Effectiveness of the Use of Three-Dose Intravitreal Ziv-Aflibercept in the Management of Diabetic Macular Edema in a Real-Life Setting.

Purpose: It has been reported that intravitreal Ziv-aflibercept is a safe and effective drug for the treatment of diabetes macular edema (DME). The objective of this study was to evaluate in a real-life setting, the efficacy of intravitreal Ziv-aflibercept in the treatment of DME after the administration of three consecutive monthly doses. Methods: A single arm, prospective cohort study. We included patients with DME who received three doses of intravitreal Ziv-aflibercept. Data such as best corrected visual acuity (BCVA) and tomographic biomarkers before treatment and a month after the third dose were collected. DME was staged using the Panozzo classification. Results: Thirty-eight patients participated for a total of 53 eyes. The mean age was 59 ± 8.1 years. We observed significant changes after the third dose in the parameters studied (BCVA in LogMAR pre-treatment (0.6 ± 0.33) and post-treatment (0.4 ± 0.29) [p<0.001], macular thickness pre-treatment (501 ± 167 µm) and post-treatment (324 ± 114 µm) [p<0.001], macular volume pre-treatment 10.8 (7.5-17.8) mm3 and post-treatment 9.3 (0-13.6) mm3 [p<0.005]). And 73.6% of the patients presented an advanced severe stage during their pre-treatment evaluation and after post-treatment, 64.2% of the patients no longer presented edema. No systemic or ocular adverse events occurred. Conclusion: The use of three consecutive monthly doses of intravitreal Ziv-aflibercept in a real-life setting is effective and safe in the management of diabetic macular edema.

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.

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.

Academic stress and sleep quality during the COVID-19 pandemic among medical students from a university of Peru / Estrés académico y calidad del sueño en tiempos de pandemia por COVID-19 en estudiantes de medicina de una universidad del Perú

Abstract Introduction: Sleep quality is an important factor for both the physical and mental health of medical students. Objective: To evaluate the association between academic stress and sleep quality among medical students enrolled in a university of Lima (Peru) during the COVID-19 pandemic. Materials and methods: Analytical cross-sectional study carried out in 410 medical students from the School of Human Medicine of Universidad Ricardo Palma, who, in October and November 2020, were administered the Spanish version of the Pittsburgh Sleep Quality Index, the SISCO SV-21 Academic Stress Inventory, and a sociodemographic and habits questionnaire via Google Forms. Bivariate and multivariate analyzes were performed to identify factors associated with poor sleep quality and academic stress, using prevalence ratios (PR) with a 95% confidence interval and a significance level of p<0.05. Results: 97.32% of students presented with "academic stress" and 90.48% had "poor quality of sleep". Factors associated with "poor quality of sleep" were "high levels of academic stress" (aPR: 2.433; 95%CI: 1.619-3.657; p=0.000), "not living with relatives" (aPR: 1.264; 95%CI: 1.107-1.443; p=0.001), and "working in addition to studying" (aPR: 1.106; 95%CI: 1.012-1.209; p=0.026). Additionally, "female biological sex" (aPR: 1.178; 95%CI: 1.090-1.273; p=0.000) and "place of birth Lima" (aPR: 0.929; 95%CI: 0.882-0.979; p=0.006) were significantly associated with "academic stress." Conclusion: Having high levels of academic stress, not living with relatives, and working in addition to studying were factors associated with poor sleep quality among the study population during the COVID-19 pandemic.

