved not to be as useful as APACHE II score in predicting severity in acute pancreatitis.