Percepción de residentes de Medicina Física y Rehabilitación del Perú sobre su residencia médica durante la pandemia por COVID-19 / Peruvian Physical Medicine and Rehabilitation residents’ perception about their medical residency during the COVID-19 pandemic

Introducción y objetivos: La pandemia por COVID-19 ha afectado los programas de residencia médica (RM) a nivel mundial. Sin embargo, pocos reportes se han centrado en la RM de Medicina Física y Rehabilitación (MFyR). Por ello, nuestro objetivo fue describir las percepciones de los residentes de MFyR del Perú sobre su RM durante la pandemia por COVID-19. Materiales y métodos: Estudio trasversal. Durante junio de 2021, se buscó abordar a todos los residentes de MFyR del Perú, usando una encuesta virtual, anónima y voluntaria de 13 preguntas elaborada en Google Forms, que evaluó la percepción que tenían sobre la RM. Resultados: De 142 residentes de MFyR del Perú, 60 (42,3%) respondieron la encuesta. Entre estos, 21,7% consideró que su sede de residencia médica (SRM) cumplía poco o nada con los requisitos mínimos para serlo, 50% que su SRM se preocupó poco o nada por él/ella desde iniciada la pandemia por COVID-19, 35% que los médicos asistentes de su SRM se preocuparon poco o nada por lo académico, y 71,7% que la falta de médicos subespecialistas de MFyR afecta mucho a su formación. Además, 71,7% y 81,7% refirieron haber aprendido poco o nada de ecografía musculoesquelética y de estudios electrodiagnósticos, respectivamente. Finalmente, 18,3% refirieron arrepentirse de haber elegido la especialidad. Conclusiones: Encontramos una importante percepción negativa sobre la RM y una baja autopercepción de haber aprendido sobre ecografía musculoesquelética y estudios electrodiagnósticos. Resulta importante profundizar en las causas y buscar alternativas para mejorar la formación de los residentes de MFyR MFyR en el Perú.(AU)

Introduction and objectives: The COVID-19 pandemic has affected medical residency (MR) programs worldwide. However, few reports have focused on the MR of Physical Medicine and Rehabilitation (PM&R). Therefore, our objective was to describe the perceptions of PM&R residents in Peru about their MR during the COVID-19 pandemic. Materials and methods: Cross-sectional study. During June 2021, we sought to address all PM&R residents in Peru, using a virtual, anonymous and voluntary survey of 13 questions elaborated in Google Forms, which addressed their perception of RM. Results: Of 142 PM&R residents in Peru, 60 (42.3%) responded to the survey. Among these, 21.7% considered that their residency training site (RTS) met little or nothing with the minimum requirements to be one, 50% that their RTS cared little or notthing for him/her since the start of the COVID-19 pandemic, 35% that the physicians attending their RTS cared little or nothing about academics, and 71.7% that the lack of subspecialist physicians in PM&R greatly affects their training. In addition, 71.7% and 81.7% reported having learned little or nothing about musculoskeletal ultrasound and electrodiagnostic studies, respectively. Finally, 18.3% reported regretting to have chosen the specialty. Conclusions: We found an important negative perception about MR and a low self-perception of having learned about musculoskeletal ultrasound and electrodiagnostic studies. It is important to delve into the causes and look for alternatives to improve the training of PM&R residents.(AU)

[Peruvian Physical Medicine and Rehabilitation residents' perception about their medical residency during the COVID-19 pandemic]. / Percepción de residentes de Medicina Física y Rehabilitación del Perú sobre su residencia médica durante la pandemia por COVID-19.