Resumen Introducción. La calidad del sueño es un factor importante para la salud física y mental de los estudiantes de medicina. Objetivo. Evaluar la asociación entre el estrés académico y la calidad del sueño en estudiantes de medicina de una universidad de Lima, Perú, en tiempos de pandemia por COVID-19. Materiales y métodos. Estudio transversal analítico realizado en 410 estudiantes de Medicina de la Facultad de Medicina Humana de la Universidad Ricardo Palma, a quienes, entre octubre y noviembre de 2020, se les aplicó la versión en español del Índice de calidad del sueño de Pittsburgh, el Inventario de Estrés Académico SISCO SV-21 y una ficha sociodemográfica y de hábitos mediante Google Forms. Se realizaron análisis bivariados y multivariados para identificar los factores asociados a la mala calidad del sueño y al estrés académico utilizando razones de prevalencia (RP) con un intervalo de confianza del 95% y un nivel de significancia p<0.05. Resultados. El 97.32% de los estudiantes presentó "estrés académico" y el 90.48% tuvo "mala calidad del sueño". Los factores asociados a "mala calidad del sueño" fueron "altos niveles de estrés académico" (RPa: 2,433; 95%CI: 1.619-3.657; p=0.000), "no vivir con familiares" (RPa: 1,264; 95%CI: 1.107-1.443; p=0.001) y "trabajar además de estudiar" (RPa: 1,106; 95%CI: 1.012-1.209; p=0.026). Adicionalmente, "sexo biológico femenino" (RPa: 1,178; 95%CI: 1.090-1.273; p=0.000) y "lugar de nacimiento en Lima" (RPa: 0,929; 95%CI: 0.882-0.979; p=0.006) se asociaron significativamente al "estrés académico". Conclusión. Tener altos niveles de estrés académico, no vivir con familiares y trabajar además de estudiar fueron factores asociados con presentar una mala calidad del sueño en la población de estudio en tiempos de pandemia por COVID-19.

Factores bioquímicos asociados a la adherencia a la dieta mediterránea / Biochemical factors associated with adherence to a Mediterranean Diet

Introducción: Existen evidencias respecto a la relación inversa, entre la adherencia a la dieta mediterránea y el desarrollo de padecimientos crónicos como enfermedad coronaria, síndrome metabólico y diabetes. Objetivo: Determinar los factores bioquímicos asociados a la adherencia a la dieta mediterránea, en pacientes atendidos en un centro médico peruano. Métodos: Estudio transversal en 209 pacientes atendidos en un centro médico de Lima, Perú. Se utilizó el cuestionario PREDIMED para medir la adherencia a la dieta mediterránea. Se indagó la correlación entre el puntaje de adherencia a la dieta mediterránea y las covariables, edad, sexo, hipertrigliceridemia, hipercolesterolemia, hiperglicemia en ayunas y diagnóstico nutricional. Se utilizaron modelos lineales generales. Resultados: De 209 participantes, la mayoría fueron hombres (79,9 por ciento) y la mediana de edad fue de 31 años. El 20,2 por ciento tenía obesidad, quienes presentaron alteraciones en triglicéridos, fueron el 29,1 por ciento, colesterol (21,7 por ciento) y glicemia en ayunas (26,8 por ciento). En cuanto al puntaje del PREDIMED, la media fue de 4,6 puntos. Se encontró que la hiperglicemia en ayunas (Coef. = -2,08) tuvo asociación negativa con el puntaje de adherencia a la dieta mediterránea. Conclusión: La adherencia al patrón de dieta mediterránea es baja, y se correlaciona de forma negativa con hallazgos de hiperglicemia en los participantes evaluados (AU)

Introduction: There is evidence regarding the inverse relationship between adherence to the Mediterranean diet and the development of chronic conditions such as coronary heart disease, metabolic syndrome and diabetes. Objective: To determine the factors associated with adherence to the Mediterranean diet in patients attended in a Peruvian medical center. Methods: Cross-sectional analytical study in 209 patients attended at a medical center in Lima, Peru. The PREDIMED questionnaire was used to measure adherence to Mediterranean diet. Correlation between the Mediterranean diet adherence score and the covariates, age, sex, hypertriglyceridemia, hypercholesterolemia, fasting hyperglycemia and nutritional diagnosis was investigated. General linear models were used. Results: Of 209 participants, the majority were male (79.9 %) and the median age was 31 years. The 20.2 percent had obesity, those who presented alterations in triglycerides were 29.1 percent, cholesterol (21.7 percent) and fasting glycemia (26.8 percent). As for the PREDIMED score, the mean was 4.6 points. It was found that fasting hyperglycemia (Coef. = -2.08) had a negative association with the Mediterranean diet adherence score. Conclusion: Adherence to the Mediterranean diet pattern is low, and is negatively correlated with hyperglycemia findings in the participants evaluated(AU)

Factores asociados a la elección de psiquiatría como especialidad en internos de medicina de dos universidades privadas del Perú / Factors associated with choosing psychiatry among medical interns in two private universities in Peru

Objetivo: Determinar los factores asociados a la elección de psiquiatría como especialidad médica en internos de medicina de dos universidades privadas del Perú. Material y métodos: Estudio transversal realizado en internos de medicina de las universidades Ricardo Palma y San Juan Bautista. Se les administró tres instrumentos: El Inventario de Personalidad - Eysenck para adultos (EPI), la Escala de Valoración del Proceso Enseñanza - Aprendizaje, y el Cuestionario General de Salud Mental de Goldberg (QHG-12), para el estudio de las variables personalidad, percepción del proceso enseñanza - aprendizaje del curso de psiquiatría y psicopatología respectivamente. Se utilizó la prueba estadística X2 cuadrado para determinar la existencia de asociación entre las variables. Resultados: De los 223 internos de medicina estudiados, 35 (15,7%) manifestaron que elegirán psiquiatría como especialidad. La elección de psiquiatría como especialidad se asoció con: personalidad sanguínea (p=0,001); extroversión (p=0,02) y ser emocionalmente estable (p=0,03). Por otro lado, el estudio no evidenció asociación significativa entre las variables sexo, parientes con carreras afines al área de la salud mental y psicopatología con la elección de psiquiatría. Conclusiones: Existe asociación estadísticamente significativa entre el tipo de personalidad y la elección de psiquiatría. Los internos de medicina que les interesa especializarse en psiquiatría, por lo general tienen una personalidad tipo sanguínea, además son extrovertidos y emocionalmente estables.

Objective: To determine the factors associated with choosing psychiatry as a specialty among medical interns in two private universities in Peru. Methods: A cross-sectional study was carried-out among medical interns of Ricardo Palma and San Juan Bautista Universities. Three instruments were applied: personality inventory-Eysenck for adults, scale to evaluate the teaching-learning process and the Goldberg´s general survey of mental health to evaluate personality, perception of the teaching-learning process of the psychiatry and psychology courses. The X2 test was used to determine associations. Results: out of 233 medical interns evaluated, 35 (15.7%) said that would elect psychiatry as a specialty. The election of psychiatry was associated with a blood personality (p=0.001); extroversion (p=0.02) and being emotionally stable (p=0.039). On the other hand, the study did not reveal and association with sex, relatives with specialties closed to mental health and psychopathology. Conclusions: there is an association between type of personality and choosing psychiatry as a) specialty. Medical interns interested in becoming psychiatrist have a blood type of personality, are extroverted and emotionally stable.

Modelo de éxito del curso taller de titulación por tesis en medicina humana: publicación de repercusión internacional / Model of success of the course workshop title certification in human medicine: publication of international impact

Promover la Investigación en Estudiantes de Medicina y elevar la producción científica en las universidades del Perú y de Latinoamérica es una prioridad y una necesidad. Es un honor compartir con ustedes que recientemente publicamos en la prestigiosa revista Educación Medica, de Elsevier, indexada en Scopus, el articulo científico que resume la experiencia y el modelo de éxito del Curso Taller de Tesis que se dicta en la Facultad de MedicinaHumana de la Universidad Ricardo Palma: Promoting research in medical students and increasing scientific production in universities: Experience of the Undergraduate Thesis Workshop Course. La tesis de pregrado representa el trabajo académico con rigor científico, considerado como el primer paso serio de los estudiantes universitarios en el campo de la investigación, que según la nueva ley universitaria 30220 vigente en el Perú, constituye un requisito indispensable para obtener el titulo universitario.