INTRODUCTION AND OBJECTIVES: The COVID-19 pandemic has affected medical residency (MR) programs worldwide. However, few reports have focused on the MR of Physical Medicine and Rehabilitation (PM&R). Therefore, our objective was to describe the perceptions of PM&R residents in Peru about their MR during the COVID-19 pandemic. MATERIALS AND METHODS: Cross-sectional study. During June 2021, we sought to address all PM&R residents in Peru, using a virtual, anonymous and voluntary survey of 13 questions elaborated in Google Forms, which addressed their perception of RM. RESULTS: Of 142 PM&R residents in Peru, 60 (42.3%) responded to the survey. Among these, 21.7% considered that their residency training site (RTS) met little or nothing with the minimum requirements to be one, 50% that their RTS cared little or notthing for him/her since the start of the COVID-19 pandemic, 35% that the physicians attending their RTS cared little or nothing about academics, and 71.7% that the lack of subspecialist physicians in PM&R greatly affects their training. In addition, 71.7% and 81.7% reported having learned little or nothing about musculoskeletal ultrasound and electrodiagnostic studies, respectively. Finally, 18.3% reported regretting to have chosen the specialty. CONCLUSIONS: We found an important negative perception about MR and a low self-perception of having learned about musculoskeletal ultrasound and electrodiagnostic studies. It is important to delve into the causes and look for alternatives to improve the training of PM&R residents.

The use of unmanned aerial vehicles for health purposes: a systematic review of experimental studies.

BACKGROUND: Unmanned aircraft vehicles (UAVs) have had a rapid escalation in manageability and affordability, which can be exploited in healthcare. We conducted a systematic review examining the use of drones for health-related purposes. METHODS: A search was conducted in Medline, Embase, Global Health, Scopus, CINAHL and SciELO. Experimental studies were selected if the population included human subjects, the intervention was the use of UAVs and there was a health-related outcome. RESULTS: Of 500 results, five met inclusion criteria during an initial search. An updated search yielded four additional studies. Nine studies, all in high-income countries, were included for systematic syntheses: four studies addressed out-of-hospital cardiac arrest emergencies, three assessed drones for identification of people after accidents, one used drones to transport blood samples and one used drones to improve surgical procedures in war zones. CONCLUSIONS: Research on the use of drones in healthcare is limited to simulation scenarios, and this review did not retrieve any studies from low- and middle-income countries.

Guía de práctica clínica para la evaluación y el manejo de la hemorragia digestiva alta en el Seguro Social del Perú (EsSalud) / Clinical practice guideline for the evaluation and management of upper gastrointestinal bleeding for the Peruvian Social Security (EsSalud)

Objetivo: Proveer recomendaciones clínicas basadas en evidencia para la evaluación y el manejo de pacientes con hemorragia digestiva alta (HDA) en el seguro social del Perú (EsSalud). Materiales y métodos: Se conformó un grupo elaborador local (GEG-Local) conformado por especialistas en gastroenterología y metodólogos. El GEG-Local formuló 11 preguntas clínicas a ser respondidas por la presente guía de práctica clínica (GPC). Se buscaron y seleccionaron GPC de HDA publicadas a partir del 2012, que respondieran a las preguntas planteadas y obtuvieran un puntaje mayor a 60% en los dominios 1 y 3 del instrumento Appraisal of Guidelines for Research and Evaluation II (AGREE-II). Durante septiembre del 2017 se realizaron búsquedas bibliográficas en Pubmed, para actualizar 9 preguntas clínicas de las GPC preseleccionadas, y para responder 2 preguntas de novo. La calidad de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG-Local revisó la evidencia y formuló las recomendaciones, los puntos de buenas prácticas clínicas y el flujograma de evaluación y manejo, usando la metodología GRADE Finalmente, la GPC fue aprobada con Resolución N° 80-IETSI-ESSALUD-2017. Resultados: La presente GPC abordó 11 preguntas clínicas, divididas en cuatro temas: valoración de riesgo, manejo inicial, manejo de HDA no variceal, y manejo de HDA variceal. En base a dichas preguntas se formularon 10 recomendaciones (7 recomendaciones fuertes y 3 recomendaciones débiles), 24 puntos de buena práctica clínica, y 2 flujogramas. Conclusión: Este artículo es el resumen de la GPC de EsSalud, en la cual se valoró la evidencia científica disponible sobre evaluación y manejo de HDA.

Objective: To provide evidence-based clinical recommendations for the evaluation and management of patients with upper gastrointestinal bleeding (UGB) in the Peruvian Social Security (EsSalud). Materials and methods: A local guideline development group (local GDG) was established, including specialists in gastroenterology and methodologists. The local GDG formulated 11 clinical questions to be answered by this clinical practice guide (CPG). We searched and selected CPG of UGB published from 2012, which answered the posed questions and obtained a score higher than 60% in domains 1 and 3 of the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. During September 2017, bibliographic searches were conducted in Pubmed, to update 9 clinical questions of the preselected CPGs, and to answer 2 de novo questions. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG reviewed the evidence and formulated the recommendations, points of good clinical practice and the flowchart of evaluation and management, using the GRADE methodology Lastly, the CPG was approved with Resolución N° 80-IETSI-ESSALUD-2017. Results: This CPG addressed 11 clinical questions, divided into four themes: risk assessment, initial management, management of non-variceal UGB, and management of variceal UGB. Based on these questions, 10 recommendations (7 strong recommendations and 3 weak recommendations), 24 points of good clinical practice, and 2 flow charts were formulated. Conclusion: This article is the summary of the EsSalud' CPG, where the available scientific evidence on evaluation and management of UGB was evaluated.

Factors associated with regular sunscreen use by medical students of a Peruvian university.

INTRODUCTION: Use of sunscreen is encouraged to reduce the risk of skin pathologies caused by radiation. It is important to acknowledge the associated factors that promote or hinder sunscreen use in young populations as to design better prevention policies. OBJECTIVE: To determine the factors associated with regular sunscreen use among first year medical students from a Peruvian university. MATERIALS AND METHODS: A cross-sectional study was performed. Our population was first-year medical students from a Peruvian university. We administrated an electronic survey to evaluate socio-demographic data, as well as student knowledge, attitudes, and practices regarding photo-protection. We used ordinal logistic regression to analyze the factors associated with sunscreen use. RESULTS: Of 420 first-year students, 299 completed our survey. We found that 53.5% of the participants were less than 18 years old, 63.2% were female, 9.3% (females more than males) responded that a sunburn was worth it to look tan, and 38.1% always or almost always used sunscreen during the summer. Factors associated with sunscreen use in the ordered logistic adjusted regression were male sex (OR = 0.50, IC95% = 0.34-0.86), participation in photo-protection workshops within the last year (OR = 2.40, IC95% = 1.28-4.37), and having somebody to remind them the use of sunscreen during the last three months (OR = 3.80, IC95% = 1.28-11.20). CONCLUSIONS: In our sample, a higher sunscreen use was more often observed among female participants, those who attended skin protection workshops, and those reminded to use sunscreen. This highlights the importance of educational and reminder activities in the adoption of protective habits, such as sunscreen use.

Low anastomotic stricture rate after Roux-en-Y gastric bypass using a 21-mm circular stapling device.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as a safe and effective procedure for morbid obesity management. Amongst some of the postoperative complications are gastrojejunal (GJ) anastomotic strictures, with an incidence of 3 to 27 % in some series. This study evaluates the incidence of GJ strictures using a 21-mm circular stapling device and its response to treatment with endoscopic balloon dilation. METHODS: A retrospective chart review was conducted of patients who underwent LRYGB between January 2007 and September 2010. We used our previously published technique of retrocolic, retrogastric Roux-en-Y bypass, using a 21-mm circular stapler to construct the gastrojejunostomy. Postoperatively, patients with persistent food intolerance underwent an endoscopy. Those found to have a GJ stricture (defined as inability to pass the endoscope beyond he anastomotic site) underwent pneumatic dilation with a 12-mm balloon. RESULTS: A total of 338 patients underwent LRYGB. Median follow-up was 57.6 weeks (8-137). Twenty-two patients underwent an endoscopy due to food intolerance. Sixteen patients (4.7 %, 16/338) were identified with GJ stricture and received at least one endoscopic dilation. The other six patients had a normal endoscopic evaluation. GJ strictures presented at an average of 35 days (13 to 90 days) postoperatively. Four patients underwent two endoscopic interventions, and one underwent three endoscopic interventions. CONCLUSIONS: We hereby demonstrate that the construction of GJ anastomosis with a 21-mm circular stapler is associated with a low stricture rate using our standardized technique. Strictures are amenable to balloon dilatation with subsequent long-term resolution of symptoms.