Promoting Research in Medical Students and increasing scientific production in the universities of Peru and Latin America is a priority and a necessity. It is an honor to share with you that we recently published in the prestigious journal Educación Medica, of Elsevier, indexed in Scopus, the scientific article that summarizes the experience and the success model of the Thesis Workshop Course that is given in the Faculty of Human Medicine of the Ricardo Palma University: Promoting research in medical students and increasing scientific production in universities: Experience of the Undergraduate Thesis Workshop Course. The undergraduate thesis represents academic work with scientific rigor, considered as the first serious step of university students in the field of research, which according to the new university law 30220 in force in Peru, is an essential requirement to obtain the university degree .

La investigación: mas allá del ranking de las universidades / The research: beyond the ranking of the universities

Uno de los procesos más importantes y del cual se sustentan todas las demás actividades universitarias es la investigación. La investigación es creación, producción original, desarrollo de argumentación y coherencia de ideas, revisión exhaustiva, reflexión profunda, resolución de misterios y, en última instancia, enfoque en los sueños. El enfoque conceptual integral, propuesto por Rico1, para quien la investigación "es colonizar una parcela pequeña o grande, plantar, cultivar, cosechar y distribuir sus frutos, para que luego otros vengan a mejorar, optimizar y superar nuestra tarea".

One of the most important processes and of which all other university activities are sustained is research. Research is creation, original production, development of argumentation and coherence of ideas, exhaustive review-deep reflection, solving mysteries and, ultimately, giving focus to dreams. The integral conceptual approach, proposed by Rico1, for whom the research "is to colonize a small or large plot, to plant, cultivate, harvest and distribute its fruits, so that later others come to improve, optimize and overcome our task".

Factores asociados al pronóstico y supervivencia en pacientes adultos hospitalizados con diagnóstico de leucemia mieloide aguda del hospital nacional dos de mayo período 2014 a 2016 / Factors Associated With Prognosis And Survival In Hospitalized Adult Patients Diagnosed With Acute Myeloid Leukemia At The Hospital Nacional Dos De Mayo Period 2014 To 2016

Introduccion: La supervivencia en pacientes con diagnóstico de Leucemia Mieloide Aguda (LMA) se puede ver afectada por diversos factores clínicos, citogenéticos e inmunofenotípicos. Objetivo: Determinar las características del tamizaje para cáncer CCU en 08 establecimientos de salud (EESS) de Lima Metropolitana sedes del Internado Médico de la FAMURP en el 2017. Métodos: Se realizó un estudio observacional, transversal, retrospectivo y analítico, basado en la revisión de historias clínicas de todos los pacientes adultos con diagnóstico de Leucemia Mieloide Aguda, diagnosticados en Abril del 2014 a diciembre de 2016 y se realizó un seguimiento para determinar su desenlace final a 2 años asociándolo a la presencia de factores condiciones de mortalidad. La muestra final fue de 39 pacientes. Resultados: De los 39 pacientes 16 (41%) fueron mayores de 60 años, 23 (59%) fueron menores de 60 años, 13 de los pacientes (33%) presentaron una cifra de Leucocitos mayor a 50 000 al diagnóstico y 26 (77%) presentaron una cifra menor a 50 000. 33 pacientes presentaron una Leucemia de Novo (84%) y 6 (16%) presentaron una Leucemia secundaria a un Síndrome Mielo Displásico o algún antecedente de quimioterapia previa. No se obtuvo datos de todos los pacientes según clasificación Franco Americano Británica (FAB), Inmunofenotipo y Cariotipo. La supervivencia se evaluó en 3 tiempos, a los 6 meses, al año y a los 2 años desde la fecha del diagnóstico, teniendo que a los 6 meses la sobrevida global de los 39 pacientes había sido el 69 % (25), al año 49% (18) y a los 2 años se mantuvo en el mismo rango. La supervivencia al año y 2 años del diagnóstico se obtuvo el mismo Odds Ratio (OR) de 4.5 para la variable Leucocitos al diagnóstico mayor a 50 000 (IC 95%: 1.008 ­ 20.507), considerándola como un factor de riesgo para mortalidad. En el análisis de supervivencia de la misma variable mencionada con la supervivencia al año y dos años que la supervivencia fue significativamente menor en el grupo de pacientes con leucocitos al diagnóstico mayor a 50 000. Conclusión: En nuestra población de estudio se encontró significancia estadística al momento de evaluar la variable Leucocitos al diagnóstico mayor a 50 000 encontrándola como factor asociado a la mortalidad a 2 años, con una supervivencia significativamente mayor que el grupo de pacientes con Leucocitos al diagnóstico menor a 50 000.

Introduction: Survival in patients diagnosed with acute myeloid leukemia (AML) may be affected by various clinical, cytogenetic and immunophenotypic factors. Methods: An observational, transversal, retrospective and analytical study was conducted, based on the review of clinical histories of all adult patients with diagnosis of acute myeloid leukemia diagnosed in April 2014 to December 2016, a follow-up was made to determine their final outcome at 2 years. We calculated the OR and performed survival curves of each prognosis variable independent associated with survival in 3 times: 6 months, 1 year and 2 years. Results: Of the 39 patients 16 (41%) were older than 60 years, 23 (59%) were less than 60 years, 13 of the patients (33%) showed a number of leukocytes greater than 50 000 to the diagnosis and 26 (77%) showed a number less than 50 000. 33 patients presented a De Novo leukemia (84%) and 6 (16%) presented leukemia secondary to a myelo dysplastic syndrome or some antecedent of previous chemotherapy. No complete data were obtained from all patients according to FAB classification, Immunophenotyping and Karyotype. Survival was assessed in 3 times, at 6 months, year and 2 years from the date of diagnosis, overall survival of the 39 patients was 69% (25) at 6 months, and 49% (18) at 1 and 2 years. For the survival of the year and 2 years of the diagnosis we got the same OR of 4.5 for the variable leukocytes to the diagnosis greater than 50 000(IC 95%: 1,008 ­ 20,507), considering it as a risk factor for mortality. In the survival analysis of the same variable mentioned, survival at year and two years was significantly lower for the group of patients with leukocytes at diagnosis greater than 50 000. Conclusion: In our study, statistical significance was found evaluating the variable Leukocytes at diagnosis greater than 50 000, finding it as an associated factor with mortality to 2 years, with a significantly greater survival than the group of patients with leukocytes at diagnosis less than 50 000.

[National consensus of diagnosis and treatment of non-small cell lung cancer]. / Consenso nacional de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas.

Mexican specialists in oncology, oncologic surgery, thoracic surgery, pneumology, pathology, molecular biology, anesthesiology, algology, psychology, nutrition, and rehabilitation (all of them experts in lung cancer treatment) in order to develop the National Consensus on Lung Cancer. The consensus has been developed as an answer to the need of updated Mexican guidelines for the optimal treatment of the disease, as well as to the requirements that such guidelines be established by multidisciplinary panel, depicting the current attention given to cancer lung cases in Mexico. Thus, this paper analyses the epidemiological review, screening, diagnosis, staging, pathology, translational medicine, and the suitable therapies for early, locally advanced, and metastatic disease in the first, second, and third lines of management, as well as rehabilitation and palliative measures.

[Epidemiological pattern of breast cancer mortality in Mexico State]. / Patrón epidemiológico de la mortalidad por cáncer de mama en el Estado de México.

BACKGROUND: breast cancer (BC) is the leading cause of death secondary to malignancy in women. It ranks third in mortality in women in reproductive age, produced by non-modifiable (genetic and hormonal) and modifiable factors. Our objective was to describe and analyze the epidemiological characteristics of deaths from BC in the State of Mexico. RESULTS: of 273 verbal autopsies, the most common age (23.07 %) was between 40 and 49 years. The educational level of schooling were complete elementary school (20.51 %), incomplete elementary school (19.04 %) and complete high school (13.91 %). the institution with the highest number of patients was the Instituto Mexicano del Seguro Social with 139 (50.91 %). The towns with a higher frequency were Malinalco, Ayapango, Atizapán, Zacualpan and Apaxco. The Mortality was higher in Valle de Bravo, Coatepec Harinas and Toluca. CONCLUSIONS: the increase in BC has permitted the emergence of a new hypothesis known as endocrine disruption, according to this premise, this results from exposure to chemicals introduced into the environment by human activity capable of altering the hormonal balance.