A monoclonal antibody that inhibits Trypanosoma cruzi growth in vitro and its reaction with intracellular triosephosphate isomerase.

In parasites of the order Kinetoplastida, such as Trypanosoma cruzi and Trypanosoma brucei, glycolysis is carried out by glycolytic enzymes in glycosomes. One of the glycolytic enzymes is triosephosphate isomerase (TIM), which in T. brucei is localized exclusively in glycosomes, whereas in T. cruzi, the localization of TIM has not been fully ascertained. In the present work, we made a monoclonal antibody (mAb 6-11G) against recombinant T. cruzi TIM (rTcTIM). Incubation of T. cruzi epimastigotes with the mAb inhibited parasite survival. Western blotting showed that the mAb recognized rTcTIM and a 27 kDa band in T. cruzi lysates that corresponded to TcTIM. Sera from patients with Chagas disease recognized rTcTIM and cross-reacted with human recombinant TIM. The cross reactivity between parasite and human TIM possibly contributes to the autoimmune pathogenesis of Chagas disease. Electron microscopy of T. cruzi epimastigotes with the mAb showed that TIM was located within glycosomes, in the cytoplasm, the nucleus, and the kinetoplast. Collectively, the data shed new light on T. cruzi TIM and opens perspectives for drug design.

Evidence of a direct projection of the vomeronasal organ to the medial preoptic nucleus and hypothalamus.

In rodents the vomeronasal system plays an important role in modulating the hypothalamic control of gonadotropin secretion. It is accepted that the anatomical pathways by which the vomeronasal organ influences the neuroendocrine aspects of the reproductive behavior involves a polysynaptic system, including the accessory olfactory bulb, the 'vomeronasal amygdala', the bed nucleus of the stria terminalis and medial preoptic and ventromedial hypothalamic nuclei. We found that 72 h after unilateral transection of the vomeronasal nerves of an ipsilateral orthograde degeneration is seen in the neuropil of the medial preoptic, ventromedial, and arcuate hypothalamic nuclei. This represents an anatomical evidence of a monosynaptic link between the vomeronasal neuroepithelium and the medial preoptic nucleus, and hypothalamus.

Ultrastructural and immunocytochemical study of a primary gastrinoma of the liver.

A primary hepatic gastrinoma found in a 13-year-old boy was studied by light microscopy, immunohistochemistry, electron microscopy, and immunoelectron microscopy. Results were consistent with a neuroendocrine neoplasm with abundant gastrin-immunoreactive cells. Unlike all previously reported cases of primary hepatic neuroendocrine tumors, which have been endocrinologically asymptomatic, the patient had a Zollinger-Ellison syndrome apparently cured by surgical resection of the tumor.

Langerhans-like cells in amphibian epidermis.

Langerhans cells have been described in epidermis and other stratified epithelia of mammals. In other vertebrates equivalent cells have not been found. Amphibians show skin graft rejection, so it is possible that these animals have epidermal cells homologous to Langerhans cells. In this work we demonstrate the existence of ATPase-positive dendritic cells in frog epidermis that are similar ultrastructurally to mammalian Langerhans cells, except for the absence of Birbeck granules.

Giant cytoplasmic granules in Langerhans cells of Chediak-Higashi syndrome.

Giant membrane-bound cytoplasmic granules were found in the epidermal Langerhans cells of a patient with the Chediak-Higashi syndrome. These cells also contained normal-appearing Birbeck granules. The giant granules had a granular or sometimes globular internal structure; they are believed to derive from fusion of lysosomes or some portion of Birbeck granules. It is unclear whether this morphologic change in Langerhans cell interferes with their antigen-presenting function; it may be, in part, responsible for the frequent infections seen in patients with Chediak-Higashi syndrome that are otherwise more clearly related to the abnormalities in neutrophils and lymphocytes. The Langerhans cell is another cellular type in Chediak-Higashi syndrome in which giant cytoplasmic granules are found.